scholarly journals Lateral Hip Pain in an Athletic Population: Differential Diagnosis and Treatment Options

2010 ◽  
Vol 2 (3) ◽  
pp. 191-196 ◽  
Author(s):  
Robert C. Grumet ◽  
Rachel M. Frank ◽  
Mark A. Slabaugh ◽  
Walter W. Virkus ◽  
Charles A. Bush-Joseph ◽  
...  
Keyword(s):  
Treatment Options ◽  
Pain Syndrome ◽  
Hip Pain ◽  
Treatment Modalities ◽  
Diagnostic Tools ◽  
Iliotibial Band ◽  
Trochanteric Bursitis ◽  
Medline Search ◽  
Trochanteric Region ◽  
Lateral Hip Pain

Context: Historically, the term greater trochanteric pain syndrome has been used to describe a spectrum of conditions that cause lateral-sided hip pain, including greater trochanteric bursitis, snapping iliotibial band, and/or strains or tendinopathy of the abductor mechanism. Diagnosis of these conditions may be difficult because clinical presentations are variable and sometimes inconclusive. Especially difficult is differentiating intrinsic pain from pain referred to the greater trochanteric region. The purposes of this article are to review the relevant anatomy and pathophysiology of the lateral hip. Evidence Acquisition: Data were collected through a thorough review of the literature conducted through a MEDLINE search of all relevant papers between 1980 and January 2010. Results: Recent advances in imaging and an improved understanding of pathomechanics have helped to guide the evaluation, diagnosis, and appropriate treatment for patients presenting with lateral hip pain. Conclusion: Various diagnostic tools and treatment modalities can be used to effectively manage the athletic patient presenting with lateral hip pain.

scholarly journals Pathogenesis and contemporary diagnoses for lateral hip pain: a scoping review

2020 ◽  
Author(s):  
Karadi Hari Sunil Kumar ◽  
Jaikirty Rawal ◽  
Naoki Nakano ◽  
André Sarmento ◽  
Vikas Khanduja
Keyword(s):  
Scoping Review ◽  
Pain Syndrome ◽  
Gluteus Medius ◽  
Hip Pain ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
Snapping Hip ◽  
External Snapping Hip ◽  
Snapping Hip Syndrome ◽  
Lateral Hip Pain

Abstract Purpose Recent advances in diagnostic imaging techniques and soft tissue endoscopy now allow for precise diagnosis and management of extra-articular hip pathology. The aim of this scoping review is to present an evidence-based update of the relevant literature focussing only on the pathoanatomy, clinical assessment and the diagnosis of pathology in the peritrochanteric space. Methods A literature search was performed on PubMed to include articles which reported on the anatomy and diagnosis of greater trochanteric pain syndrome, trochanteric bursitis, gluteus medius tears and external snapping hip syndrome. Results A total of 542 studies were identified, of which 49 articles were included for full text analysis for the scoping review. Peritrochanteric space pathology can be broadly classified into (1) greater trochanteric pain syndrome (GTPS), (2) abductor tears and (3) external snapping hip syndrome. Anatomically, gluteus medius, gluteus minimus and tensor fascia lata work in conjunction to abduct and internally rotate the hip. The anterolateral part of the gluteus medius tendon is more prone to tears due to a thin tendinous portion. Increased acetabular anteversion has also been shown to be associated with gluteal and trochanteric bursitis. In terms of clinical examination, tests which were found to be most useful for assisting in the diagnoses of lateral hip pain were the single-leg stance, resisted external derotation of the hip, hip lag sign and the Trendelenburg’s test. Dynamic ultrasound along with guided injections and MRI scan do assist in differentiating the pathology and confirming the diagnosis in patients presenting with lateral hip pain. Finally, the assessment of baseline psychological impairment is essential in this group of patients to ensure outcomes are optimised. Conclusion Lateral hip pain used to be a poorly defined entity, but advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation and management of this cohort of patients. A thorough appreciation of the anatomy of the abductor musculature, specific clinical signs and imaging findings will lead to an appropriate diagnosis being made and management plan instituted. Level of evidence IV.

