Greater Trochanteric Pain Research Articles

Are Platelet Rich Plasma Injections More Effective in Tendinopathy or Enthesopathy?

Introduction: Chronic overuse insertional tendinopathy (entesopathy) is highly prevalent, but is an extremely difficult condition that generates a high medical expense. Alternative and co-adjuvant therapies to improve the quality of life and physical function of affected patients are currently being sought. Materials and Methods: A total of 31 patients affected by entesopathy at different anatomical sites (elbow tendinopathy, greater trochanter pain syndrome and plantar fasciopathy) were treated with three peritendinous injections of autologous platelet rich plasma (PRP) and included in the present investigation. VAS scale and segmental scores for the affected site before the first injection of PRP and at 6 months after the last injection were used. One hundred and seven patients that underwent the same injection protocol in the same time lapse were used as a control group, and were represented by patients with non-insertional tendinopathy (shoulder and at Achilles tendon). Results: Significantly lower values between pre-treatment and follow-up pain scores at all-time points were found in the patients affected by entesopathy compared to tendinopathy (p<0.001). As a confirmative finding, the segmental scores at the shoulder and ankle did not improve overtime, differently from what occurred in patients with entesopathy. Conclusion: At 6 months following peritendinous injections of PRP in patients with entesopathy there was a significant reduction of pain, associated to a significant improvement in recorded segmental scores. Conversely, the treatment was not effective in patients with pure tendinopathy at the shoulder and ankle level. These favorable findings point to consider PRP as a promising therapy for patients affected by entesopathy.

Gluteus medius, gluteus minimus and tensor fascia latae are overactive during gait in post-menopausal women with greater trochanteric pain syndrome

Gluteus medius, gluteus minimus and tensor fascia latae are overactive during gait in post-menopausal women with greater trochanteric pain syndrome

AKT answer relating to greater trochanteric pain syndrome

AKT answer relating to greater trochanteric pain syndrome

AKT question relating to greater trochanteric pain syndrome

AKT question relating to greater trochanteric pain syndrome

Do ultrasound-guided steroid injections have better results than blind injections in patients with trochanteric bursitis (greater trochanteric pain syndrome)?

Do ultrasound-guided steroid injections have better results than blind injections in patients with trochanteric bursitis (greater trochanteric pain syndrome)?

The impact of lower extremity pain conditions on clinical variables and health-related quality of life in patients with stroke

Background: The presence of lower extremity pain may be associated with poorer motor recovery, impaired activities of daily living (ADL), reduced quality of life, and disability in patients with stroke.Objective: The aims of the study were to describe the characteristics of lower extremity pain conditions and to evaluate the impact of lower extremity pain on clinical variables, and health-related quality of life in patients with stroke.Methods: One hundred and eighty-five patients with stroke who have self-reported pain in the lower extremity were included in the study. Lower extremity pain characteristics of stroke survivors including etiology, intensity, onset time, frequency, aggravating factors, relieving factors, site, and location of pain were evaluated and recorded. The Brunnstrom motor recovery scale, the functional ambulation category, the mini-mental state examination, the star cancellation test, the beck depression inventory, the Barthel Index, and the Short Form-36 Questionnaire (SF-36) were used.Results: The causes of lower extremity pain were diagnosed as osteoarthritis (51.1%), central neuropathic pain (28.7%), mixed pain (10.3%), low back pain associated with leg pain (8.6%), greater trochanteric pain syndrome (5.2%), prior hip fracture (2.4%), heterotopic ossification (2%), developmental hip luxation (1%), hallux valgus (0.5%), and malignancy (0.5%). The intensity of lower extremity pain was a significant predictor of cognitive functions, ADL, depression, and all SF-36 subscales except emotional role and vitality. The duration of lower extremity pain was a significant predictor of depression and lower extremity spasticity.Conclusions: Since lower extremity pain conditions have a significant important influence on clinical variables and health-related quality of life in stroke survivors, early identification and appropriate treatment of the lower extremity pain conditions should be carried out in order to reduce the level of disability in stroke patients.

Gluteal and tensor fascia latae muscle activity in response to isometric loading in greater trochanteric pain syndrome

Gluteal and tensor fascia latae muscle activity in response to isometric loading in greater trochanteric pain syndrome

Ultrasound evaluation of the greater trochanter pain syndrome: bursitis or tendinopathy?

