Skip to main content
Erschienen in: Clinical Rheumatology 3/2019

28.09.2018 | Original Article

Glucocorticoid injections for greater trochanteric pain syndrome: a randomised double-blind placebo-controlled (GLUTEAL) trial

verfasst von: Michael John Nissen, Laure Brulhart, Antonio Faundez, Axel Finckh, Delphine Sophie Courvoisier, Stéphane Genevay

Erschienen in: Clinical Rheumatology | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Small observational studies suggest that local glucocorticoid (GC) injection may be effective in the management of the greater trochanteric pain syndrome (GTPS). The objective was to perform the first randomised double-blind placebo-controlled trial to investigate the efficacy of local GC injection in the management of GTPS. The trial was conducted between November 2011 and May 2015. Inclusion criteria included lateral hip pain (LHP) for greater than 1 month, a LHP score of ≥ 4/10 and typical LHP reproduced by palpation of the greater trochanter. Participants were randomised in a 1:1 ratio to injection with a combination of local anaesthetic and GC (intervention) or injection with normal saline solution (placebo). The primary outcome of interest was the difference in pain intensity at 4 weeks post-injection between the two groups. Patients were followed for 6 months. A total of 46 patients were included. There were no significant differences between the two groups in terms of pain reduction at 1 month (p = 0.23). When including all measures in the first 4 weeks and using multilevel regression, there was a trend towards improvement in pain scores in favour of the intervention group (p = 0.08). There were no significant differences in pain scores between groups at 3 and 6 months. In the management of GTPS, local glucocorticoid injections are of no greater efficacy than injection of normal saline solution. Given the lack of long-term improvement and the potential for cortisone-related side effects, this intervention is of limited benefit.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Leonard MH (1958) Trochanteric syndrome; calcareous and noncalcareous tendonitis and bursitis about the trochanter major. J Am Med Assoc 168:175–177CrossRefPubMed Leonard MH (1958) Trochanteric syndrome; calcareous and noncalcareous tendonitis and bursitis about the trochanter major. J Am Med Assoc 168:175–177CrossRefPubMed
2.
Zurück zum Zitat Lustenberger DP, Ng VY, Best TM, Ellis TJ (2011) Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med 21:447–453CrossRefPubMedPubMedCentral Lustenberger DP, Ng VY, Best TM, Ellis TJ (2011) Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med 21:447–453CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC, Multicenter Osteoarthritis Study Group (2007) Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 88:988–992CrossRefPubMedPubMedCentral Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC, Multicenter Osteoarthritis Study Group (2007) Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 88:988–992CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Collee G, Dijkmans BA, Vandenbroucke JP, Rozing PM, Cats A (1990) A clinical epidemiological study in low back pain. Description of two clinical syndromes. Br J Rheumatol 29:354–357CrossRefPubMed Collee G, Dijkmans BA, Vandenbroucke JP, Rozing PM, Cats A (1990) A clinical epidemiological study in low back pain. Description of two clinical syndromes. Br J Rheumatol 29:354–357CrossRefPubMed
5.
Zurück zum Zitat Schapira D, Nahir M, Scharf Y (1986) Trochanteric bursitis: a common clinical problem. Arch Phys Med Rehabil 67:815–817PubMed Schapira D, Nahir M, Scharf Y (1986) Trochanteric bursitis: a common clinical problem. Arch Phys Med Rehabil 67:815–817PubMed
6.
Zurück zum Zitat Swezey RL (1976) Pseudo-radiculopathy in subacute trochanteric bursitis of the subgluteus maximus bursa. Arch Phys Med Rehabil 57:387–390PubMed Swezey RL (1976) Pseudo-radiculopathy in subacute trochanteric bursitis of the subgluteus maximus bursa. Arch Phys Med Rehabil 57:387–390PubMed
7.
Zurück zum Zitat Tortolani PJ, Carbone JJ, Quartararo LG (2002) Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J 2:251–254CrossRefPubMed Tortolani PJ, Carbone JJ, Quartararo LG (2002) Greater trochanteric pain syndrome in patients referred to orthopedic spine specialists. Spine J 2:251–254CrossRefPubMed
8.
Zurück zum Zitat Bird PA, Oakley SP, Shnier R, Kirkham BW (2001) Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum 44:2138–2145CrossRefPubMed Bird PA, Oakley SP, Shnier R, Kirkham BW (2001) Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum 44:2138–2145CrossRefPubMed
9.
