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Shockwave Therapy in the Treatment of Trochanteric Bursitis

Mauro Meyer

INTRODUCTION:

Trochanteric bursitis is the inflamation of the trochanteric bursa causing chronic pain on the lateral aspect of the hip and tight, irradiating to the knee; more frequent in women more than 40 years and less than 60 years. The current treatment consist of non-steroidal anti-inflamatory agents, physiotherapy(ultrasound and similars) and local injection of steroids with or without anaesthetic drugs. When these conservative procedures fail, the option is the surgical treatment. We used the shockwave therapy for the treatment of the trochanteric bursitis after the fail of the conservative procedures and before the surgery like a last effort to avoid it.


MATERIAL AND METHODS:

18 patients, all women aging from 40 to 86 years (media 60), with chronic trochanteric bursitis for more than 12 months, having done all the conservative procedures without success, were submited to shockwaves therapy between march and july 2001. The diagnoses was confirmed by clinical examination plus a thickening of the bursa wall by echography or irregularieties or peritrochanteric calcifications on x-rays. By palpation, the points of pain were localized in the region of the great trochanter and was apllied 600 shockwaves per point of pain, resulting in 1500 shockwaves if it was just one point up to 3000 shockwaves if were more than one point. Patients helped in the depth location of the impact, and no analgesic or sedative were used before, during or after the treatment. Pressure waves were applied using the Orthima of Direx Medical Systems. The energy used vary from level 1(0,03mJ/msquare) to 3(0,2mJ/msquare). In september 2001, all patients were revised and asked about the pain in a Visual Analogue Scale (VAS) of 10, and asked about satisfaction or not about the result of the treatment. In october 2001, patients not satisfied with the result of the treatment were invited to do more one session, and one patient did not accept repeat the treatment. Patients satisfied but with VAS level less than 8 were invited to do the same, and all accepted repeat the treatment.


RESULTS:

3 patients were unsatisfied with the treatment and the other fiftheen were satisfied. The results with the VAS vary from 5 to 10 in the satisfied group and zero for all patients in the unsatisfied group. 2 of 6 patients that used low energy level 1 were from the unsatisfied group and the others four of the satisfied group were two in level 5, one in level 8 and one in level 9 in the VAS. The results of the new treatment of the patients of the usatisfied group and of the satisfied group with VAS level less than 8 will be shown in the congress.


CONCLUSION:
Patients may know very well about the possibilities of the treatment and agree with the perspective of more than one procedure. Probably, becouse is a large area to be treated, it is difficult to solve it just in one procedure in some patients. It is important show to the patients the difference of the pain from the trochanteric bursitis and from other pathologies like low back pain, becouse when they can differentiate it, the sactisfaction with the treatment were almost 100%. Shockwave therapy for treatment of trochanteric bursitis seems to be a new and efficient treatment reducing dramatically the number of patients that go to the surgery.

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