ESWT for Conditions of the Hip
Trochanteric Bursitis and Avascular Necrosis

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Extracorporeal Shock Wave Therapy, or ESWT, was first developed 20 years ago as a treatment for kidney stones. Now researchers have found this treatment effective in treating a wide variety of joint conditions. Specifically, ESWT is now proving itself effective in several common conditions of the hip which have typically been resistant to non-invasive treatment. When physical therapy, NSAIDS, or rest and ice fail to alleviate hip symptoms, doctors have typically used surgery as the next option. However, with ESWT, treatment is applied in only one session, in the doctor’s office, lasting only twenty minutes. Both trochanteric bursitis of the hip and avascular necrosis of the hip (femoral head) are routinely treated with Shockwave Therapy.

Bursitis is a painful condition caused by chronic inflammation of small, fluid filled protective sacs found around joints. When this occurs to the bursa protecting the large, bony prominence on the outside of the femur just below the hip bones (the greater trochanter), it’s called trochanteric bursitis. It’s both extremely common and can be quite painful. Frequently, it’s known simply as hip bursitis. This condition typically starts off with only mild pain, and like many chronic joint conditions tends to get worse over time.

Signs and symptoms that your hip pain may be trochanteric bursitis:
The classic symptom is pain and tenderness just below the greater trochanter

  • Typically, no pain is felt inside the hip joint itself
  • Pain radiating from the greater trochanter down the side of the hip
  • Worse with running and walking
  • Visible swelling and redness may or may not be present

Avascular necrosis (AVN) of the hip joint is a less common but potentially much more severe condition. Any bone, including the femur, is living tissue which requires a surprisingly high level of circulation to remain healthy. Whenever this blood flow is lessened, the bone itself can begin to die. This is known as avascular necrosis.

Signs and symptoms that your hip pain may be avascular necrosis: Note that in its early stages, avascular necrosis may be painless

  • Pain is typically felt inside the hip joint itself
  • Initial stages often present as pain when putting weight on the bone (standing)
  • Pain is almost always worse when walking, jogging, or running
  • A clicking or “ratcheting” may be felt, especially in later stages
  • Note that the pain of AVN sometimes mimics the pain of other hip conditions.

Hip Extracorporeal Shockwave Therapy FAQs:

What is avascular necrosis (AVN)?

Avascular necrosis occurs when normally healthy tissue begins to die due to a lack of blood flow. The word “vascular” refers to blood vessels and blood circulation. The word “necrosis” means cell or tissue death. Avascular necrosis can occur anywhere in the body, but is found most often in bones with a poor blood supply. Specifically, our New York hip ESWT avascular necrosis patients usually present with AVN of the femoral head inside the hip socket. Avascular necrosis is always a serious condition requiring medical attention.

What causes avascular necrosis?

Most patients don’t realize that bone is living tissue with a rich blood supply. Any time that the blood supply to a bone is decreased, avascular necrosis can occur. AVN often occurs without an obvious cause, and many of our ESWT hip avascular necrosis New York patients have a history of the following:

  • Long term corticosteroid use (cortisone). Taken either orally or injected, cortisone use is associated with over 35% of all avascular necrosis cases.
  • Sickle cell disease
  • HIV infection
  • Chemotherapy and radiation therapy for cancer
  • Longstanding degenerative arthritis
  • A history of traumatic injury of the hip joint or pelvis

What are the signs and symptoms of avascular necrosis?

At first, there may be no symptoms at all. Many of our avascular necrosis talus Pittsburgh patients only learn they have AN during routine X-rays, sometimes in preparation for a hip replacement. The first symptoms usually felt are a usually sharp hip pain, directly inside the joint, which typically becomes more constant as the disease progresses. Eventually the joint can be affected to the point where the bone collapses—resulting in severe pain whenever the joint is used. As an extremely general rule, the time elapsed between the first feelings of pain and bone collapse ranges from 6 months to over a year.

Why does AVN commonly occur at the hip?

AVN can occur in any bone. However, bones which naturally have a poor blood supply are more vulnerable. The head of the femur (the “ball” part of the ball-and-socket joint) has a single small artery providing its entire blood supply, and many cases of AVN are seen here. Often our Cranberry ESWT hip avascular necrosis patients considering hip replacement surgery have an extensive history of arthritis in the hip joint. When enough degeneration occurs, blood supply can become affected.

What other bones are frequent sites for avascular necrosis?

