Investigating the Effect of Extracorporeal Shock Wave Therapy on reducing Chronic Pain in Patients with Pes Anserine Bursitis: A Randomized, Clinical- Controlled Trial

Document Type : Original Article

Authors

Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Knee pain, is one of the most common causes of patients' referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB) for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients. Materials and Methods: This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months), who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT). Pain scores of all patients were measured using the Visual Analog Scale (VAS) and McGill Pain Questionnaire (MPQ) (total and present pain indexes [TPIs and PPIs]) before intervention, immediately after intervention (3rd week), and after 8 weeks. The pain scores were then compared and statistically analyzed. Results: In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week): P=0.02, P= 0.04 respectively; and 8 weeks after the end of treatment: P=0.01, P= 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001). Conclusion: The results showed that ESWT could be effective in reducing the pain and treating PAB.

Keywords

1.
Butcher JD, Salzman KL, Lillegard WA. Lower extremity bursitis. Am Fam Physician 1996;53:2317-24.  Back to cited text no. 1
    
2.
Hansen PA, Willick SE. Musculoskeletal disorders of the lower limb. In: Braddom RL, editor. Physical Medicine & Rehabilitation. 4th ed., Vol. 843. Philadeiphia, PA: Saunders; 2011. p. 59.  Back to cited text no. 2
    
3.
Rennie WJ, Saifuddin A. Pes anserine bursitis: Incidence in symptomatic knees and clinical presentation. Skeletal Radiol 2005;34:395-8.  Back to cited text no. 3
    
4.
Helfenstein M Jr, Kuromoto J. Anserine syndrome. Rev Bras Reumatol 2010;50:313-27.  Back to cited text no. 4
    
5.
Voorneveld C, Arenson AM, Fam AG. Anserine bursal distention: Diagnosis by ultrasonography and computed tomography. Arthritis Rheum 1989;32:1335-8.  Back to cited text no. 5
    
6.
Yoon HS, Kim SE, Suh YR, Seo YI, Kim HA. Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci 2005;20:109-12.  Back to cited text no. 6
    
7.
Uson J, Aguado P, Bernad M, Mayordomo L, Naredo E, Balsa A, et al. Pes anserinus tendino-bursitis: What are we talking about? Scand J Rheumatol 2000;29:184-6.  Back to cited text no. 7
    
8.
Hanada ED, Keplinger FS, Gupta N. Knee bursitis. In: Forontera WR, Silver JK, Rizzo TD. Essentials of Physical Medicine and Rehabilitation. 7th ed. Philadeiphia, PA: Saunders; 2008. p. 355-8.  Back to cited text no. 8
    
9.
Forbes JR, Helms CA, Janzen DL. Acute pes anserine bursitis: MR imaging. Radiology 1995;194:525-7.  Back to cited text no. 9
    
10.
Marra MD, Crema MD, Chung M, Roemer FW, Hunter DJ, Zaim S, et al. MRI features of cystic lesions around the knee. Knee 2008;15:423-38.  Back to cited text no. 10
    
11.
Alvarez-Nemegyei J, Canoso JJ. Evidence-based soft tissue rheumatology IV: Anserine bursitis. J Clin Rheumatol 2004;10:205-6.  Back to cited text no. 11
    
12.
Kang I, Han SW. Anserine bursitis in patients with osteoarthritis of the knee. South Med J 2000;93:207-9.  Back to cited text no. 12
    
13.
Basford J. Physical agents. In: Delisa J, Gans B, editors. Rehabilatien Medicine: Principles and Practice. 3rd ed. Philadelphia: JP Lippincott; 1998. p. 812-25.  Back to cited text no. 13
    
14.
Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue. Muscles Ligaments Tendons J 2012;2:33-7.  Back to cited text no. 14
    
15.
Glencross PM, Consuelo TL. Pes Anserine Bursitis Treatment & Management. Available from: http://www.google.com/. [Last accessed on 2014 Feb 12].  Back to cited text no. 15
    
16.
Zhao Z, Jing R, Shi Z, Zhao B, Ai Q, Xing G. Efficacy of extracorporeal shockwave therapy for knee osteoarthritis: A randomized controlled trial. J Surg Res 2013;185:661-6.  Back to cited text no. 16
    
17.
Speed C. A systematic review of shockwave therapies in soft tissue conditions: Focusing on the evidence. Br J Sports Med 2014;48:1538-42.  Back to cited text no. 17
    
18.
Furia JP, Rompe JD, Cacchio A, Del Buono A, Maffulli N. A single application of low-energy radial extracorporeal shock wave therapy is effective for the management of chronic patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2013;21:346-50.  Back to cited text no. 18
    
19.
Smith J, Sellon JL. Comparing PRP injections with ESWT for athletes with chronic patellar tendinopathy. Clin J Sport Med 2014;24:88-9.  Back to cited text no. 19
    
20.
Henk VD, Johannes Z, Inge VA, Ron LD. The TOPSHOCK Study: Effectiveness of radial shock wave therapy compared to focused shock wave therapy for treating pattelar tendinopath design of a randomized controlled trial. BMC Musculoskelet Disord 2012;12:229-36.  Back to cited text no. 20
    
21.
Vahdatpour B, Sajadieh S, Bateni V, Karami M, Sajjadieh H. Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments. J Res Med Sci 2012;17:834-8.  Back to cited text no. 21
    
22.
Vahdatpour B, Taheri P, Zade AZ, Moradian S. Efficacy of extracorporeal shockwave therapy in frozen shoulder. Int J Prev Med 2014;5:875-81.  Back to cited text no. 22
    
23.
Vahdatpour B, Alizadeh F, Moayednia A, Emadi M, Khorami MH, Haghdani S. Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: A randomized, controlled trial. ISRN Urol 2013;2013:972601.  Back to cited text no. 23
    
24.
Pires PR, Lui M. Effectiveness of Shock Wave Therapy in Patients with Pes Anserine Bursitis. IN: ISMST; 2009. Available from: http://www. Scholar.google.com/. [Last accessed on 2014 Jul 30].  Back to cited text no. 24