Extracorporeal Shockwave Therapy for Refractory Greater Trochanteric Pain Syndrome

Abstract

Introduction: Greater trochanteric pain syndrome (GTPS) is a common and disabling condition characterized by pain and tenderness at or around the trochanteric area. Extracorporeal shockwave therapy (ESWT) has been described as a method of treatment. The National Institute for Health and Clinical Excellence (NICE, UK) guidance suggests a possible benefit but with limited evidence.

Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta‐analysis

“…CSI also resulted in a marked short‐term improvement (HG 1.52) in one study (Rompe et al., 2009), illustrating a large treatment effect, but at an undefined level of significance. Significant baseline to medium‐term improvements were reported following SWT at p < 0.05 in all six non‐RCTs that measured this change (Furia et al., 2009; Maffuli et al., 2018; Sultan & Lovell, 2015; Wheeler, 2022a; Wheeler & Tattersall, 2016), whereas no SWT or control groups analysed within RCTs reported significant improvements. In addition, although not assigned a significance level, a HG of 1.73 in one study between baseline and medium‐term follow‐up indicates a large but non‐significant intervention effect (Carlisi et al., 2019).…”

“…Full details including of each included study are presented in Table 2 with their respective inclusion/exclusion criteria presented in Appendix . All but three studies (Furia et al., 2009; Seo et al., 2018; Sultan & Lovell, 2015) administered three SWT sessions per week, ranging from one (Furia et al., 2009) to 12 (Seo et al., 2018) with TED fluctuating between 60 and 875 mJ/mm 2 . Participant follow‐up post‐SWT varied between one (Sultan & Lovell, 2015) and four (Maffuli et al., 2018; Ramon et al., 2020) occasions, ranging between 1 week (Seo et al., 2018) and 2 years (Maffuli et al., 2018) post‐treatment.…”

“…Similarly, inclusion/exclusion criteria differed greatly across studies, with pooling of both sub‐acute and chronic GTPS symptom duration likely impacting the probability of symptom resolution (Anderson et al., 2014; Main et al., 2008) and/or response to SWT. Despite its established place as gold standard for GTPS diagnosis (Amin & Abdelkerim, 2022; Kenanidis et al., 2020), MRI was consistently utilised in only two studies (Matteo et al., 2009; Seo et al., 2018), and inconsistently in another four (Ramon et al., 2020; Sultan & Lovell, 2015; Wheeler et al., 2022; Wheeler & Tattersall, 2016), further highlighting diagnostic heterogeneity. The potential resultant misdiagnosis and subsequent inclusion/exclusion of relevant subjects from analysis impacts summative conclusions (Barratt et al., 2017; Koulischer et al., 2015), and highlights the need for more rigorously established assessment and diagnostic criteria upon which more reliable comparable data can be produced.…”

“…Full details including of each included study are presented in Table 2 with their respective inclusion/exclusion criteria presented in Appendix 3. All but three studies (Furia et al, 2009;Seo et al, 2018;Sultan & Lovell, 2015) administered three SWT sessions per week, ranging from one (Furia et al, 2009) to 12 (Seo et al, 2018) - - SWT varied between one (Sultan & Lovell, 2015) and four (Maffuli et al, 2018;Ramon et al, 2020) occasions, ranging between 1 week (Seo et al, 2018) and 2 years (Maffuli et al, 2018) post-treatment. Pain was reported using numerical pain rating score (NPRS) in seven studies and visual analogue score (VAS) in five studies, with a variety of functional measures utilised (Table 2).…”