Long-Term Efficacy of Combined Focused and Radial Extracorporeal Shockwave Therapy for Gluteus Medius Tendon Pathology: A Pilot Study

Abstract

Background: Gluteus medius tendinopathy is amongst the most prevalent lower limb tendinopathies and is now recognized as the primary cause of insidious lateral hip pain. Typically affecting middle-aged women, this condition causes disability and reduced quality of life as it negatively impacts most daily life activities. Several studies demonstrate that extracorporeal shockwave therapy is effective in reducing pain and promoting functional recovery in several musculoskeletal disorders including tendinopathies. However, most published data are limited to evaluating focal or radial shockwaves as single interventions. Contrariwise, there is little evidence reporting the use of combined ESWT treatment and outcomes for managing tendon pathologies, and no data are reported on combined ESWT for gluteus medius tendinopathy. Objectives: The aim of this study was to evaluate the clinical outcomes of combined ESWT in gluteus medius tendinopathy. Methods: Medical charts of 11 consecutive patients with gluteal tendinopathy confirmed by ultrasound who underwent a combined ESWT protocol were reviewed. Changes in pain severity and lower limb function were evaluated using the numerical rating scale, the Victorian Institute of Sports Assessment for Gluteal tendinopathy questionnaire, and the Roles and Maudsley score. Clinical outcome measurements were collected at baseline (T0), 2 months after combined ESWT (T1), and at long-term follow-up (T2), at least 10 months post-treatment (mean 26 months). Results: The mean age of the sample was 62.55 ± 3.17 years. A marked prevalence of females was recorded (nine subjects, 81.8%). A significant improvement was observed in all outcome criteria both at short- and long-term follow-up after combined ESWT compared to baseline (p < 0.05). Treatment success rates were 90.9% and 81.8% at T1 and T2, respectively. Conclusions: Combined ESWT is effective and safe for patients with gluteal tendinopathy, with good long-term results in terms of pain relief and improved functional impairment.

Keywords: combined shockwave therapy; focused shockwave; functional outcomes; gluteal tendinopathy; radial shockwave; sports medicine; ultrasonography.

Figure 1

Long-axis image of a tendinopathic gluteus medius tendon (A) with contralateral healthy comparison (B) showing hypoechoic thickening at the attachment onto the iliac bone (IB) and irregularities of the bone margin due to the presence of an enthesophyte (arrow).

Figure 2

Flow diagram of participant recruitment, allocation, and analysis.

Figure 3

Transverse ultrasound views of pathological attachments of gluteus medius tendons onto the greater trochanter (GT). Representative images of tendinosis (A), enthesopathy (B), and enthesopathy accompanied by tendinosis (C).

Figure 4

Average clinical outcome variations following c-SWT across time points of the study. NRS-p score (A), VISA-G (B), and R&M score (C). * p < 0.05 vs. T0.

Figure 5

Longitudinal views of the gluteus medius tendon from a patient in the study before (A) and after (B) combined ESWT. At baseline, the ultrasound image showed hypoechoic thickening at the tendon’s insertion onto the iliac bone (IB). Irregularities of the tendon’s superior contour were also evident. In contrast, a marked improvement in the morphological aspect of the tendon was evident at T2, as shown by the more homogeneous tendon fibrillar pattern and reduced thickness.

Figure 6

Linear correlation charts between outcome measures and patients’ age at different follow-ups following combined ESWT. NRS-p score (A), VISA-G score (B), and R&M score (C).