Zurück zum Zitat Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P (2008) Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum 59:241–246CrossRefPubMed Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P (2008) Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum 59:241–246CrossRefPubMed
10.
Zurück zum Zitat Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN (2014) Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplast 29:383–386CrossRef Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN (2014) Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplast 29:383–386CrossRef
11.
Zurück zum Zitat Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B (2005) Prognosis of trochanteric pain in primary care. Br J Gen Pract 55:199–204PubMedPubMedCentral Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B (2005) Prognosis of trochanteric pain in primary care. Br J Gen Pract 55:199–204PubMedPubMedCentral
12.
Zurück zum Zitat Barratt PA, Brookes N, Newson A (2017) Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med 51:97–104CrossRefPubMed Barratt PA, Brookes N, Newson A (2017) Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med 51:97–104CrossRefPubMed
13.
Zurück zum Zitat Williams BS, Cohen SP (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 108:1662–1670CrossRefPubMed Williams BS, Cohen SP (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 108:1662–1670CrossRefPubMed
14.
Zurück zum Zitat Ege Rasmussen KJKJ, Fan NKJ (1985) Trochanteric bursitis. Treatment by corticosteroid injection. Scand J Rheumatol 14:417–420CrossRefPubMed Ege Rasmussen KJKJ, Fan NKJ (1985) Trochanteric bursitis. Treatment by corticosteroid injection. Scand J Rheumatol 14:417–420CrossRefPubMed
15.
16.
Zurück zum Zitat Shbeeb MI, O’Duffy JD, Michet CJ Jr, O’Fallon WM, Matteson EL (1996) Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol 23:2104–2106PubMed Shbeeb MI, O’Duffy JD, Michet CJ Jr, O’Fallon WM, Matteson EL (1996) Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis. J Rheumatol 23:2104–2106PubMed
17.
Zurück zum Zitat Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW et al (2011) Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med 9:226–234CrossRefPubMedPubMedCentral Brinks A, van Rijn RM, Willemsen SP, Bohnen AM, Verhaar JA, Koes BW et al (2011) Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. Ann Fam Med 9:226–234CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N (2009) Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med 37:1981–1990CrossRefPubMed Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N (2009) Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med 37:1981–1990CrossRefPubMed
19.
Zurück zum Zitat Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMed Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMed
20.
Zurück zum Zitat Baron G, Tubach F, Ravaud P, Logeart I, Dougados M (2007) Validation of a short form of the western Ontario and McMaster universities osteoarthritis index function subscale in hip and knee osteoarthritis. Arthritis Rheum 57:633–638CrossRefPubMed Baron G, Tubach F, Ravaud P, Logeart I, Dougados M (2007) Validation of a short form of the western Ontario and McMaster universities osteoarthritis index function subscale in hip and knee osteoarthritis. Arthritis Rheum 57:633–638CrossRefPubMed
21.
Zurück zum Zitat Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233CrossRefPubMed Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233CrossRefPubMed
22.
Zurück zum Zitat Labrosse JM, Cardinal E, Leduc BE, Duranceau J, Remillard J, Bureau NJ et al (2010) Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR Am J Roentgenol 194:202–206CrossRefPubMed Labrosse JM, Cardinal E, Leduc BE, Duranceau J, Remillard J, Bureau NJ et al (2010) Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR Am J Roentgenol 194:202–206CrossRefPubMed
23.
Zurück zum Zitat Kelly AM (2001) The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 18:205–207CrossRefPubMedPubMedCentral Kelly AM (2001) The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 18:205–207CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Westenberg RF, Zale EL, Heinhuis TJ, Ozkan S, Nazzal A, Lee SG et al (2018) Does a brief mindfulness exercise improve outcomes in upper extremity patients? A randomized controlled trial. Clin Orthop Relat Res 476:790–798CrossRefPubMedPubMedCentral Westenberg RF, Zale EL, Heinhuis TJ, Ozkan S, Nazzal A, Lee SG et al (2018) Does a brief mindfulness exercise improve outcomes in upper extremity patients? A randomized controlled trial. Clin Orthop Relat Res 476:790–798CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Deckers K, De Smedt K, Mitchell B, Vivian D, Russo M, Georgius P et al (2018) New therapy for refractory chronic mechanical low back pain-restorative neurostimulation to activate the lumbar multifidus: one year results of a prospective multicenter clinical trial. Neuromodulation 21:48–55CrossRefPubMed Deckers K, De Smedt K, Mitchell B, Vivian D, Russo M, Georgius P et al (2018) New therapy for refractory chronic mechanical low back pain-restorative neurostimulation to activate the lumbar multifidus: one year results of a prospective multicenter clinical trial. Neuromodulation 21:48–55CrossRefPubMed
