Who Wants to be IT: An Underappreciated Cause of Lateral Thigh Pain and Paresthesias

Abductor tendon lesions and insertional tendinopathy are the most common causes of lateral thigh pain. Gluteal tendon pathology is more prevalent in women and frequency increases with age. Chronic atraumatic tears result in altered lower limb biomechanics. The chief complaint is lateral thigh pain. Clinical examination should include evaluation of muscle strength, lumbar spine, hip and fascia lata pathology. The hip lag sign and 30-second single leg stance tests are useful in diagnosing abductor insufficiency. Magnetic resonance imaging (MRI) is the gold-standard investigation to identify abductor tendon tears and evaluate the extent of muscle fatty infiltration that has predictive value on the outcome of abductor repair. Abductor tendinosis treatment is mainly conservative, including non-steroidal anti-inflammatory medications, activity modification, local corticosteroid injections, plasma-rich protein, physical and radial shockwave therapy. The limited number of available high-quality studies on treatment outcomes and limited evidence between tendinosis and partial ruptures make it difficult to provide definite conclusions regarding the best management of gluteal tendinopathy. Surgical management is indicated in complete and partial gluteal tendon tears that are unresponsive to conservative treatment. There are various open and arthroscopic surgical procedures for direct repair of abductor tendon tears. There is limited evidence concerning surgical management outcomes. Prerequisites for effective tendon suturing are neurologic integrity and limited muscle fatty infiltration. Chronic irreparable tears with limited muscle atrophy and limited fatty infiltration can be augmented with grafts. Gluteus maximus or/vastus lateralis muscle transfers are salvage reconstruction procedures for the management of chronic end-stage abductor tears with significant tendon insufficiency or gluteal atrophy. Cite this article: EFORT Open Rev 2020;5:464-476. DOI: 10.1302/2058-5241.5.190094

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Management of Lateral Thigh Pain following Cephalomedullary Nail: A Technical Note

Spartan Medical Research Journal ◽

10.51894/001c.12931 ◽

2020 ◽

Author(s):

Michael Rosen ◽

Connor Kasik ◽

Michael Swords

Keyword(s):

Technical Note ◽

Thigh Pain ◽

Cephalomedullary Nail ◽

Lateral Thigh

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Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00609-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Carlos Hernández-Pascual ◽

José Ángel Santos-Sánchez ◽

Juan Manuel García-González ◽

Carlos Fernando Silva-Viamonte ◽

Carmen Pablos-Hernández ◽

...

Keyword(s):

Thigh Pain ◽

Long Term Results ◽

Unstable Fracture ◽

Historical Cohort ◽

Term Survival ◽

Long Term Survival ◽

Distal Locking ◽

Mechanical Complications ◽

Lateral Thigh

Abstract Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. Results Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. Conclusions Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence Therapeutic study, level 2b.

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Distal femoral cortical hypertrophy not associated with thigh pain using a short stem femoral implant

Hip International ◽

10.1177/1120700020913872 ◽

2020 ◽

pp. 112070002091387 ◽

Cited By ~ 1

Author(s):

David A Crawford ◽

Joanne B Adams ◽

Michael J Morris ◽

Keith R Berend ◽

Adolph V Lombardi

Keyword(s):

Direct Anterior Approach ◽

Activity Level ◽

Thigh Pain ◽

Short Stem ◽

Thickness Change ◽

Gruen Zone ◽

Stem Size ◽

Patient Reported ◽

Cortical Hypertrophy ◽

Lateral Thigh

Background: Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with postoperative thigh pain after THA. Methods: All patients who underwent an uncomplicated primary THA via a direct anterior approach with the Taperloc Microplasty (Zimmer Biomet, Warsaw, IN, USA) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1 year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH. 293 patients were included in the study. Results: Mean follow-up was 3.2 years. A total of 218 hips (74%) had cortical hypertrophy in Gruen zone 3 and 165 hips (56%) had cortical hypertrophy in Gruen zone 5. 52 hips (18%) had ⩾25% cortical hypertrophy in zone 3 and 91 hips (31%) had ⩾25% cortical hypertrophy in zone 5. A total of 44 patients (15%) reported anterior thigh pain and 43 patients (15%) reported lateral thigh pain. Development of DFCH in either Gruen zone 3 or 5 was not associated with anterior or lateral thigh pain. Stem size was positively correlated with zone 3 hypertrophy and inversely related to zone 5 hypertrophy. Thigh pain was not associated with patient age, gender, activity level or stem size. Conclusions: The development of distal femoral cortical hypertrophy after THA with a short stem implant was high, but not associated with patient-reported anterior or lateral thigh pain.

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