Case 14.2

2014 ◽  
pp. 677-678
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Clinical Diagnosis ◽  
Pain Syndrome ◽  
Hip Pain ◽  
Greater Trochanter ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
Fluid Collections ◽  
Lateral Hip Pain ◽  
Made In ◽  
T2 Weighted Images

42-year-old woman with bilateral hip pain Axial (Figure 14.2.1) and coronal (Figure 14.2.2) fat-suppressed FSE T2-weighted images reveal crescentic fluid collections adjacent to the greater trochanters bilaterally. Trochanteric bursitis Greater trochanteric pain syndrome is a clinical diagnosis made in the setting of lateral hip pain exacerbated by movement of the leg or lying on the affected hip, with associated tenderness on palpation of the greater trochanter. ...

scholarly journals Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology

2021 ◽  
Vol 9 ◽  
pp. 205031212110225
Author(s):  
Mark A Pianka ◽  
Joseph Serino ◽  
Steven F DeFroda ◽  
Blake M Bodendorfer
Keyword(s):  
Wide Spectrum ◽  
Pain Syndrome ◽  
Operative Management ◽  
Hip Pain ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
Treatment Indications ◽  
Careful Clinical Examination ◽  
Wide Range ◽  
Tendon Pathology

Greater trochanteric pain syndrome is a common cause of lateral hip pain, encompassing a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and external coxa saltans. Greater trochanteric pain syndrome is primarily a clinical diagnosis, and careful clinical examination is essential for accurate diagnosis and treatment. A thorough history and physical exam may be used to help differentiate greater trochanteric pain syndrome from other common causes of hip pain, including osteoarthritis, femoroacetabular impingement, and lumbar stenosis. Although not required for diagnosis, plain radiographs and magnetic resonance imaging may be useful to exclude alternative pathologies or guide treatment of greater trochanteric pain syndrome. The majority of patients with greater trochanteric pain syndrome respond well to conservative management, including physical therapy, non-steroidal anti-inflammatory drugs, and corticosteroid injections. Operative management is typically indicated in patients with chronic symptoms refractory to conservative therapy. A wide range of surgical options, both open and endoscopic, are available and should be guided by the specific etiology of pain. The purpose of this review is to highlight pertinent clinical and radiographic features used in the diagnosis and management of greater trochanteric pain syndrome. In addition, treatment indications, techniques, and outcomes are described.

scholarly journals Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Study of a Pregnant Female

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E487-E493
Author(s):  
Shaik Ahmed
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Conclusive Evidence ◽  
Treatment Modalities ◽  
Child Bearing ◽  
The Impact

Background: Spinal cord stimulation (SCS) is a form of neuromodulation, used to treat chronic neuropathic pain refractory to conventional medical management. Spinal cord stimulators are treatment options when intractable chronic pain has not responded to more conventional treatment modalities. Currently, the use of SCS is contraindicated in pregnancy. Nevertheless, many SCS/ neuromodulation recipients are women of child bearing age who may become pregnant. There are no published reports that focus on the possible side effects of SCS or neuromodulation therapy on human fertility, fetal development, pregnancy, delivery, or lactation. Objectives: The purpose of this current report is to present a case study on the use of SCS/ neuromodulation during pregnancy. Study Design: Presentation of the case of a 24 year old female who became pregnant after receiving an SCS implantation for pain control secondary to complex regional pain syndrome (CRPS). The SCS was in use at the time of conception but deactivated when patient became aware of her pregnancy and intermittently reactivated for five minute intervals throughout the entire pregnancy. Results: Currently very little documented evidence is available regarding the safety of using a SCS/ neuromodulator during pregnancy; therefore its use during pregnancy is contraindicated. Available literature suggests that, women who have chosen to keep the SCS/neuromodulator activated during pregnancy have delivered healthy babies without any life threatening complications. Limitations: Case presentations do not provide conclusive evidence of treatment effectiveness. This data is only preliminary and future studies should be used to assess outcomes and measures to provide quantification of the SCS implantation during pregnancy. Conclusions: Women of child bearing age who are recipients of SCS/neuromodulation implantation should be informed of the limited knowledge available regarding the impact of SCS/ neuromodulation use during pregnancy. For current recipients, decisions about ongoing use during pregnancy should be an individual decision based on the potential risks and benefits. Key words: Pregnancy and complex regional pain syndrome, pregnancy and reflex sympathetic dystrophy, pregnancy and spinal cord stimulators, pregnancy and electromagnetic fields, and pregnancy and neuromodulator.