Ruta, Santiago MD*; Quiroz, Cristian MD*; Marin, Josefina MD*; Catay, Erika MD*; Rosa, Javier MD*; García-Monaco, Ricardo MD†; Soriano, Enrique R. MD*‡ Author Information

Comment on "intra-articular hip injections for lateral hip pain" by M. C. Bessette etal.

With interest I was reading the article about intra-articular hip injections for lateral hip pain by Bessette et al. [1]. Refractory greater trochanteric pain syndrome (GTPS) is a common and challenging problem in daily practice. It is interesting to see that intra-articular injection might be a solution to a seemingly extra-articular problem. A few comments and questions rose to my mind. The authors state the diagnosis of GTPS was made clinically, although some patients had magnetic resonance imaging (MRI) available at the time of initial consultation. In Table I, all patients except two have MRI outcomes. Most of the MRI scans show intra-articular pathology. This suggests that at time of inclusion, the MRI outcomes were known and could be a form of bias. Inclusion criteria required patients to have lateral hip pain for at least 6 months, at least one prior trochanteric corticosteroid injection, one course of NSAID and physiotherapy (PT). Unfortunately, no further comment is made about the type of PT patients had followed. After inclusion, directed PT by a therapist familiar with hip-specific exercises, were given. We know that an intra-articular hip block is a perfect differentiating tool in hip-spine dilemma. I am not sure if it is as helpful to differentiate intra-articular from extra-articular pathologies. The extra-articular structures are close to the joint capsule, and we have to assume that the capsule is watertight and no leakage or spreading will occur. Patients experienced significant improvements at 1 and 12 weeks. It is interesting to know the result from the Marcaine after a few hours, as usually is recorded after a hip joint block. Sadly this is not mentioned. Could it be possible that the 1-week improvement is due to the anaesthetic and 12-week improvement because of a functional hip protocol? In short, are we looking at the result of injection or at a well-established PT program? Unfortunately, only 9 of the 16 (56%) patients were reviewed after 1 week and only 7 (44%) patients after 12 weeks. The authors state that a larger cohort with better adherence to protocol would make the results more robust. I think that it might not make the results more robust but could show us a total different outcome. Because of the aforementioned issues, small study size and the variable follow-up, one should be very careful to drawing conclusions from this study. I agree with the authors’ conclusion this study leaves room for future research into this matter.

A Comparative Study between Hyaluronic Acid and Corticosteroids for the Treatment of the Greater Trochanteric Pain Syndrome

Objective: To date, there are no studies addressing the efficacy of hyaluronic acid (HA) injections at the trochanteric bursa in patients with greater trochanteric pain syndrome (GTPS). The objective of the study was to compare the efficacy and safety of HA to corticosteroid injections for the treatment of the GTPS. Methods: This prospective, randomized, two-arm trial involved 47 patients with unilateral or bilateral GTPS. Patients received an intra-bursal injection of 40 mg triamcinolone acetonide plus 1mL lidocaine, or of 60 mg HA. Patients completed visual analog scales (VAS) and Likert scales to evaluate interference of pain with daily activity, recovery from pain, and treatment satisfaction. A non-inferiority analysis was also performed. Results: Mean VAS score for pain significantly decreased comparing baseline with 1, 3 and 6 months in both treatment groups. VAS score for pain on palpation was also significantly lower than baseline in both arms. No significant differences were found between groups. Analysis of Likert scales at the sixth month didn’t detect statistically significant differences between treatment groups. The non-inferiority analysis showed that the treatment with HA was non-inferior to corticosteroids. No secondary adverse effects were found among the patients of both groups during the follow-up. Conclusions: The treatment with HA has demonstrated to be non-inferior to corticosteroids after 6 months of follow-up in patients with GTPS. Therefore, the treatment with HA may be considered an effective alternative therapeutic strategy to reduce pain in patients in whom the treatment with corticosteroids, or other therapies, have been unsuccessful or contraindicated.

Greater Trochanteric Pain Syndrome (GTPS) after Lumbar Spinal Injections:ACase Series

Subjects: Five patients with low back pain and radicular symptoms. Case description: Five patients presented with low back pain radiating to the lower extremity, which correlated with pathology identified on MRI. After undergoing the appropriate spinal injection, each patient complained of severe back pain, difficulty in ambulation and lateral hip pain with maximum tenderness at the ipsilateral greater trochanteric area. All experienced complete pain relief with injection of the greater trochanteric bursa. Discussion: After undergoing a Spinal interventional procedure, patients may complain of acute onset of severe pain in the back, hip, and leg. Prior to proceeding with costly investigations, it is important to rule out GTPS. 20% of patients referred to spine specialists with back pain/sciatica have been found to have GTPS. Conclusion: This report highlights the importance of ruling out other possible causes of low back pain/sciatica before and after interventional spinal injection therapy

Clinical outcomes of trochanteric syndrome endoscopically treated.

