Shockwave Therapy for Trochanteric Bursitis

Ana Cláudia SouzaAna Cláudia SouzaFlavia ArkaderFlavia ArkaderPaulo Rockett Paulo Rockett

Paulo SantosPaulo Santos

AnatomyAnatomy

Some cases of bursitis Some cases of bursitis happened with happened with

tendinosis of the tendinosis of the gluteus tendongluteus tendon

calcificationscalcifications

and

Collagen degeneration Necrosis Pseudochondroid metaplasy Angiofibroblastic hyperplasia vascularisation and inflammatory cells. Calcifications

Histological Findings

What is the mechanism of What is the mechanism of shockwave therapy in Hip Bursitis?shockwave therapy in Hip Bursitis?

Microbiological Theory

eNOS

PHISYCAL ENERGY

Biological Response

VEGF PCNANeo

vascular

Improved blood supply

Bone repair tendon repair

Tissue regeneration

BMP-2

- International Society for Musculoskeletal Shockwave Therapy ISMSTNEWSLETTER

Retrospective study

Electro hydraulic high-energy device REFLECTRON – HMT

3 Brazilian Centers

Jun 2002 – Feb 2006 = 44 months 64 Hips treated 56 with follow up 6 bilateral 41 women – 9 men Average age 61: range, 27-79

Conditions for ESWT of Soft Tissue pathologies

Pain for at least 6 months

Unsuccessful regular conservative therapy over a period of at least 3 months

unsuccessful surgery

At least 3 of the following therapies :

physiotherapy thermotherapyphysiotherapy thermotherapy

infiltration acupuntureinfiltration acupunture

medicationmedication immobilization immobilization

electrotherapy neural therapyelectrotherapy neural therapy

ultrasound low dose X-ray treatmentultrasound low dose X-ray treatment

Inflammatory arthritis and Gout Previous corticosteroid injection in the last 6 weeks Acute infection Blood coagulation disorders Pregnancy Neurological Abnormality Tumor

DiagnosisDiagnosis

Medical history and clinical presentation

X-ray Ultrasound MRI

X-rays and ultrasound: before treatment, 90 and 180 days after

Patients were reviewed at 45, 90 and 180 days

Evaluation of subjective pain by visual analog scale (VAS)

Roles and Maudsley score

Roles and Maudsley Roles and Maudsley scorescore

Grade 1Grade 1 EExcellentxcellent no pain, full movement and no pain, full movement and activityactivity

Grade 2Grade 2 GoodGood occasional pain, full movement occasional pain, full movement and activityand activity

Grade 3Grade 3 AAcceptablecceptable some discomfort after some discomfort after prolonged activityprolonged activity

Grade 4Grade 4 PoorPoor pain limiting activitypain limiting activity

Protocol Application

One application

Local Anaesthesia

1200 impulses1200 impulses

Energy flux 0.130 to 0.144 mJ/mm²Energy flux 0.130 to 0.144 mJ/mm²

Reapplication after 3 months of follow-upReapplication after 3 months of follow-up

56 Trochanteric Bursitis

Treatments Cases 45 days 90 days 180 days

1 52 68% 76% 83%

2 4 63% 73% 88%

3 0

No significant adverse affect was observed

Complications

Local swelling Local hematoma Petechial hemorrhage

Final ResultsRoles and Maudsley score

7

17

18

14

5

10

24

17

42

27

23

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

45 days 90 days 180 days

56 Trochanteric Bursitis

ExcellentGoodAcceptablePoor

Final Results – 180 daysRoles and Maudsley score

56 Trochanteric Bursittis

Excellent23

41%

Acceptable2

3%Poor4

4%

Good27

48%

No Corticosteroide

Injection44

88%

12%

50 / 89%

49 = No corticosteroide Injection

7 = Corticosteroide Injection

Final Results – 180 daysRoles and Maudsley score

56 Trochanteric Bursittis

Excellent23

41%

Acceptable2

3%Poor4

4%

Good27

48%No Cortic Injection

583%

Cortic Injection

117%

6 cases=poor or acceptable

Previous Corticosteroid InjectionCortic Injection

12%

No Cortic Injection

4488%

No Cortic Injection

583%

Cortic Injection

117%

Excellent / GoodExcellent / Good Poor / AcceptablePoor / Acceptable

66

Previous corticoid injection treatment doesn’t change ours results

CONCLUSION

ESWT must be considered as an alternative in the treatment of chronic trochanteric bursitis .

ESWT presents advantages for not being invasive, not presenting significant complications beyond lesser operational costs; more over preventing the significant potential risks described in the literature of the traditional surgical procedures.

Muito ObrigadaMuito Obrigada