ILIOTIBIAL BAND Z-LENGTHENING FOR REFRACTORY TROCHANTERIC BURSITIS (GREATER TROCHANTERIC PAIN SYNDROME)

2007 ◽  
Vol 77 (11) ◽  
pp. 996-998 ◽  
Author(s):  
Roy A. Craig ◽  
David P. Gwynne Jones ◽  
Andrew P. Oakley ◽  
John D. Dunbar
Keyword(s):  
Pain Syndrome ◽  
Iliotibial Band ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis

scholarly journals Targeted therapy in advanced desmoid tumors: Current perspectives

2020 ◽  
Vol 11 (3) ◽  
pp. 9-16
Author(s):  
Amrallah A. Mohammed ◽  
Hani EL-Tanni ◽  
Hani M. EL-Khatib
Keyword(s):  
Targeted Therapy ◽  
Treatment Options ◽  
Aggressive Fibromatosis ◽  
Local Tumor Control ◽  
The Body ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Desmoid Tumors ◽  
Treatment Needs ◽  
Medline Search

Abstract Background Desmoid tumors/aggressive fibromatosis (DTs/AF) are cytological bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. The exact cause still remains unknown, however, they may present sporadically or as a manifestation of a hereditary syndrome called familial adenomatous polyposis (FAP). Although they lack the capacity to establish metastases, DTs/AF may be devastated and occasionally fatal. As a result of the heterogeneity of DTs/AF, treatment needs to be individualized to improve local tumor control and maintain patients’ quality of life. Therefore, after a multidisciplinary approach, all treatment options should be discussed with patients. Where systemic chemotherapy has been shown to be unsuccessful with marked side effects in case of advanced DTs/AF, new therapeutic options are needed. Methods A Medline search was conducted and published articles in different studies from 2000 to the present were reviewed. Conclusion More research is needed to illustrate both the prognostic and predictive factors of the targeted therapy and the value of their combinations with or without other treatment modalities to get the best result for the treatment of advanced DTs/AF.

scholarly journals Greater Trochanteric Pain Syndrome (GTPS): A clinical prospective study of treatment options

2022 ◽  
Vol 1 (1) ◽  
pp. 1-14
Author(s):  
Oluseun Olufade
Keyword(s):  
Corticosteroid Injection ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Treatment Modalities ◽  
Post Intervention ◽  
Significant Difference ◽  
Observational Prospective Cohort Study ◽  
Operative Strategies ◽  
Greater Trochanter Pain Syndrome ◽  
Clinically Significant

Background: There are few prospective studies evaluating the efficacy of various non-operative strategies for treatment of greater trochanter pain syndrome (GTPS). There is a diversity of available interventions and lack of clear consensus for the best modality thus far. Design: Observational prospective cohort study performed during the period of October 2017 and March 2019. Methods: The main objective was to determine if there is a difference in outcome of the Lower Extremity Functional Scale (LEFS) for subjects treated with conservative management (PT), corticosteroid injection (CSI), or percutaneous ultrasonic tenotomy (PUT). Participants were assigned based on physician treatment in a non-randomized manner to PT, a single CSI, or the PUT treatment arm. Subjects participated in outcome assessments at baseline and at 1-, 3-, 6-, and 12-months post intervention. Results: 112 individuals with unilateral GTPS were recruited for this study with 69 PT patients, 31 CSI patients, and 12 PUT patients. The adjusted mean LEFS scores averaged across all time periods remained statistically different between PT, CSI, and PUT (p = 0.0093), indicating significant difference between each treatment arm. PT group saw the greatest improvements from baseline score starting at 1 month and up to 1 year (p = .0004). CSI group did not see significant LEFS improvement until 6 months (p = 0.04) and did not maintain clinically significant improvement by 1 year. PUT group saw significant LEFS improvement at 3 months (p = 0.0001) and maintained clinically significant improvements (≥ 9 LEFS points) throughout the course of the study. Conclusion: PT patients over the study period showed the greatest improvements in LEFS scores compared to CSI and PUT patients. We believe that PT is the best indicated course of treatment for GTPS. PUT may be considered as an additional option if patients have failed other treatment modalities. CSI shows benefit at 6 months, but overall inferior to PT and PUT.