Greater trochanteric pain syndrome (GTPS) is clinically defined as greater trochanter pain with mechanical characteristics. Most cases of GTPS are resolved with conservative treatment. Surgical techniques are reserved for those who had unsatisfactory results with conservative treatment. The aim of the present paper is to describe the outcomes observed within endoscopic treatment of peritrochanteric pathology. Twenty-three patients were included in the present study, undergoing surgery between January 2010 and December 2011, diagnosed with GTPS and surgically treated with endoscopy. All patients were evaluated with Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) Modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS). The Scales were assessed before surgery and at 3, 6 and 12 months postoperatively. All scores showed statistically significant differences (p < 0.001) within all periods. The endoscopic technique has proven to be safe and reproducible with good and excellent results, thus being an additional surgical procedure to consider within therapeutic management of greater trochanteric pain syndrome. IV. Case series.

Greater Trochanteric Pain Syndrome: Frequency and Associated Factors in Patients with Stroke

Background: Greater trochanteric pain syndrome (GTPS) is a common cause of lower extremity pain and is estimated to affect between 10% and 25% of the population. Despite all the research, there are no data in the literature about GTPS in the stroke population. Objective: The aim of the study was to determine frequency and related factors of GTPS in patients with stroke. Methods: Eighty-six patients with stroke were recruited from an inpatient rehabilitation department. Presence or absence of lateral thigh or hip pain was recorded. All patients with stroke (with or without self-reported pain) were examined using clinical criteria for the diagnosis of GTPS. Results: Lateral thigh or hip pain was reported on initial interviews by 29 of 86 patients. GTPS was diagnosed by means of structured physical examination maneuvers in 17 patients with stroke and self-reported pain and 11 patients with stroke without self-reported pain. Twenty-eight patients (32.6%) had GTPS. The following factors were significantly associated with GTPS: lower extremity spasticity, depression, and iliotibial band syndrome. No correlation was found between GTPS and age, sex, lesion localization, motor status, neglect, sensory loss, time since stroke, low back pain, knee and hip osteoarthritis, or health-related quality of life. Conclusion: In this study, we showed that patients with stroke have a high percentage of GTPS. Early diagnosis and treatment of pain from GTPS are important in this population, because GTPS may limit applicability of motor training and affect rehabilitation outcomes.

Gait characteristics of women with fibromyalgia: a premature aging pattern

BackgroundFibromyalgia is a condition which involves chronic pain. Middle-aged individuals with fibromyalgia seem to exhibit changes in gait pattern, which may prematurely expose them to a gait pattern which resembles that found in the elderly population. ObjectiveTo determine the 3D spatial (linear and angular) gait parameters of middle-aged women with fibromyalgia and compare to elderly women without this condition. Methods25 women (10 in the fibromyalgia group and 15 in the elderly group) volunteered to participate in the study. Kinematics was performed using an optoelectronic system, and linear and angular kinematic variables were determined. ResultsThere was no difference in walking speed, stride length, cadence, hip, knee and ankle joints range of motion between groups, except the pelvic rotation, in which the fibromyalgia group showed greater rotation (P<0.05) compared to the elderly group. Also, there was a negative correlation with pelvic rotation and gluteus pain (r = - 0.69; P<0.05), and between pelvic obliquity and greater trochanter pain (r = - 0.69; P<0.05) in the fibromyalgia group. ConclusionMiddle-aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed.

Características da marcha de mulheres com fibromialgia: um padrão prematuro de envelhecimento

BackgroundFibromyalgia is a condition which involves chronic pain. Middle‐aged individuals with fibromyalgia seem to exhibit changes in gait pattern, which may prematurely expose them to a gait pattern which resembles that found in the elderly population. ObjectiveTo determine the 3D spatial (linear and angular) gait parameters of middle‐aged women with fibromyalgia and compare to elderly women without this condition. Methods25 women (10 in the fibromyalgia group and 15 in the elderly group) volunteered to participate in the study. Kinematics was performed using an optoelectronic system, and linear and angular kinematic variables were determined. ResultsThere was no difference in walking speed, stride length, cadence, hip, knee and ankle joints range of motion between groups, except the pelvic rotation, in which the fibromyalgia group showed greater rotation (P<0.05) compared to the elderly group. Also, there was a negative correlation with pelvic rotation and gluteus pain (r = –0.69; P<0.05), and between pelvic obliquity and greater trochanter pain (r = –0.69; P<0.05) in the fibromyalgia group. ConclusionMiddle‐aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed.

