Do ultrasound guided trochanteric bursa injections of corticosteroid for greater trochanteric pain syndrome provide sustained benefit and are imaging features associated with treatment response?

Bolton, William; Kidanu, Debora; Dube, B.; Grainger, Andrew J.; Rowbotham, Emma; Robinson, Philip

doi:10.1016/j.crad.2017.11.020

Cited by 12 publications

(6 citation statements)

References 20 publications

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“…CSIs allow for remarkable improvement in pain in the first 4 to 8 weeks (grades 1-3 tendinopathy; LoE 1b, 25,26,42 LoE 4 36 ). Several studies agreed on a positive short-term effect of CSIs in GTPS papers, 6,44,49,57 but the therapeutic benefit was shown to usually last no longer than 3 to 6 months. 6,7,49 However, different articles reported significantly improved outcomes up to 104 weeks from baseline, 25,26,42 confirming a treatment effect for a single CSI after that time as well.…”

Section: Body Of Evidence For Low-to Moderate-grade Gluteal Tendon Disease (Grades 1-2 Tendinopathy)mentioning

confidence: 98%

“…Several studies agreed on a positive short-term effect of CSIs in GTPS papers, 6,44,49,57 but the therapeutic benefit was shown to usually last no longer than 3 to 6 months. 6,7,49 However, different articles reported significantly improved outcomes up to 104 weeks from baseline, 25,26,42 confirming a treatment effect for a single CSI after that time as well. Of note, the therapeutic response was less successful after structural abnormalities within the gluteal tendons had developed.…”

Section: Body Of Evidence For Low-to Moderate-grade Gluteal Tendon Disease (Grades 1-2 Tendinopathy)mentioning

confidence: 98%

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Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

Ladurner

Fitzpatrick

O’Donnell

2021

Orthopaedic Journal of Sports Medicine

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Background: Gluteal tendinopathy is the most common lower limb tendinopathy. It presents with varying severity but may cause debilitating lateral hip pain. Purpose: To review the therapeutic options for different stages of gluteal tendinopathy, to highlight gaps within the existing evidence, and to provide guidelines for a stage-adjusted therapy for gluteal tendinopathy. Study Design: Systematic review; Level of evidence, 4. Methods: We screened Scopus, Embase, Web of Science, PubMed, PubMed Central, Ovid MEDLINE, CINAHL, UpToDate, and Google Scholar databases and databases for grey literature. Patient selection, diagnostic criteria, type and effect of a therapeutic intervention, details regarding aftercare, outcome assessments, complications of the treatment, follow-up, and conclusion of the authors were recorded. An assessment of study methodological quality (type of study, level of evidence) was also performed. Statistical analysis was descriptive. Data from multiple studies were combined if they were obtained from a single patient population. Weighted mean and range calculations were performed. Results: A total of 27 studies (6 randomized controlled trials) with 1103 patients (1106 hips) were included. The mean age was 53.7 years (range, 17-88 years), and the mean body mass index was 28.3. The ratio of female to male patients was 7:1. Radiological confirmation of the diagnosis was most commonly obtained using magnetic resonance imaging. Reported treatment methods were physical therapy/exercise; injections (corticosteroids, platelet-rich plasma, autologous tenocytes) with or without needle tenotomy/tendon fenestration; shockwave therapy; therapeutic ultrasound; and surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair (with or without tendon augmentation). Conclusion: There was good evidence for using platelet-rich plasma in grades 1 and 2 tendinopathy. Shockwave therapy, exercise, and corticosteroids showed good outcomes, but the effect of corticosteroids was short term. Bursectomy with or without iliotibial band release was a valuable treatment option in grades 1 and 2 tendinopathy. Insufficient evidence was available to provide guidelines for the treatment of partial-thickness tears. There was low-level evidence to support surgical repair for grades 3 (partial-thickness tears) and 4 (full-thickness tears) tendinopathy. Fatty degeneration, atrophy, and retraction can impair surgical repair, while their effect on patient outcomes remains controversial.

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Section: Body Of Evidence For Low-to Moderate-grade Gluteal Tendon Disease (Grades 1-2 Tendinopathy)mentioning

confidence: 98%

Section: Body Of Evidence For Low-to Moderate-grade Gluteal Tendon Disease (Grades 1-2 Tendinopathy)mentioning

confidence: 98%

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

Ladurner

Fitzpatrick

O’Donnell

2021

Orthopaedic Journal of Sports Medicine

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“…Both image-and landmark-guided techniques have been shown to be effective with pain reduction at 3-6 months [53][54][55], but with either nonexistent [56,57] or limited effect on long-term pain reduction [58,59]. Many of these procedures however were performed using the more common landmark or fluoroscopy guidance which tend to result in injections into the trochanteric bursa or subgluteus medius bursa [54,60].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided bursal injections

et al. 2022

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The native bursa is a structure lined by synovium located adjacent to a joint which may serve to decrease friction between the tendons and overlying bone or skin. This extra-articular structure can become inflamed resulting in bursitis. Steroid injections have proven to be an effective method of treating bursal pathology in various anatomic locations. Performing these procedures requires a thorough understanding of relevant anatomy, proper technique, and expected outcomes. Ultrasound is a useful tool for pre procedure diagnostic evaluation and optimizing needle position during these procedures while avoiding adjacent structures. The purpose of this article is to review core principles of ultrasound-guided musculoskeletal procedures involving bursae throughout the upper and lower extremities.

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“…Greater trochanteric pain syndrome (GTPS) is a clinical diagnosis characterized by chronic pain around the greater trochanter and moderate-to-severe disability that impacts quality of life. 3 , 6 , 7 , 13 Most commonly, the source of pain is gluteal tendinopathy involving the gluteus medius and/or minimus. Gluteal tendinopathy increases with age and typically affects women in their 40s, 50s, and 60s.…”

mentioning

confidence: 99%

Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial

Atilano,

Martin,

Ignacio Martin

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Greater trochanteric pain syndrome (GTPS) is characterized by gluteal enthesopathy involving the peritrochanteric space and associated with chronic pain and functional impairment. A corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain. However, it is important to investigate treatment options that will relieve pain in the peritrochanteric space. Purpose: To compare the clinical efficacy of subfascial platelet-rich plasma (PRP) injection and enthesis needling for GTPS. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 92 patients (90% women; mean age, 55 years old; mean body mass index, 25.3 kg/m2) were randomly divided into a subfascial PRP injection group and an enthesis needling group. Descriptive data and radiographic measurements of the pelvis—including leg-length difference, pelvic width difference, and pelvic trochanteric index—were recorded. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment. Results: Baseline demographic and radiological characteristics were similar between the groups. The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the HOS-SS subscore compared with the needling group (32.09 [95% CI, 28.99-40.20] vs 20.52 [95% CI, 11.99-29.05]; P = .048). At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of >20% ( P = .040). After subfascial PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension ( P = .006 and P = .004, respectively). The pelvic trochanteric index was predictive of HOS-ADL and HOS-SS outcomes ( P = .011 and P = .022, respectively). The interaction between treatment modality and fascia nodule influenced HOS-ADL and HOS-SS outcomes ( P = .021 and P = .023) as well as the interactions of treatment modality, fascia nodules, and calcifications ( P = .027). Conclusion: Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the HOS-SS was greater in the PRP group. Registration: NCT04231357 (ClinicalTrials.gov identifier).

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Do ultrasound guided trochanteric bursa injections of corticosteroid for greater trochanteric pain syndrome provide sustained benefit and are imaging features associated with treatment response?

Cited by 12 publications

References 20 publications

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

Ultrasound-guided bursal injections

Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial

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