Greater trochanteric
pain syndrome }

Pathology

Greater trochanteric pain syndrome (GTPS) includes a number of disorders of the lateral peritrochanteric space of the hip such as tears of the gluteus medius and minimus, trochanteric bursitis, and external coxa saltans.

The main clinical symptoms are pain and reproducible tenderness in the region of the greater trochanter and/or the buttock or lateral thigh. Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of hip pain or to establish the diagnosis of GTPS when in doubt.

The greater trochanter is the site of attachment for the tendons of five muscles: the gluteus medius and gluteus minimus laterally, and the piriformis, obturator externus and obturator internus medially. As in the shoulder, injury and subsequent degeneration may occur in the components of the rotator cuff of the hip, starting with tendonitis, tendinosis, and eventual tear. This process occurs more commonly in the gluteus medius than the gluteus minimus.

Furthermore, there are three bursas present around the lateral aspect of the greater trochanter, i.e., the subgluteus maximus bursa, the subgluteus medius bursa and the gluteus minimus bursa. These bursas are believed to serve as cushioning for the gluteus tendons, the iliotibial band, and the tensor fascia latae. Trochanteric bursitis mostly occurs secondary to repetitive friction between the greater trochanter and the iliotibial band with hip flexion and extension. Trochanteric bursitis is also often associated with overuse, trauma, or other conditions that may alter normal gait patterns.

GTPS has been reported to affect between 10% and 25% of the general population, with an increased prevalence in women compared to men.

Therapy of symptomatic tendon tears comprises rest, antiinflammatory medications and physiotherapy focusing on range of motion and strengthening exercises. Trochanteric bursitis is usually self-limiting and responds to rest, ice, antiinflammatory medications and physiotherapy focusing on stretching, flexibility, strengthening and gait mechanics. When symptoms persist despite these interventions, bursal injections of local anesthetics and corticosteroid can provide effective pain relief.

Radial shock wave therapy (RSWT) has been demonstrated to be efficient for recalcitrant GTPS. In case of inefficacy of RSWT, surgical intervention may be considered in cases in which other potential sources of the patient’s symptoms have been ruled out.

Treatment Procedure

1. PALPATE
Locate the area of pain through palpation and biofeedback.

2. MARK
Mark the area of pain.

3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.

4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.

Recommended Settings

Swiss
DolorClast }

  Treatment Myofascial therapy
Number of treatment sessions 3 to 5 3 to 5
Interval between two sessions 1 week 1 week
Air pressure Evo Blue® 3 to 4 bar 3 to 4 bar
Air pressure Power+ 2.5 to 4 bar 2 to 4 bar
Impulses 2000 on the painful spot 2000
Frequency 8Hz to 12Hz 12Hz to 20Hz
Applicator 15mm 36mm
Skin pressure Moderate to Heavy Moderate to Heavy

 

Clinical Proofs

Rompe JD, Segal NA, Cacchio A, et al.
Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.
Am J Sports Med 2009;37 1981-1990
http://www.ncbi.nlm.nih.gov/pubmed/19439758

Furia JP, Rompe JD, Maffulli N.
Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome
Am J Sports Med 2009;37:1806-1813
http://www.ncbi.nlm.nih.gov/pubmed/19439756

Risks

Side effects of Radial Shock Wave Therapy (RSWT®) using the Swiss DolorClast®

When performed properly, RSWT® with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:

  • Pain and discomfort during and after treatment (anesthesia is not necessary)
  • Reddening of the skin
  • Petechia
  • Swelling and numbness of the skin over the treatment area

These device-related nonserious adverse events usually disappear within 36h after the treatment.

Accordingly the following contraindications of RSWT® using the Swiss DolorClast® must be considered:

  • Treatment over air-filled tissue (lung, gut)
  • Treatment of pre-ruptured tendons
  • Treatment of pregnant women
  • Treatment of patients under the age of 18 years (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
  • Treatment of patients with blood-clotting disorders (including local thrombosis)
  • Treatment of patients treated with oral anticoagulations
  • Treatment of tissue with local tumors or local bacterial and/or viral infections
  • Treatment of patients treated with cortisone

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