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A large test of 3 treatment for greater trochanter pain

Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 2009 Oct;37(10):1981–90. PubMed #19439758.
Tags: exercise, treatment, devices, self-treatment

PainSci summary of Rompe 2009?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★★?5-star ratings are for sentinel studies, excellent experiments with meaningful results. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

This was a large, long-term test of three therapies for three hundred patients with greater trochanter pain syndrome. Corticosteroid injections, home exercises, and repetitive low-energy shock wave therapy were pitted against each other, and the results measured at 1, 4, and 15 months. The study glaringly omitted a placebo group, which is a shame.

Those who received steroid injections were the clear winners in the short term, but only in the short term. At four months, they no longer had the lead. And by 15 months, not only were they back to their original pain levels, but those who did home training and shockwave therapy were doing quite well. Those groups probably represent normal healing, since neither of those therapies is known for producing excellent lasting results.

These results imply a surprisingly stark contrast between short and long term results. One implication is that steroids not only help in the short term but actually harm in the long term. “The role of corticosteroid injection for greater trochanter pain syndrome needs to be reconsidered,” the authors suggest.

~ Paul Ingraham

original abstract

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

STUDY DESIGN: 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).

CONCLUSION: 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.

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