Labrosse JM, Cardinal E, Leduc BE, et al.. 34,35, Grades of Progressive Tendon Degeneration 37. Physical therapy had been performed in 3 of 11 studies Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P. Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Morphology of the bursae associated with the greater trochanter of the femur. In a recent study, Fearon et al. a. Treatment of Gluteal Tendinopathy: A Systematic Review and Expect months rather than weeks for this to improve. References 4, 8, 9, 14, 17, 22, 23, 29, 31, 33, 36, 38, 39, 42, 50, 53. and was commonly determined using a Likert scale. Commonly implicated in the etiology of lateral hip pain, the trochanteric bursae are thought to cushion the gluteus tendons, iliotibial tract, piriformis, and tensor fascia lata at the bony greater trochanter. Having low back pain may be a risk factor for GTPS. This may result in higher tensile stresses to the iliotibial tract and hip abductors, predisposing them to injury. Pseudotrochanteric bursitis: the differential diagnosis of lateral hip pain. Robinson NA, Spratford W, Welvaert M, Gaida J, Fearon AM. WebGreater trochanteric pain syndrome (GTPS) is a commonregional pain syndrome characterized by chronic, intermit-tent pain over the buttock and lateral aspect of the thigh [1]that may radiate down the leg to the level of the However recent research has shown that it more commonly affects: The main symptom of GTPS is pain on the side of your hip and thigh. This image shows increased T2 signal intensity in the right gluteus medius 1, and minimus 2, tendons at their insertions on the greater trochanter (. 14 1923; 125: 71838. In 5 of these studies, outcome reporting did not allow for a differentiation of their results according to the disease stage, while 1 study The overall mean duration of symptoms (20 studies Brinks A, van Rijn RM, Bohnen AM, et al.. Effect of corticosteroid injection for trochanter pain syndrome: design of a randomised clinical trial in general practice. Greater Trochanteric Pain Syndrome 8 The most common bursa involved is the trochanteric bursa. -40, 42, 50, 51, 53, 55. ##References 4, 23, 25, 26, 29, 37, 40, 50, 53. aReferences 8, 9, 14, 18, 21, 22, 29, 36, 40, 41, 50, 53. bReferences 4, 8-10, 14, 17, 18, 21-23, 25, 26, 29, 31-33, 36-39, 41, 50, 51, 53, 55. cReferences 4, 14, 17, 21-23, 29, 31, 40, 50, 53. dReferences 8, 14, 17, 18, 21-23, 29, 31, 38, 40, 41, 53, 55. eReferences 8 a Grade 2 tendinopathy is characterized by an increased signal of the tendon on T1-weighted MRI scans, while the fluid-sensitive image appears largely normal. ) was 28.3 (range, 19.4-40.2). It is important to address hip rotator cuff tendinopathy and pelvic core instability. Association of preoperative gluteal muscle fatty infiltration with patient outcomes in women after hip abductor tendon repair augmented with LARS. Both achieved significant improvements in pain (VAS) and function (mHHS, HOS, Nonarthritic Hip Score). Craig RA, Jones DP, Oakley AP, Dunbar JD. Trochanteric Bursitis - Causes, Treatment of Greater described a correlation between poor clinical results and the extent of fatty degeneration in gluteal tendon injuries. Arthritis Rheum. 2008; 37: 9039. 9 (18) reported degenerative changes in the hip abductors in 20% of 176 consecutive patients undergoing total hip arthroplasty for osteoarthrosis, and in 16% of these patients, the gluteus medius or minimus was the sole abductor involved. Supplemental Material for this article is available at http://journals.sagepub.com/doi/suppl/10.1177/23259671211016850. Eccentric hyperadduction may exceed tendon tensile elasticity, resulting in strains and tears of various degrees. MRI has been shown to be an accurate means of diagnosing gluteal tendon tears, with a reported sensitivity of 73% and specificity of 95% for the presence of tears. 1995; 316: 15164. These benefits were demonstrated by Furia et al. Greater trochanteric pain syndrome: Evaluation and 1999; 173: 11236. Therefore, well-designed studies evaluating the long-term efficacy of needle tenotomy versus PRP are needed to support its use in gluteal tendinopathy. A total of 27 studies (6 randomized controlled trials) with 1103 patients (1106 hips) were included. Med. (1) Greater Trochanteric Pain Syndrome. The anatomy of these bursae is complex and somewhat controversial. J. J. Roentgenol. 