In our Erie ESWT hip avascular necrosis patients alone, we’ve also seen AVN in the small bones of the wrist (typically the scaphoid), ankle, (typically the talus), mandible, and the area of the shoulder blade just to the inside of the shoulder joint. All of these bones or areas of bone have a poor blood supply.

What is trochanteric bursitis?

Bursa are small fluid filled sacs which protect joints. When they become chronically inflamed, it’s known as bursitis, much as chronic inflammation of tendons is known as tendonitis. The large bony “bump” on the side of hip just below the actual hip bones is known as the greater trochanter. When the large bursa pads which protect this part of the joint become inflamed it’s known as trochanteric bursitis. Many of our ESWT hip avascular necrosis Trenton area patients who come in with other hip problems present with bursitis as well.

What causes trochanteric bursitis?

This type of bursitis is typically an overuse injury, and it occurs with great frequency in runners. Years of walking and running contribute to almost all cases—especially if patients also have a large Leg Length Inequality (LLI). If the legs are of significantly different lengths uneven wear and tear results and can result in bursitis. Many of our New York ESWT bursitis patients also have a history of previous hip surgery. Often trochanteric bursitis doesn’t have an obvious cause.

What are the signs and symptoms of trochanteric bursitis?

Not surprisingly, the tell-tale symptom is almost always pain just below the greater trochanter. Very few of our Pittsburgh ESWT bursitis patients come in with pain in the actual joint. Although this is a chronic irritation and inflammation based condition, visible swelling isn’t always present. Pain starts out mild and becomes more severe as the condition progresses, and is almost guaranteed to be more severe when walking or running.

What are some common treatments for these conditions?

Only a few procedures are used to treat AVN. All are invasive, and complete joint replacement is considered a major surgery—invasive orthopedic procedures should always be a last resort.

Bone grafts:

As much as is possible, the damaged bone is removed in a procedure known as debridement. Healthy bone is harvested from another area of the body and implanted on the femoral head. Note that this isn’t always successful as this part of the hip joint generally has a poor blood supply to begin with. Although less invasive than a complete replacement, this is still a major surgery.

Total joint replacement:

This option is reserved only for severely damaged joints. Much as it sounds, the joint is removed and a artificial replacement is set into the hip socket and shaft of the femur.

A note on trochanteric bursitis:

Although the pain of bursitis can become severe, surgery is almost never an option. Treatment is typically limited to over the counter pain medications (NSAIDS), cortisone injections, and physical therapy. Often patients find themselves in a situation where their symptoms are severe enough to limit their daily activities, yet they find little relief with these conservative therapies. Unfortunately, bursitis of the hip is generally regarded as being resistant to treatment.

How can ESWT (Extracorporeal Shockwave Therapy) treat these conditions?

Extracorporeal Shockwave Therapy (ESWT) is an excellent treatment for avascular necrosis—it’s unique, in fact. Remember that avascular necrosis is bone death due to lack of blood circulation. To date, Shockwave Therapy is the only treatment recognized to cause an effect called neo-vascularization (the formation of many new capillary arteries in the area). ESWT effectively uses high-intensity ultrasound energy to “jump-start” the healing process. We feel that several of our Pittsburgh ESWT hip avascular necrosis patients have been saved from surgery thanks to Shockwave therapy.

Many chronic overuse conditions such as bursitis have two things in common—chronic inflammation and incomplete healing. Shockwave Therapy addresses both of these issues as described above.

Treatment with ESWT

During the session, you comfortably recline while the affected hip is placed on a warm water bubble and covered with gel. The injured area is viewed with diagnostic ultrasound. Then, we then deliver tiny little pressure waves or “shockwaves” to the injured area. Healing occurs gradually over the next 6-12 weeks.

Approved by the National Institute for Clinical Excellence for use on tennis elbow one year ago, we are happy to make this treatment available to you. Call our office today to begin experiencing the relief this treatment offers in one short session.

Sound Medical Technologies, Inc. offers several ESWT– related services. We provide trained staff and certified technicians to operate the equipment during ESWT procedures. Physician certifications, recommendations and our clinical applications specialist can answer all your questions.

Call Sound Medical Technologies to learn how you can have this technology available on a case-by-case basis, without purchase or lease. We deliver and set up the machine and provide you with educational materials for patients. Assist you in providing the procedure. You maintain control of the patient relationship. You receive the reimbursement into your practice.

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