Gluteal Tendinopathy Research Articles

Vague, Non-palpable Hip Pain In A Runner

HISTORY: A 54-year-old female experienced runner presented to a sports medicine center with six months of insidious left anterior hip pain and hip weakness while training for a marathon. She had run 9 previous marathons but this was to be her first in 7 years. The pain was in the left anterolateral hip with occasional radiation into the left groin. She had noted some left hip weakness while hiking and also noticed a change in her running stride. She could not correlate any particular movement or activity with the pain but it was more noticeable while running. She denied any trauma, prior hip injury, back pain, numbness or tingling. PHYSICAL EXAMINATION: The patient had decreased single leg balance, left worse than right, and overall unsteadiness with deep squatting. She had mild tenderness to palpation along the left iliac crest and left sacroiliac joint. There was full painless range of motion of her lumbar spine, bilateral hips, knees and ankles. Manual muscle testing showed 4/5 right and 4-/5 left hip flexion strength but was otherwise 5/5 in the bilateral lower extremities. She had a positive left Ober's sign and positive left Thomas test. Reflexes were 2+ and symmetric in her lower extremities. Sensation to light touch was intact bilaterally. Her femoral and dorsalis pedis pulses were palpated bilaterally and were normal. Overall there was a noticeable inability to reproduce her pain on PHYSICAL EXAMINATION. DIFFERENTIAL DIAGNOSIS: 1. Iliopsoas strain/bursitis 2. Femoral stress fracture 3. Gluteal tendinopathy 4. Acetabular labral tear 5. Pelvic mass TEST AND RESULTS: X-rays of the pelvis and a pelvic MRI were ordered. X-rays showed mild degenerative changes of the pubic symphysis but were otherwise normal. Pelvis MRI found a large 23.6 × 13.4 × 20.7 cm cystic mass within the pelvic cavity. FINAL WORKING DIAGNOSIS: Benign serous cystadenoma TREATMENT AND OUTCOMES: 1. Gynecology referral. 2. Exploratory laparotomy and left salpingo-oophorectomy. 3. The pelvic mass was completely resected and the final pathology was consistent with a benign serous cystadenoma. 4. 2 months after resection the patient began a rehabilitation program with a clinical exercise physiologist focusing on core strengthening and pelvic stabilization exercises. 5. Resumed running and 4 months after resection completed 10K of the 2010 Chicago marathon.

Gluteal Tendon Reconstruction in Association with Hip Arthroplasty

We studied a prospective cohort of patients in whom gluteal tendon reconstruction was undertaken in association with hip arthroplasty. Over the course of 10 years, 24 patients had gluteal tendon reconstruction performed either at the time of hip arthroplasty or post-operatively, using the Ligament Augment and Reconstruction System (LARS), suture anchors, direct suture to bone, or a combination of these techniques. All patients were assessed clinically and by patient-centred outcome measures, including the hip disability and osteoarthritis score (HOOS). The mean post-operative HOOS was significantly better than pre-operative score (p < 0.05). The mean post operative score in the domains of symptoms, pain, activities of daily living (ADL), sports and quality of life (QoL) was 72 (SD 12.8), 73 (SD 15.9), 71 (SD 11.8), 54 (SD 22.6) and 57 (SD 21.76) respectively. There were two failures of gluteal tendon reconstruction which required revision using LARS. One patient died of an unrelated cause. Surgical intervention should be considered in gluteal tendinopathy at the time of hip arthroplasty or when symptoms occur following arthroplasty.

Paper 21: The Outcome of Arthroscopic Treatment of Lateral Trochanteric Pain Syndrome – A Retrospective Review

An Outcome Study of 30 consecutive patients with Lateral Trochanteric Pain Syndrome who had not responded to 6 months of conservative treatment, and were then treated with Arthroscopic decompression, bursectomy and Radiofrequency microdebridement. Recalcitrant Lateral Trochanteric Pain Syndrome (LTPS), hip pain caused by trochanteric bursitis, gluteus medius and minimus tendinopathy and or tears, is increasingly being treated arthroscopically. We undertook a retrospective review of 30 consecutive patients (31 hips) with a diagnosis of LTPS with or without gluteus medius and minimus tendinopathy or tears. The study period was from 2003 to 2009 and all patients had a minimum follow up of 6 months. Eligible subjects had a history of at least 6 months conservative treatment, and local anaesthetic and steroid injections into their trochanteric bursa leading to a transient improvement of their symptoms. They were subsequently investigated using clinical examination and ultrasound scan (USS) to confirm a pre operative diagnosis of LTPS (with or without trochanteric bursitis and with abductor tendon pathology). No patient had a preoperative Gluteal tendon tear. Surgery was undertaken in the lateral position and an arthroscopic slit of the Iliotibial Band (ITB), trochanteric bursectomy, and radiofrequency microdebridement of the abductor tendons was performed. Post operatively, all subjects were mobilised, full weight bearing, with no restriction in activity. At their latest review, clinical and USS examinations were performed. We report a mean follow up of 15.1 months, (range 6-46 months). The average age at operation was 56 years (range 19 to 80 years), with a mean body mass index of 26.4 (range 18.9-33.3). There were 22 right and 9 left sided procedures. At their last review, 1 patient had a limp and USS demonstrated a Gluteus medius tear and 9 (29%)patients had a positive Trendelenberg sign and USS demonstrated Gluteal tendon tears in 3. 12 (39%) could perform a single leg stance for 30 seconds pain free, and 19 (61%) had no pain with resisted abduction. Analysis of the Outcome Scores demonstrated that the mean Modified Harris Hip Score (MHSS) improved from 63 to 78 points, and the Non Arthritic Hip Score (NAHS) from 60 to 79 points at final review. Follow up USS demonstrated normal tendons in 4 hips (19%), tendonosis/tendinopathy in 11 (52%), partial thickness tears in 4 (19%), and complete tears in 2 (10%). Arthroscopic ITB decompression with trochanteric bursectomy and radiofrequency microdebridement of the hip abductor tendons is safe and effective in the treatment of refractory lateral hip pain. This intervention should be considered in the management of this difficult condition in selected patients with mild to moderate gluteal tendinopathy