42 Hip Pain in Adults: Evaluation and Differential Diagnosis Sports Med. 26,37 26. nonoperative treatment not further specified in 4 studies, Greater trochanteric pain syndrome 2011; 21: 3745. confirming a treatment effect for a single CSI after that time as well. but the therapeutic benefit was shown to usually last no longer than 3 to 6 months. Of note, recognition and understanding of the disease have largely evolved in the past 20 years, and the number of publications before the time frame analyzed in this review is very limited. 2007; 88: 98892. The effect of road camber on running kinematics. Data from multiple studies were combined if they were obtained from a single patient population (eg, reporting of 2 different follow-up times of a single patient population). Davies H, Zhaeentan S, Tavakkolizadeh A, Janes G. Surgical repair of chronic tears of the hip abductor mechanism. Klin. However lateral hip pain produced with active internal rotation, active external rotation, or resisted abduction, at 45 of hip flexion, suggests gluteus medius or gluteus minimus dysfunction. 28. 18 The patient should be advised to avoid lying lateral decubitus on the side of the injured hip. in 2 studies each. Symptom relief varies depending on the affected joint. https://creativecommons.org/licenses/by-nc-nd/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, sj-pdf-1-ojs-10.1177_23259671211016850.pdf, http://journals.sagepub.com/doi/suppl/10.1177/23259671211016850, No or minimal changes within gluteal tendons, Increased tendon signal on T1-weighted images and normal appearance on T2-weighted images, Tendinosis, angiofibroblastic hyperplasia, and disorganization and fragmentation of collagen fibers, Increased signal intensity on T2-weighted images, Depletion of functional tendon cells and breakdown of collagen and extracellular matrix, Discontinuity of 1 or both gluteal tendons, Gross structural disruption and mechanical failure, No. found that debridement without repair only provided modest clinical results in patients with partial-thickness tears of the gluteal tendons and therefore recommended repair be considered in every case. The role of physical therapy needs to be clarified, as there is evidence for the positive effect of exercise, while there are no treatment protocols that have proven its effectiveness. 35. Moreover, 2 articles were removed for an inadequate number of participants not evident on the abstract review. reported overall high satisfaction after open repair, with postoperative improvements maintained over 5 years. Get new journal Tables of Contents sent right to your email inbox, September/October 2012 - Volume 11 - Issue 5, Greater Trochanteric Pain Syndrome: More than Bursitis and Iliotibial Tract Friction, Articles in PubMed by Garry Wai Keung Ho, MD, CAQSM, Articles in Google Scholar by Garry Wai Keung Ho, MD, CAQSM, Other articles in this journal by Garry Wai Keung Ho, MD, CAQSM, Treatment Options in Overuse Injuries of the Knee: Patellofemoral Syndrome, Iliotibial Band Syndrome, and Degenerative Meniscal Tears, Diagnosis and Current Treatment Options of Shoulder Impingement, Entrapment Neuropathies of the Upper Extremity, Diagnosis, Treatment Options, and Rehabilitation of Chronic Lower Leg Exertional Compartment Syndrome, by the American College of Sports Medicine. Greater trochanteric pain syndrome - Wikipedia Radiological confirmation of the diagnosis was most commonly obtained using magnetic resonance imaging. According to the existing evidence, a single LR-PRP injection is a reasonable option. Partial-thickness and full-thickness tears in the hip abductors and in the older population, muscle atrophy, and fatty degeneration can easily be seen on MRI (26). Relat. Greater Trochanteric Pain Syndrome Usually this is a personal preference. 29. Ebert JR, Smith A, Breidahl W, Fallon M, Janes GC. 30. Additionally the tendinosis encountered in GTPS is likely due to a process intrinsic to the tendon itself. Assoc. Gluteal tendinopathy is the most common lower limb tendinopathy. 43. Break up periods of prolonged sitting and standing. WebPolicy Symptoms and Causes What causes trochanteric bursitis? and MRI or sonography was used in 2 studies. 