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 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. ...

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

Greater Trochanteric Pain Syndrome (Trochanteric Bursitis) in Low Back Pain

1991 ◽  
Vol 20 (4) ◽  
pp. 262-266 ◽  
Author(s):  
G. Collée ◽  
B. A. C. Dijkmans ◽  
J. P. Vandenbroucke ◽  
A. Cats
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Low Back ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis

Greater trochanteric pain syndrome

2016 ◽  
Vol 10 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Debora Kidanu ◽  
Emma Rowbotham ◽  
Andrew J Grainger ◽  
Philip Robinson ◽  
William S Bolton
Keyword(s):  
Imaging Techniques ◽  
Corticosteroid Injection ◽  
Pain Syndrome ◽  
Injection Therapy ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
Duration Of Action ◽  
Predict Treatment Response

Greater trochanteric pain syndrome (GTPS) is a common problem that is both debilitating and challenging to manage. In the past, the terms GTPS and greater trochanteric bursitis were used interchangeably, however, inflammation is not always a feature, and in fact, overuse or injury of the gluteal muscles may be the predominant feature. GTPS is now understood to involve multiple pathologies that affect the intra-articular or peri-articular spaces of the hip. Early detection and management of GTPS by GPs can improve patients’ quality of life. Currently, the use of corticosteroid injection therapy and imaging in the management of GTPS may be suboptimal. The aim of this article is to review the current management of GTPS, evidence for the efficacy and duration of action of corticosteroid injection therapy and the role of imaging techniques in the diagnosis and management of GTPS, including the ability to identify pathology and predict treatment response.

Greater Trochanteric Pain Syndrome: Abductors, External Rotators

2017 ◽  
Vol 21 (05) ◽  
pp. 539-546 ◽  
Author(s):  
Anna Falkowski ◽  
Balazs Kovacs ◽  
Anna Hirschmann
Keyword(s):  
Pain Syndrome ◽  
Tendon Injury ◽  
Iliotibial Band ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
Surgical Access ◽  
Asymptomatic Patients ◽  
Fatty Atrophy ◽  
Tendon Tears ◽  
Postoperative Setting

AbstractChronic pain and tenderness at the greater trochanter characterizes trochanteric pain syndrome. For a long time, trochanteric bursitis was thought to be the only underlying pathology; however, investigations have shown that tendinopathy of the abductors is the main cause, followed by iliotibial band thickening and, to a lesser extent, abductor tendon tears. Trochanteric bursitis can be associated with it. On magnetic resonance imaging (MRI), peritrochanteric T2 abnormalities are evident in greater trochanteric pain syndrome. However, this is also frequently encountered in asymptomatic patients. In the postoperative setting, patients with total hip arthroplasties and transtendinous lateral or posterior surgical access are prone to tendon injury. Symptomatic patients typically present with tendon tears, whereas peritrochanteric fluid, thickening, and signal alterations of the abductors and fatty atrophy of the gluteus minimus muscle are often encountered in asymptomatic postoperative hips. MRI and ultrasound are proven and reliable imaging modalities in patients with greater trochanteric pain syndrome. Awareness of typical imaging findings, in particular in postoperative patients, are helpful in the evaluation of patients.

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 Greater Trochanteric Pain Syndrome Due to Tumoral Calcinosis in a Patient with Chronic Kidney Disease

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. E775-E782
Author(s):  
Sang Eun Lee
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pain Syndrome ◽  
Pain Clinic ◽  
Tumoral Calcinosis ◽  
Leg Pain ◽  
Greater Trochanteric Pain Syndrome ◽  
Trochanteric Bursitis ◽  
The Past ◽  
Left Buttock

Tumoral calcinosis is a rare syndrome characterized by massive subcutaneous soft tissue deposits of calcium phosphate near the large joints. It is more prevalent in patients with chronic kidney disease undergoing dialysis. A 57-year-old woman was referred to our pain clinic with the complaint of severe pain in the left buttock and lateral hip. The patient had been suffering from chronic kidney disease for 10 years and had been undergoing peritoneal dialysis over the past 5 years. The patient’s symptom was initially suspected to be of lumbar origin at the L5 level and a left L5 transforaminal epidural block was performed, but without success. Reevaluation of the physical examination revealed severe tenderness over the left greater trochanter and piriformis muscle. On ultrasonographic evaluation, multiple mass-like lesions in the left buttock were observed. About 30 mL of fluid was aspirated from the cystic lesions, followed by 30 mL mixture of 0.08% levobupivacaine and triamcinolone 40 mg injected into the bursa under ultrasound guidance, which brought pain relief. Trochanteric bursitis was thought of as the cause of the symptoms. The patient was diagnosed with tumoral calcinosis based on the past medical history, simple plain radiographs, and hip magnetic resonance imaging (MRI). We diagnosed a case of greater trochanteric pain syndrome due to tumoral calcinosis related to chronic kidney disease in a patient whose symptoms had initially been considered to be radiating leg pain caused by lumbar spinal disease. We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid. Key words: Trochanteric bursitis, greater trochanteric pain syndrome, tumoral calcinosis

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