A rare case of traumatic rupture of gluteus medius and literature review

IntroductionThe understanding of hip abductor tendon tears remains in its infancy.CaseWe present a unique case of complete, traumatic rupture of the gluteus medius tendon and a literature review.DiscussionWhilst our case is unique, gluteal tendon tears and tendinopathy are probably much more common than originally thought.ConclusionWe encourage clinicians to consider it amongst their differential diagnoses of hip pain, especially in conjunction with trochanteric bursitis.

Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Greater Trochanteric Pain Syndrome

Background Greater trochanteric pain syndrome is often a manifestation of underlying gluteal tendinopathy. Extracorporeal shock wave therapy is effective in numerous types of tendinopathies. Hypothesis Shock wave therapy is an effective treatment for chronic greater trochanteric pain syndrome. Study Design Case control study; Level of evidence, 3. Methods Thirty-three patients with chronic greater trochanteric pain syndrome received low-energy shock wave therapy (2000 shocks; 4 bars of pressure, equal to 0.18 mJ/mm 2; total energy flux density, 360 mJ/mm2). Thirty-three patients with chronic greater trochanteric pain syndrome were not treated with shock wave therapy but received additional forms of nonoperative therapy (control). All shock wave therapy procedures were performed without anesthesia. Evaluation was by change in visual analog score, Harris hip score, and Roles and Maudsley score. Results Mean pretreatment visual analog scores for the control and shock wave therapy groups were 8.5 and 8.5, respectively. One, 3, and 12 months after treatment, the mean visual analog score for the control and shock wave therapy groups were 7.6 and 5.1 (P < .001), 7 and 3.7 (P < .001), and 6.3 and 2.7 (P < .001), respectively. One, 3, and 12 months after treatment, mean Harris hip scores for the control and shock wave therapy groups were 54.4 and 69.8 (P < .001), 56.9 and 74.8 (P < .001), and 57.6 and 79.9 (P < .001), respectively. At final follow-up, the number of excellent, good, fair, and poor results for the shock wave therapy and control groups were 10 and 0 (P < .001), 16 and 12 (P < .001), 4 and 13 (P < .001), and 3 and 8 (P < .001), respectively. Chi-square analysis showed the percentage of patients with excellent (1) or good (2) Roles and Maudsley scores (ie, successful results) 12 months after treatment was statistically greater in the shock wave therapy than in the control group (P < .001). Conclusion Shock wave therapy is an effective treatment for greater trochanteric pain syndrome.

Gluteal tendinopathy in refractory greater trochanter pain syndrome: Diagnostic value of two clinical tests

To evaluate the value (sensitivity and specificity) of 2 modified physical tests for the diagnosis of gluteal tendinopathy in patients with refractory greater trochanter pain syndrome (GTPS). The 2 tests were prospectively evaluated by a single physician in all consecutive patients with persistent (> or =4 months) GTPS and no hip joint arthropathy seen on radiography between 2002 and 2006. The 2 tests evaluated the occurrence of pain similar to spontaneous pain during a single-leg stance held for 30 seconds and resisted external derotation in a supine position (hip flexed 90 degrees ) then prone position (hip extended). A matched control population without hip pain was examined similarly. Tendinitis, tendon tear, and associated bursitis in the target group were documented by magnetic resonance imaging (MRI) in transverse, coronal, and sagittal planes, with MRI serving as the gold standard. Seventeen patients completed the study (mean +/- SD age 68.1 +/- 10.8 years, mean duration of symptoms 13 months). MRI revealed tendinopathy and/or bursitis of the gluteus medius and/or minimus tendons in all patients, with evidence of tearing in 15. Sensitivity and specificity were 100% and 97.3%, respectively, for the single-leg stance test and 88% and 97.3%, respectively, for the resisted external derotation test in the supine position. The 30-second single-leg stance and resisted external derotation tests had very good sensitivity and specificity for the diagnosis of tendinous lesion and bursitis in patients with MRI-documented refractory GTPS.

MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome

Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females. In this pictorial review the pertinent MRI and US anatomy of the gluteal tendon insertions on the greater trochanter and the adjacent bursae are reviewed. The direct (peritendinitis, tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed.

Scintigraphy of gluteal tendonopathy.

A 67-year-old woman with a long history of back pain began a walking program for exercise. Six weeks later, she experienced pain in the posterior aspect of her left thigh that became increasingly severe. She was referred to an orthopedic surgeon, who ordered a plain radiograph, the findings of which were reported as normal. He found localized tenderness in the upper third of the posterior thigh. Bone scintigraphy revealed a localized area of increased uptake at the site, and computed tomography (CT) showed calcification in the tendon of the gluteus maximus at its insertion into the posterior cortex of the left femur. This was thought to be consistent with gluteal tendinopathy, because it is similar to previously reported cases.