23,56 Some error has occurred while processing your request. no improvement in clinical retear rates, patient-reported outcomes, or pain was seen when a platelet-rich fibrin matrix (PRFM) was added to tendon repair, but improvements in iHOT-12 and SF-12 scores suggest that the PRFM might have a role in improving subjective outcomes of hip-specific and overall physical function (LoE 3). About 1.8 people per 1,000 per year develop GTPS, and women are affected about 2 to 3 times more often than men. Keep reading to learn more about this common hip condition, including symptoms, causes, and treatment options. What are the symptoms of greater trochanteric pain syndrome? By contrast, fatty degeneration did not affect postoperative functional abilities in a study by Makridis et al. ) or numeric rating scale (NRS; 2 studies In addition, there is LoE 1b supporting the use of PRP for the treatment of low- to moderate-grade gluteal tendinopathy (grades 1 and 2). National Library of Medicine Trochanteric bursitis and tendinitis. -42, 50, 53, 55. #References 8, 9, 14, 17, 18, 21-23, 29, 31, 32, 36-41, 51, 53, 55. The authors declare no conflict of interest and do not have any financial disclosures. Cohen DB, Kawamura S, Ehteshami JR, Rodeo SA. Nonoperative measures should be applied to treat grades 1 and 2 tendinopathy. Bursal effusions are seen as large anechoic collections. Bone J. Surg. MRI and sonography were used in 3 studies, 9,10,25,26,33,51 This systematic review summarized the results of 27 articles that evaluated treatment options and outcome effects for gluteal tendinopathy. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome, Radiofrequency microdebridement as an adjunct to arthroscopic surgical treatment for recalcitrant gluteal tendinopathy: a double-blind, randomized controlled trial, Application of the Goutallier/Fuchs rotator cuff classification to the evaluation of hip abductor tendon tears and the clinical correlation with outcome after repair. Regenerative injection therapy involves the injection of biologic, usually autologous, tissue grafts. NM Amsterdam (the Netherlands): Kugler Publications; 2009. p. 97. a 30-second single-leg stance test (3 studies The long head of the biceps brachii crosses the humeral head; the reflected head of the rectus femoris crosses in front of the femoral head. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. 10. Examples include autologous whole blood, platelet-rich plasma concentrates, processed lipoaspirate concentrates, and bone marrow aspirate concentrates. Jenna graduated from the University of Canberra with a Masters of Physiotherapy after completing a Bachelor of Applied Science in Human Biology. On physical examination, there is typically direct tenderness to palpation over the greater trochanter, reproducing or accentuating the patients pain. These findings strongly suggest that, at least in long-standing GTPS, bursal inflammation does not play a causative role in pain. GTPS comprises gluteal tendon injuries 82 Alinga St A positive Ober test indicates iliotibial tract contracture. Trochanteric Bursitis: Causes, Treatment, and Exercises - Healthline An official website of the United States government. Each region features two abductor-external rotators prone to injury in the shoulder, the supraspinatus and infraspinatus lie deep in the subacromial-subdeltoid bursae; in the hip, the gluteus medius and gluteus minimus lie deep in the trochanteric bursae. Surgical interventions show favorable outcomes for the treatment of partial-thickness tears. ), Harris Hip Score (HHS; 8 studies Authors Laura Pumarejo Gomez , John M. Childress 1 Affiliation 1 Florida International University PMID: 32491365 Bookshelf ID: NBK557433 Excerpt Hip pain is a common orthopedic problem. 2003; 23: 5760. Historically, the term "trochanteric bursitis" was used to describe any pain around the lateral hip. Bird PA, Oakley SP, Shnier R, Kirkham BW. Final revision submitted December 29, 2020; accepted February 15, 2021. This pain may radiate occasionally down to the calf. The term greater trochanteric pain syndrome (GTPS) encompasses trochanteric bursitis, gluteus medius and gluteus minimus and a diagnostic injection can be performed to test for pain resolution. Evaluating these problems can be challenging because of the myriad of potential causes. Nonarthritic Hip Score, 6,44,49,57 Repetitive movements such as walking or running, Prolonged period of pressure on the hip or greater trochanter, Lazy standing (all your weight onto one leg). While specific to the greater trochanter, the term is broad enough to include a number of etiologies including tendinopathies, tears, trigger points, iliotibial band friction, and inflammation and effusion of the trochanteric bursae. As this