Comparing Dry Needling, Cortisone for Greater Trochanteric Pain Syndrome

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The terminology of GTPS was changed to reflect findings indicating that injury to the contractile tissues, rather than bursitis, is often the cause of the condition.
The terminology of GTPS was changed to reflect findings indicating that injury to the contractile tissues, rather than bursitis, is often the cause of the condition.

Results of a randomized trial published in the Journal of Orthopaedic and Sports Physical Therapy showed that dry needling was noninferior to cortisone injections in treating greater trochanteric pain syndrome (GTPS).1

GTPS was formerly known as greater trochanteric or subgluteal bursitis, and the terminology was changed to reflect findings indicating that injury to the contractile tissues, rather than bursitis, is often the cause of the condition.2 The investigators in the present study defined GTPS as “includ[ing] a number of disorders involving the lateral hip, such as bursitis, gluteal tears, external coxa saltans (snapping hip), and trigger points in contractile tissue crossing the hip.”3

Although GTPS has long been treated with bursal cortisone injections, the logic of this approach is unclear in light of this refined understanding of the syndrome's etiology. In addition, cortisone injections are associated with significant side effects. Dry needling uses filament needles similar to those used in acupuncture, able to stimulate myofascial trigger points. Noting previous findings that dry needling is noninferior to analgesic injections for the treatment of myofascial pain syndrome and patellar tendinopathy, the researchers sought to compare the effectiveness of dry needling and cortisone injections in improving GTPS-related pain and function.4,5

Adult patients with lateral hip pain were randomly assigned to a dry needling group (n=21) or a cortisone injection group (n=22). Scores on the numeric pain rating scale (0-10) at 6 weeks after treatment initiation served as the primary outcome. The secondary outcome measure was the Patient-Specific Functional Scale (PSFS; 0-10), in which patients identify tasks that are restricted due to their condition. Patients were evaluated at baseline and 1, 3, and 6 weeks after treatment began.

The results demonstrate no significant difference in outcomes in the two treatments. A noninferiority test with a 1.5 margin for both pain and averaged function scores at 6 weeks showed noninferiority between groups (P <.01).

Although additional studies investigating the effectiveness of dry needling are needed, these findings suggest that it may represent an effective strategy for treating patients with GTPS. “This would not only avoid any detrimental effects of steroids in these patients, but would also provide an equally effective alternative treatment for individuals with contraindications to steroid injection and for those who do not respond positively to cortisone injection,” the researchers concluded.

Summary and Clinical Applicability

Dry needling was found to be noninferior to cortisone injections for the treatment of greater trochanteric pain syndrome, as indicated by assessment of pain and functional limitations.  

Limitations

Limitations include the lack of a control group and the relatively small sample size and short study period.

 

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References

  1. Brennan KLAllen BC, Maldonado YM. Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: a noninferiority randomized clinical trial. J Orthop Sports Phys Ther. 2017;47(4):232-239. doi:10.2519/jospt.2017.6994
  2. Silva F, Adams T, Feinstein J, Arroyo RA. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. 2008;14(2):82-86. doi: 10.1097/RHU.0b013e31816b4471
  3. Pavkovich R. Effectiveness of dry needling, stretching, and strengthening to reduce pain and improve function in subjects with chronic lateral hip and thigh pain: a retrospective case series. Int J Sports Phys Ther. 2015;10(4):540-551.
  4. Ga H, Choi JH, Park CH, Yoon HJ. Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients – a randomised trial. Acupunct Med. 2007;25(4):130-136.
  5. van Ark M, Zwerver J, van den Akker-Scheek I. Injection treatments for patellar tendinopathy. Br J Sports Med. 2011;45(13):1068-1076. doi:10.1136/bjsm.2010.078824
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