A Randomized Controlled Trial of Ultrasound-guided Platelet-Rich-Plasma (PRP) Injection Versus Extracorporeal Shock Wave Therapy (ESWT) for Great Trochanter Pain Syndrome (GTPS) With Gluteus Medius or Minimus Tendinopathy

The purpose of this study is to compare the efficacy of ultrasound-guided platelet-rich
plasma (PRP) injection versus extracorporeal shock wave therapy for management of refractory
Greater Trochanteric Pain Syndrome (GTPS).

GTPS is a common cause of extra-articular lateral hip pain which occurs in up to 10- 25% of
the population, and is a common presenting complaint to primary care and Sports Medicine
clinics. Previously, most cases of GTPS were diagnosed as trochanteric bursitis, for which
the standard treatment focused on relieving inflammation with non-steroidal anti-inflammatory
medications and corticosteroid injections. However, corticosteroid injections typically only
provide short term pain relief, likely secondary to the fact that the underlying pathology is
likely not from an isolated bursal inflammation. Recent studies suggest that in fact the most
common cause of GTPS is gluteus medius or minimus tendinopathy or tear. Platelet rich plasma
(PRP) has been used in treating tendinopathies and tendon tears throughout the body to
promote healing through the concentrated growth factors released from platelets.
Extracorporeal shock wave therapy (ESWT) is another treatment which has been used
increasingly in the treatment of tendinopathies. The purpose of this randomized prospective
study is to compare the efficacy of PRP injection to ESWT in treating patients with a
clinical diagnosis of GTPS.

Inclusion Criteria:

Individuals with documented diagnosis of greater trochanter pain syndrome, with MRI
evidence of gluteus minimus or medius tendinopathy, whose lateral hip pain has been
refractory to conservative management with non-steroid anti-inflammatory medications and at
least 6 weeks of Physical Therapy.

Exclusion Criteria:

1. Age < 18 or > 65 years

2. Pregnancy

3. Full-thickness tear of the involved gluteal tendons, bursa, and intra-articular
structures.

4. Evidence of concomitant injury to the involved lower extremity, including
radiculopathy or radiculitis, piriformis syndrome, ischial tuberosity avulsion

5. History of prior steroid injection and Orthobiologic injection or surgery to the
involved lower extremity f. Any inflammatory or neoplastic disorder

g. Blood coagulation disorders or use of antiplatelet or anticoagulant drugs h. Severe knee
or hip osteoarthritis i. Patients with symptoms of more than 6 months' duration were not
considered as patients in the chronic stages of this condition and may require a different
therapeutic approach including surgical treatment.

j. Severe Diabetes Mellitus who need insulin injection k. Severe active lumbar
radiculopathy with pain, numbness, or weakness in a dermatomal distribution l. Implanted
pacemaker