review focused on treatment options for primary gluteal tendon injuries, full-text articles reporting treatment options for greater trochanteric pain syndrome without specifying the underlying abnormality were removed from further analysis. To date, the use of these therapies in the treatment of GTPS, specifically, has not been well studied. The age old question. Greater trochanteric pain syndrome: Evaluation and management Sports Med. A pathology model to explain the clinical presentation of load-induced tendinopathy. Even though the small numbers do not allow for generalization, there are concerns as to whether this treatment option is suitable for partial-thickness tears. It presents with varying severity but may cause debilitating lateral hip pain. Clin. 4. Local corticosteroid injections (CSIs) within the previous 3 months or a certain tear size (full-thickness tears) were exclusion criteria found in articles reporting nonoperative treatment measures. There were 22 studies reporting treatment options for greater trochanter pain syndrome without specifying the underlying abnormality, disqualifying them from this analysis. The study type, level of evidence (LoE; according to the Oxford Centre for Evidence-Based Medicine), performance of a power analysis, treatment allocation, and blinding were also assessed to evaluate the quality of the research. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram outlining the systematic search process is shown in Figure 1. ), Hip Outcome Score (HOS; 4 studies 33,40,42 Bethesda, MD 20894, Web Policies J. 42 Female predisposition to GTPS may be attributed to biomechanical factors unique to women, including the size and shape of the gynecoid pelvis and its association with relative knee valgus and hip varus. Greater Trochanteric Pain Syndrome, also known as GTPS, affects the tendons and bursae surrounding the greater trochanter, the most prominent part of the femur on the side of the hip. Currently load (or exercise) is considered the primary catalyst to improve tendon function and return it to health. Arch. 2007; 8: 95. Home remedies You may be able to manage your symptoms at home by: applying ice to the injured area for 10 to 15 minutes at a time to reduce inflammation In one study, measuring leg lengths in patients with and without GTPS, LLDs were not associated with GTPS (37). Standing with equal weight on both side OR slight transfers of weight from side to side. Running Injuries: 5 Proven Steps to Fixing Your ITB, What is Long-Covid, Recovery and Returning to Activity. Available: https://cdn.journals.lww.com/anesthesia-analgesia/Fulltext/2009/05000/Greater_Trochanteric_Pain_Syndrome__A_Review_of.49.aspx 6/5/19, (2) Greater Trochanteric Pain Syndrome: a review of diagnosis and management in general practice. a Duplicates were removed. Endoscopic repair of partial-thickness undersurface tears of the abductor tendon: clinical outcomes with minimum 2-year follow-up. While GTPS can develop from several processes, the most common cause of GTPS is likely hip abductor tendinopathy principally of the gluteus medius and gluteus minimus. Complication rates varied. Web3) Ice and Heat. 4,21,22,31,50 Most reports suggest a female predominance in GTPS, but other studies have shown an equal prevalence between men and women (36). And usually the term Greater Trochanteric Pain is just as confusing or concerning. No failure of tendon repair was reported with this technique, but 1 patient underwent revision for removal of the LARS interference screw, which caused local irritation. Pain typically is not exacerbated by passive internal rotation pain with passive flexion and internal rotation suggests an intraarticular problem or perhaps femoroacetabular impingement (FAI). Usually this is a personal preference. PROM scores, pain or clinical retears, and patient satisfaction did not improve by adding a PRFM to tendon repair. and case series (LoE 4). ** The reported failure rate of repair was 4.5%. The LoE of the eligible studies was limited. 53 All surgical intervention studies required failed nonoperative treatment for study inclusion, with failure being assumed if symptoms were not controlled after rest, analgesics/nonsteroidal anti-inflammatory drugs, physical therapy, and single or multiple injections (typically corticosteroids or occasionally PRP) over a time period of typically 3 to 6 months. While these procedures can be done via surface anatomy landmarks, ultrasonographic needle guidance helps to ensure precision and higher effectiveness (17). In some cases, myofascial trigger points from gluteus dysfunction may cause referral pain patterns mimicking lumbar radiculopathy (2). 