Evidence on the efficacy and safety of extracorporeal shockwave therapy (ESWT) for refractory greater trochanteric pain syndrome is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake ESWT for refractory greater trochanteric pain syndrome should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy. In particular, patients should be informed about the possibility of pain during and after treatment, and the risk that symptoms may worsen. They should be provided with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having ESWT for refractory greater trochanteric pain syndrome (see section 3.1).
This procedure should only be carried out by clinicians with specific training in the administration of ESWT for refractory greater trochanteric pain syndrome and in accordance with manufacturer's instructions.
NICE encourages further research into ESWT for refractory greater trochanteric pain syndrome. Research studies should clearly describe patient selection, imaging, and treatment protocols. Outcomes should include functional and quality-of-life scores with at least 1 year of follow-up.