Pathophysiology and First-Line Treatment of Osteoarthritis

2002 ◽  
Vol 36 (4) ◽  
pp. 679-686 ◽  
Author(s):  
Jesse H Hogue ◽  
Tracey L Mersfelder
Keyword(s):  
Data Extraction ◽  
Treatment Options ◽  
Primary Treatment ◽  
Data Sources ◽  
Treatment Modalities ◽  
Comparable Efficacy ◽  
Antiinflammatory Drugs ◽  
Medline Search ◽  
Cox 2 ◽  
Cox 2 Inhibitors

OBJECTIVE: To review the pathophysiology of osteoarthritis (OA) and the various treatment modalities, focusing specifically on acetaminophen (APAP), nonsteroidal antiinflammatory drugs (NSAIDs), and cyclooxygenase-2 (COX-2) inhibitors as the primary treatment options. DATA SOURCES: Primary literature and tertiary references were identified by a MEDLINE search (1966–March 2001) and through other secondary sources. STUDY SELECTION AND DATA EXTRACTION: After evaluating the articles and references identified from the data sources, all the information that was judged relevant by the reviewers was included in the review article. DATA SYNTHESIS: OA is the most common joint disorder worldwide. Current research suggests that factors such as inflammation and changes in subchondral bone may play a larger role in the pathophysiology than previously thought. With this research and the development of COX-2 inhibitors, selecting the medication of choice for OA has become difficult. CONCLUSIONS: More research needs to be done before the pathophysiology of OA can be clearly determined. In the meantime, treatment should be based on clinical data and patient response. Studies have shown that APAP and NSAIDs have comparable efficacy, as do traditional NSAIDs and COX-2 inhibitors. APAP is associated with fewer toxicities than are the traditional NSAIDs. Due to their mechanism of action, the new COX-2 inhibitors should result in fewer adverse effects compared with traditional NSAIDs, but evidence from clinical trials has not been conclusive. Therefore, APAP should still be considered the drug of choice for OA.

Treatment of Female Sexual Dysfunction

2003 ◽  
Vol 37 (4) ◽  
pp. 546-555 ◽  
Author(s):  
Kelly R Ragucci ◽  
Nicole S Culhane
Keyword(s):  
Sexual Dysfunction ◽  
Female Sexual Dysfunction ◽  
Data Extraction ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Individual Characteristics ◽  
Treatment Modalities ◽  
Medline Search ◽  
Sexual Pain ◽  
Arousal Disorder

OBJECTIVE: To review the pathophysiology and psychology of female sexual dysfunction (FSD) and describe potential prevention and treatment strategies for the disorder. DATA SOURCES: Articles identified from a MEDLINE search (1966–June 2002) using the term female sexual dysfunction. Additional references were obtained from cross referencing retrieved articles. STUDY SELECTION AND DATA EXTRACTION: After evaluating various review articles, clinical trials, and investigational studies, all information that was deemed relevant by the reviewers was included. DATA SYNTHESIS: FSD is a multicausal and multidimensional problem combining biological, psychological, and interpersonal factors. The American Foundation for Urological Disease classifies FSD into 4 broad categories: sexual desire disorders, arousal disorder, orgasmic disorder, and sexual pain disorders. Depending on specific individual characteristics and category of disorder, a variety of potential treatments are available. Pharmacists can play a role in identifying and managing medication-related adverse effects that may be exacerbating FSD and educating women on treatment modalities. CONCLUSIONS: FSD is a complicated disorder that is often difficult to identify, classify, and treat appropriately. Pharmacists should have an understanding of the potential causes of FSD and the treatment options available so that they may make appropriate recommendations and counsel women effectively.

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