Reverse less invasive stabilization system for treatment of femoral intertrochanteric fracture

Objective To evaluate the clinic effect of reverse less invasive stabilization system (LISS) in treatment of femoral intertrochanteric fracture.Methods The study enrolled 22 cases of femoral intertrochanteric fractures treated with reverse LISS from January 2007 to January 2011.Twelve out of the cases were males and 10 were females,with age ranging from 44 to 86 years (mean,72.5 years).Left fracture occurred in 8 cases and right in 14 cases.Causes of injury included fall on the ground in 15 cases,vehicle accidents in 4 cases,and fall from height in 3 cases.There were 15 cases of type Ⅲ and 9 of type Ⅳ according to Evans-Jensen classification and all fractures were closed injuries.Time from injury to operation was 3-14 days (mean,5.3 days).Results Intraoperative hemorrhage was (130.5 ± 60) ml and operation time was (55 ± 15) min.All cases were followed up for 12-30 months (mean,14.8 months).Fracture healing time was 10-27 weeks (mean,13.4 weeks).Harris hip score was excellent in 11 cases,good in 8,fair in 2,and poor in 1,with excellent and good rate of 86％.Two cases felt greater trochanter pain at follow-up ; one presented with plate breakage and malunion at 6 months postoperatively,but may need no further treatment; the rest healed without complications of surgical site infection,varus deformity of the hip,implant breakage,fracture redisplacement,screw drawing pullout or cutout.Conclusion Reverse LISS plating is an effective treatment for femoral intertrochanteric fractures,but the procedure can not assure 100％ success. Key words: Femoral fractures; Fracture fixation,internal; Surgical procedures, minimally invasive

Greater Trochanteric Hip Pain

In the patient with lateral hip pain, there is a broad differential diagnosis, making appropriate evaluation and management challenging. Greater trochanteric pain syndrome is a term used to denote chronic lateral hip pain and encompasses several painful soft tissue diagnoses including coxa saltans, trochanteric bursitis, and gluteus minimus and medius tendon tears. An overview of these common causes is presented through a series of cases that encompass the anatomic associations, classic presentations, diagnostic tests, and management strategies unique to each disorder. By reviewing this information, we hope to provide clinicians with the tools to evaluate greater trochanteric pain syndrome efficiently and effectively.

Peritrochantäre Schmerzsyndrome

Greater trochanteric pain is one of the common complaints in orthopedics. Frequent diagnoses include myofascial pain, trochanteric bursitis, tendinosis and rupture of the gluteus medius and minimus tendon, and external snapping hip. Furthermore, nerve entrapment like the piriformis syndrome must be considered in the differential diagnosis. This article summarizes essential diagnostic and therapeutic steps in greater trochanteric pain syndrome. Careful clinical evaluation, complemented with specific imaging studies and diagnostic infiltrations allows determination of the underlying pathology in most cases. Thereafter, specific nonsurgical treatment is indicated, with success rates of more than 90 %. Resistant cases and tendon ruptures may require surgical intervention, which can provide significant pain relief and functional improvement in most cases.

Conservative Treatment Options for Osteoarthritis of the Hip

Osteoarthritis (OA) of the hip is a common musculoskeletal problem. Often, hip pain begins as femoroacetabular impingement (FAI) that later develops into hip OA. Early symptoms of FAI include groin or greater trochanter pain, asymmetrical hip rotation, limited hip flexion, weakness of the hip flexors and abductor muscles, and the presence of pelvic obliquity. Later, symptoms and signs of clinical hip OA appear including stiffness in the hip lasting less than 1 hour, greater limitation of hip motions in all 3 body planes, increased weakness of most of the surrounding hip muscles, and eventually gait deviations. The purpose of this article was to describe the clinical diagnosis of both FAI and moderate hip OA in an attempt to start early conservative management in a patient who if not treated will likely develop hip OA. We emphasize that only by early recognition of FAI or of moderate hip OA will a conservative treatment program have potential for success. The conservative treatment of late hip OA is often ineffective, especially once the hip joint develops significant joint narrowing and other radiologic changes occur.

Are Ultrasound-Guided Injections Effective for Trochanteric Bursitis?

We often assume that bursitis is the cause of pain and tenderness over the greater trochanter of the hip. Patients with greater trochanteric pain