Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.
BACKGROUND
There are no controlled studies testing the efficacy of various nonoperative strategies for treatment of greater trochanter pain syndrome. Hypothesis The null hypothesis was that local corticosteroid injection, home training, and repetitive low-energy shock wave therapy produce equivalent outcomes 4 months from baseline.


METHODS
Randomized controlled clinical trial; Level of evidence, 2.


METHODS
Two hundred twenty-nine patients with refractory unilateral greater trochanter pain syndrome were assigned sequentially to a home training program, a single local corticosteroid injection (25 mg prednisolone), or a repetitive low-energy radial shock wave treatment. Subjects underwent outcome assessments at baseline and at 1, 4, and 15 months. Primary outcome measures were degree of recovery, measured on a 6-point Likert scale (subjects with rating completely recovered or much improved were rated as treatment success), and severity of pain over the past week (0-10 points) at 4-month follow-up.


RESULTS
One month from baseline, results after corticosteroid injection (success rate, 75%; pain rating, 2.2 points) were significantly better than those after home training (7%; 5.9 points) or shock wave therapy (13%; 5.6 points). Regarding treatment success at 4 months, radial shock wave therapy led to significantly better results (68%; 3.1 points) than did home training (41%; 5.2 points) and corticosteroid injection (51%; 4.5 points). The null hypothesis was rejected. Fifteen months from baseline, radial shock wave therapy (74%; 2.4 points) and home training (80%; 2.7 points) were significantly more successful than was corticosteroid injection (48%; 5.3 points).


CONCLUSIONS
The role of corticosteroid injection for greater trochanter pain syndrome needs to be reconsidered. Subjects should be properly informed about the advantages and disadvantages of the treatment options, including the economic burden. The significant short-term superiority of a single corticosteroid injection over home training and shock wave therapy declined after 1 month. Both corticosteroid injection and home training were significantly less successful than was shock wave therapy at 4-month follow-up. Corticosteroid injection was significantly less successful than was home training or shock wave therapy at 15-month follow-up.
OrthoTrauma Evaluation Center, Mainz, Germany. profrompe@web.de
Jan D
JD
Rompe
Neil A
NA
Segal
Angelo
A
Cacchio
John P
JP
Furia
Antonio
A
Morral
Nicola
N
Maffulli
D018771:Arthralgia / Q000628:therapy*; D005081:Exercise Therapy / Q000009:adverse effects; D005260:Female; D005269:Femur; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006621:Hip Joint; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D020127:Recovery of Function; D012648:Self Care; D016896:Treatment Outcome
D005938:Glucocorticoids; D011239:Prednisolone