26.
Zurück zum Zitat Wong SM, Hui AC, Tong PY, Poon DW, Yu E, Wong LK (2005) Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 143:793–797CrossRefPubMed Wong SM, Hui AC, Tong PY, Poon DW, Yu E, Wong LK (2005) Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 143:793–797CrossRefPubMed
27.
Zurück zum Zitat Zhang W, Robertson J, Jones AC, Dieppe PA, Doherty M (2008) The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis 67:1716–1723CrossRefPubMed Zhang W, Robertson J, Jones AC, Dieppe PA, Doherty M (2008) The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis 67:1716–1723CrossRefPubMed
28.
Zurück zum Zitat Bannuru RR, McAlindon TE, Sullivan MC, Wong JB, Kent DM, Schmid CH (2015) Effectiveness and implications of alternative placebo treatments: a systematic review and network meta-analysis of osteoarthritis trials. Ann Intern Med 163:365–372CrossRefPubMed Bannuru RR, McAlindon TE, Sullivan MC, Wong JB, Kent DM, Schmid CH (2015) Effectiveness and implications of alternative placebo treatments: a systematic review and network meta-analysis of osteoarthritis trials. Ann Intern Med 163:365–372CrossRefPubMed
29.
Zurück zum Zitat Brennan KL, Allen BC, Maldonado YM (2017) Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. J Orthop Sports Phys Ther 47:232–239CrossRefPubMed Brennan KL, Allen BC, Maldonado YM (2017) Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. J Orthop Sports Phys Ther 47:232–239CrossRefPubMed
30.
Zurück zum Zitat Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B (2013) Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA 309:461–469CrossRefPubMed Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B (2013) Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA 309:461–469CrossRefPubMed
31.
Zurück zum Zitat Dean BJ, Gettings P, Dakin SG, Carr AJ (2016) Are inflammatory cells increased in painful human tendinopathy? A systematic review. Br J Sports Med 50:216–220CrossRefPubMed Dean BJ, Gettings P, Dakin SG, Carr AJ (2016) Are inflammatory cells increased in painful human tendinopathy? A systematic review. Br J Sports Med 50:216–220CrossRefPubMed
32.
Zurück zum Zitat Dean BJ, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ (2014) The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum 43:570–576CrossRefPubMed Dean BJ, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ (2014) The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum 43:570–576CrossRefPubMed
33.
Zurück zum Zitat Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM (2010) Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord 11:206CrossRefPubMedPubMedCentral Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM (2010) Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord 11:206CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Mens JM, Nico de Wolf A, Berkhout BJ, Stam HJ (1998) Disturbance of the menstrual pattern after local injection with triamcinolone acetonide. Ann Rheum Dis 57:700CrossRefPubMedPubMedCentral Mens JM, Nico de Wolf A, Berkhout BJ, Stam HJ (1998) Disturbance of the menstrual pattern after local injection with triamcinolone acetonide. Ann Rheum Dis 57:700CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Freidlin B (2014) Methods and applications of statistics in clinical trials: planning, analysis, and inferential methods, volume 2. Chpt 12. Futility analysis. John Wiley & Sons, Inc Freidlin B (2014) Methods and applications of statistics in clinical trials: planning, analysis, and inferential methods, volume 2. Chpt 12. Futility analysis. John Wiley & Sons, Inc
Metadaten
Titel
Glucocorticoid injections for greater trochanteric pain syndrome: a randomised double-blind placebo-controlled (GLUTEAL) trial
verfasst von
Michael John Nissen
Laure Brulhart
Antonio Faundez
Axel Finckh
Delphine Sophie Courvoisier
Stéphane Genevay
Publikationsdatum
28.09.2018
Verlag
Springer London
Erschienen in
Clinical Rheumatology / Ausgabe 3/2019
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-018-4309-6

Weitere Artikel der Ausgabe 3/2019

Clinical Rheumatology 3/2019 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.