GREATER TROCHANTERIC PAIN SYNDROME
Pathology
The main clinical symptoms are pain and reproducible tenderness in the region of the greater trochanter and/or the buttock or lateral thigh. The 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 Greater trochanteric pain syndrome 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.
Greater trochanteric pain syndrome 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, anti-inflammatory medications and physiotherapy focusing on a range of motion and strengthening exercises. Trochanteric bursitis is usually self-limiting and responds to rest, ice, anti-inflammatory medications and physiotherapy focusing on stretching, flexibility, strengthening and gait mechanics. When symptoms persist despite these interventions, bursal injections of local anaesthetics and corticosteroids can provide effective pain relief.
Radial shock wave therapy has been demonstrated to be efficient for recalcitrant greater trochanteric pain syndrome.
In the case of the inefficacy of RSWT, surgical intervention may be considered in cases in which other potential sources of the patient’s symptoms have been ruled out.
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 non-serious 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 non-serious adverse events usually disappear within 36h after the treatment.
Treatment Procedure
Palpate
Locate the area of pain through palpation and biofeedback.
Mark
Mark the area of pain.
Apply gel
Apply coupling gel to transmit shock waves to the tissue.
Apply shock waves
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.
Clinical Proof
Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome.
Rompe JD, Segal NA, Cacchio A, et al.
Am J Sports Med 2009;37 1981-1990
RSWT® is a safe and effective method of treating greater trochanteric pain syndrome. DolorClast® Radial Shock Waves provided better results in a shorter time than home training.
This randomized controlled clinical trial study aimed to determine whether local corticosteroid injection, home training, and repetitive low-energy shock wave therapy provide outcomes of equal value four months from baseline.
View Study →
Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome.
Furia JP, Rompe JD, Maffulli N.
Am J Sports Med 2009;37:1806-1813
RSWT® is a safe and effective modality in the treatment of greater trochanteric pain syndrome (GTPS). Satisfactory improvement is maintained for at least 1 year!
Recommended Settings
| Recommended Settings | 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 |
Contraindications
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 anticoagulants
- Treatment of tissue with local tumors or local bacterial and/or viral infections
- Treatment of patients treated with cortisone
Some indications may not be approved in the United States of America, under regulation by the US FDA. Please refer to the respective Instructions for Use.