Trochanteric Bursitis (Greater Trochanteric Pain Syndrome)

Краткая информация для пациента

Есть ли FDA-допуск для этого показания?

Not FDA-cleared for trochanteric bursitis. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, 2004). Use here is Tier C investigational with two small case series.

Какие доказательства существуют?

Tier C (investigational). Two small case series describe 40 to 55 percent VAS pain reduction and improved Harris Hip Score at 8 weeks following 2 to 3 sessions. There are no controlled trials. Greater trochanteric pain syndrome includes trochanteric bursitis, gluteus medius/minimus tendinopathy, and external coxa saltans. Evidence-based management is NSAIDs, physiotherapy targeting hip abductor strengthening, image-guided corticosteroid injection (higher-evidence option), and (refractory cases) gluteal tendon repair. Hip osteoarthritis must be excluded as the primary pain generator.

Основные риски

• Bleeding from bite sites for 6 to 24 hours after detachment
• Bruising and tenderness over the lateral hip for 5 to 14 days
• Local skin infection or Aeromonas infection
• Allergic reaction to leech saliva
• Temporary worsening of hip pain after the procedure
• Substitution for hip abductor strengthening, which has stronger evidence
• Delay of corticosteroid injection, which has higher-quality evidence
• Missed hip osteoarthritis or femoroacetabular impingement as alternative diagnosis

Кому не следует это рассматривать

• Patients with suspected septic bursitis
• Patients with hip osteoarthritis as the primary pain generator
• Patients within 4 weeks of local corticosteroid injection
• Patients with active skin infection or breakdown over the trochanter
• Patients on anticoagulants or with severe anemia
• Patients who have not engaged with structured hip abductor strengthening

О чём спросить врача

• Has hip osteoarthritis or femoroacetabular impingement been excluded by exam and imaging?
• Have I had at least 12 weeks of structured hip abductor strengthening (gluteus medius/minimus)?
• Has image-guided corticosteroid injection been considered?
• Has tendinopathy versus bursitis been distinguished on ultrasound or MRI?
• Where exactly will the leech be placed?
• What is the realistic expected benefit, given two small case series?

Когда срочно обратиться за медицинской помощью

• Spreading redness, warmth, swelling, or fever (rule out septic bursitis)
• Sudden severe hip weakness or inability to bear weight
• Fever above 38.0 C / 100.4 F or chills
• Bleeding from a bite site lasting more than 24 hours
• Spreading redness, pus, or red streaks at any bite site
• New numbness or radiating pain down the leg