Overview

People who have chronic (long term) pain on the side of the hip or thigh area may be offered a procedure called extracorporeal shockwave therapy (ESWT) for refractory greater trochanteric pain syndrome.

The hip joint is made up of the head of the thigh bone (femur) and your pelvis. The trochanter is a bone lump towards the end of the thigh bone. Surrounding the lump are tendons, and sacs containing fluid. These sacs act as a pillow for the muscles in the hip, and sometimes the sacs can become irritated and swollen on the side of hip. When this happens you may feel pain, especially when you lie on the affected side or during repetitive movement and exercise. This is sometimes referred to as greater trochanteric bursitis.

How ESWT works

ESWT is a procedure where shockwaves are passed through the skin to the injured part of the hip using a special device. Extracorporeal means outside of the body. The shockwaves are mechanical and not electric. They are audible, low energy sound waves, which work by increasing blood flow to the injured area.

This speeds up the body’s healing process. You will usually require a course of 3 treatments, 1 week apart.

Who can have ESWT

It is offered to patients with refractory greater trochanteric pain syndrome who have not responded well enough to other non-surgical treatments, such as:

• physiotherapy
• rest
• steroid injection
• ice therapy
• painkillers

It is a minimally invasive treatment that is done as an outpatient, so you can go home the same day. ESWT can usually offer relief from pain and other symptoms.

You must not have ESWT if you:

• are pregnant
• are taking antiplatelet medicine, excluding aspirin 75mg, (for example clopidogrel) or anticoagulant medication (such as warfarin or rivaroxaban)
• have a blood-clotting disorder
• are under the age of 18
• have been diagnosed with any active cancer
• have an infection in your hip, or a history of tendon or ligament rupture
• have had any steroid injections in the previous 12 weeks
• have a cardiac pacemaker

Risks

The National Institute for Health and Clinical Excellence (NICE) say that this procedure to be safe, although it does not always work for everyone. For this reason, every patient will be monitored before and after the treatments to check how successful it has been.

Comparative studies have shown that:

• 13 out of 100 (13%) patients feel better at a month after treatment
• 68 out of 100 (68%) patients feel better at 4 months
• 74 out of 100 (74%) patients feel better at 15 months

You will be asked to complete a questionnaire before your treatment starts and again at 3 and 12 months after your treatment.

There is a small chance that, after the treatment, the condition may get worse. Your doctor or healthcare practitioner will discuss the benefits and risks of the procedure with you in more detail when you are offered the treatment.

Side effects

You will feel some pain or discomfort during the treatment, but most people find this manageable.

After the treatment, you may have redness (this may be harder to notice on brown or black skin), bruising, swelling and numbness to the area. These should improve within a week and before your next treatment.

There is a very small risk of tendon or ligament rupture and damage to the soft tissue.