Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial

doi:10.1136/bmj.b1088

Published 14 April 2009, doi:10.1136/bmj.b1088
Cite this as: BMJ 2009;338:b1088

Research

Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial

Steven P Cohen, associate professor¹^,2, Scott A Strassels, assistant professor ³, Leslie Foster, assistant professor⁴, John Marvel, assistant professor⁵, Kayode Williams, assistant professor⁵, Matthew Crooks, assistant professor⁵, Andrew Gross, pain management fellow⁶, Connie Kurihara, pain management center², Cuong Nguyen, chief⁷, Necia Williams, chief⁸

¹ Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA, ² Walter Reed Army Medical Center, Washington, DC, USA, ³ Division of Pharmacy Practice, University of Texas at Austin, Austin, TX, USA, ⁴ Department of Orthopedic Surgery, Walter Reed Army Medical Center, ⁵ Department of Anesthesiology, Johns Hopkins School of Medicine, ⁶ Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA, ⁷ Physical Medicine and Rehabilitation Service, Department of Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany, ⁸ Integrated Anesthesia Services, Walter Reed Army Medical Center and National Naval Medical Center, Bethesda, MD

Correspondence to: S P Cohen, 550 North Broadway, Suite 301, Baltimore, MD 21029 scohen40{at}jhmi.edu

Objective To determine whether fluoroscopic guidance improvesoutcomes of injections for greater trochanteric pain syndrome.

Design Multicentre double blind randomised controlled study.

Setting Three academic and military treatment facilities inthe United States and Germany.

Participants 65 patients with a clinical diagnosis of greatertrochanteric pain syndrome.

Interventions Injections of corticosteroid and local anaestheticinto the trochanteric bursa, using fluoroscopy (n=32) or landmarks(that is, "blind" injections; n=33) for guidance.

Main outcome measures Primary outcome measures: 0-10 numericalrating scale pain scores at rest and with activity at one month(positive categorical outcome predefined as $≥$ 50% pain reductioneither at rest or with activity, coupled with positive globalperceived effect). Secondary outcome measures included Oswestrydisability scores, SF-36 scores, reduction in drug use, andpatients’ satisfaction.

Results No differences in outcomes occurred favouring eitherthe fluoroscopy or blind treatment groups. One month after injectionthe average pain scores were 2.7 at rest and 5.0 with activityin the fluoroscopy group compared with 2.2 and 4.0 in the blindinjection group. Three months after the injection, 15 (47%)patients in the blind group and 13 (41%) in the fluoroscopygroup continued to have a positive outcome.

Conclusion Although using fluoroscopic guidance dramaticallyincreases treatment costs for greater trochanteric pain syndrome,it does not necessarily improve outcomes.

Trial registration Clinical trials NCT00480675 [ClinicalTrials.gov]

© Cohen et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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