Ultrasound-Guided Deep Dry Needling Versus Sham-Like Superficial Dry Needling for Greater Trochanteric Pain Syndrome: A Participant- and Assessor-Blinded, Randomized Controlled Clinical Trial

Background: Greater trochanteric pain syndrome (GTPS) is a multifactorial and often underdiagnosed musculoskeletal disorder associated with substantial pain and disability. This study evaluated the effectiveness of ultrasound-guided dry needling (US-guided DN) on pain intensity, pressure pain threshold (PPT), and disability in patients with GTPS. Methods: This participant- and assessor-blinded, randomized, sham-controlled trial randomized 50 patients with GTPS (25 per group), of whom 46 completed the study (intervention n = 24; sham n = 22). Participants received three weekly sessions of either real or sham US-guided DN, along with a standardized home exercise program. The primary outcome was activity-related pain intensity measured using the Visual Analog Scale (VAS). Secondary outcomes included PPT assessed at four anatomical sites and functional disability assessed using the Oswestry Disability Index (ODI). Results: Pain intensity and functional disability decreased over time in both groups, without evidence of superior outcomes following active dry needling. For the primary outcome (VAS), the estimated between-group difference at the final assessment was 0.50 points (95% CI: −0.44 to 1.43; p = 0.301). No significant overall group × time interactions were observed for PPT at any of the four anatomical sites. However, exploratory baseline-adjusted analyses identified significantly higher PPT values at the final assessment in the intervention group at the gluteal region and iliotibial band after Holm correction for multiple comparisons. Conclusions: US-guided DN did not demonstrate superior short-term improvements in pain intensity or disability compared with sham needling in patients with GTPS. Exploratory findings of higher baseline-adjusted PPT values at selected anatomical sites suggest possible localized differences in mechanical pain sensitivity. However, these findings do not establish a definitive treatment-specific hypoalgesic effect, and their clinical relevance remains uncertain. Trial Registration: The study was conducted in accordance with the Declaration of Helsinki and approved by the Kutahya Health Sciences University Clinical Research Ethics Committee (Approval No. 2023-09/04). The trial was prospectively registered at ClinicalTrials.gov (NCT06241872).