18,23,29,38,40,41 The follow-up period ranged from 1.5 weeks to 100 months. Most importantly, we recommend that available treatment options be discussed in detail with patients and that decisions be made in conjunction with informed patients. But this DOES NOT mean stopping completely. WebTreatment options First line management for GTPS is conservative therapy. Descriptive data (sample size, sex, age, body mass index, laterality), stage of the tendon disease (grades 1-4 tendinopathy), patient selection (inclusion and exclusion criteria), diagnostic criteria (clinical, radiological), duration of symptoms, previous treatment, type and effect of the therapeutic intervention, details about aftercare, mode and time points of outcome assessments, complications of the treatment, follow-up, and conclusion of the authors were recorded. 50 In 5 studies, full-text versions of eligible abstracts were not available. the contents by NLM or the National Institutes of Health. Common patient-reported outcome measures (PROMs) were the modified Harris Hip Score (mHHS; 9 studies Other authors have reported tenderness to areas just posterolateral or superior to the greater trochanter (3). 55 40. Greater trochanteric pain syndrome | NHS inform Chung CB, Robertson JE, Cho GJ, et al.. Gluteus medius tendon tears and avulsive injuries in elderly women: imaging findings in six patients. As for low-grade tendon disease (grades 1 and 2 tendinopathy), future research should address the lack of standardization in SWT and provide recommendations on, for example, total energy, energy per session, or number of sessions. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? 2009; 40: 598603. 37 Data extraction was performed by one of the authors (A.L.). It is likely that similar improvements in pain, function, and activity tolerance could be attained with eccentric rehabilitation of gluteal tendinosis. andnonoperative treatment including physical therapy and CSIs in 12 studies. In light of these parallels, some refer to the hip abductors the gluteus medius, gluteus minimus, and to a lesser extent, the piriformis as the rotator cuff of the hip.. Accessibility Overall, 2 authors (A.L. and Walsh et al. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. Rehabil. MRI provides high-resolution imaging of the complex peritrochanteric anatomy. For chronic pain, heat may be beneficial. Usually the diagnosis of GTPS can be made on the basis of clinical history and physical examination. achieved excellent results using the same technique. Swinburne University of Technology, Hawthorn, Australia. J. Rheumatol. Within the studies, the inclusion criteria most commonly consisted of a clinical diagnosis of the disease (see Diagnosis section), with a duration of symptoms of >12 weeks. The type of preparation, platelet concentration, activity of PRP (activated vs nonactivated), and frequency of applications have been acknowledged as contributing to the variability of the treatment effect. Or it can be an injury to both your bursa and tendons. sharing sensitive information, make sure youre on a federal Greater Trochanteric Pain Syndrome: More than Bursitis and I This is similar to the use of rotator cuff syndrome or impingement syndrome to describe a group of shoulder disorders that present similarly and are likewise initially treated similarly. Pain levels were significantly lower at 1 week compared with baseline, and significant improvement was maintained over 27 months in the latter study, even though patient-reported success was rated as good or excellent in only 56% after that period of time. Thus, 27 articles were considered for this review. Athletic risk factors include asymmetric shoe wear, particularly along the lateral aspect; iliotibial tract tightness; gluteus medius weakness or fatigability; running on a coronally convex surface; and typical overuse doing too much, too fast, too soon. Howell et al. ), a 6-minute walk test (2 studies ; for the remaining studies, the female-to-male sex ratio was calculated as 7:1. MRI may show degenerative changes to the gluteus medius and gluteus minimus tendons as abnormal T2 signal change with disturbed tendon architecture on T1-weighted imaging (Fig.
