Kindyle L. Brennan, PT, PhD

Study Design
Prospective, randomized, partially-blinded.

Background
Greater trochanteric pain syndrome (GTPS) is the current terminology for what was once called greater trochanteric or sub-gluteal bursitis. Cortisone (corticosteroid) injections into the lateral hip is a traditionally accepted treatment for this condition. However, the effectiveness of injecting the bursa with steroids is increasingly being questioned, and an equally effective treatment with fewer adverse side-effects would be beneficial.

Objective
To investigate whether administration of dry needling (DN) is non-inferior to cortisone injections in reducing lateral hip pain and improving function in patients with GTPS.

Methods
Forty-three participants (50 hips observed), all with GTPS, were randomly assigned to a group receiving cortisone injections or DN. Treatments were administered over 6 weeks, and clinical outcomes were collected at 0, 1,3, and 6 weeks. The primary outcome measure was the numeric pain rating scale (0-10). The secondary outcome measure was the Patient Specific Function Scale (0-10). Medication intake for pain was collected as a tertiary outcome.

Results
Baseline characteristics were similar in the groups. A non-inferiority test for repeated measures design on pain and averaged function scores at 6 weeks (with a non-inferiority margin of 1.5 for both outcomes), indicates non-inferiority of DN vs. cortisone injections (p-values of <0.01 for both). Medication usage (p-value=0.74) was not different between groups at the same time point. Conclusions Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN. Our data suggest that DN is a non-inferior treatment alternative to cortisone injections in this patient population. Level of Evidence Therapy, level 1b. Registered December 2, 2015 at www.clinicaltrials.gov (NCT02639039) J Orthop Sports Phys Ther, Epub 3 Mar 2017. doi:10.2519/jospt.2017.6994