Amplified Vasodilatation within the Referred Pain Zone of Trigger Points Is Characteristic of Gluteal Syndrome—A Type of Nociplastic Pain Mimicking Sciatica

Gluteal syndrome (GS) mimicking sciatica is a new disease that has been recently recognized and included in the International Classification of Diseases, 11th Revision. The present study examines nociplastic pain involvement in GS and sciatica patients using a new Skorupska protocol (SP) test that provokes amplified vasodilatation in the area of expected muscle-referred pain. A positive test is confirmed if there is (i) a development of autonomic referred pain (AURP) and (ii) an increase in the delta of average temperature (Δ₸°) > 0.3 °C at the end of the stimulation and during the observation SP phases. Chronic GS (n = 20) and sciatica (n = 30) patients were examined. The SP test confirmed muscle-referred pain for (i) all GS patients with 90.6% positive thermograms (Δ₸° 0.6 ± 0.8 °C; maximum AURP 8.9 ± 13.6% (both p < 0.05)) and (ii) those sciatica (n = 8) patients who reported pain sensation during the test with 20.6% positive thermograms (Δ₸° 0.7 ± 0.7 °C; maximum AURP 15.1 ± 17.8% (both p < 0.05)). The remaining sciatica (n = 22) patients did not report pain during the test and presented a Δ₸° decrease and the AURP size below 1%. Conclusion: Amplified vasodilatation suggesting nociplastic pain involvement was confirmed for all GS and sciatica patients who reported painful sensations in the zone typical for gluteus minimus referred pain during the test.

Оцінка ефективності програми фізичної реабілітації дітей із наслідками дисплазії кульшових суглобів

Дисплазія кульшових суглобів за несвоєчасного виявлення та лікування в ранньомудитячому віці прогресує і призводить до негативних наслідків, які починають проявлятися удітей дошкільного віку.Мета. Оцінити ефективність застосування засобів фізичної реабілітації у дітей із наслідкамидисплазії кульшових суглобів. Методи. У дослідженні взяли участь 68 дітей дошкільного вікуз односторонньою дисплазією кульшових суглобів за анамнезом (виявлено за результатамианалізу медичних карт), середній вік обстежених 5,6 ± 0,5 року. Для проведення дослідженьсформовано дві групи: основну (ОГ; n = 35) – діти, які займалися за розробленою нами про-грамою реабілітації, та контрольну (КГ; n = 33) – діти, які займалися за програмою дитячогонавчального закладу. Тривалість дослідження – 2014–2019 рр. Результати. Після проведенняпрограми фізіотерапевтичних втручань виявлено, що тонус м’язів-аддукторів наблизився дозначень інтактної кінцівки, що пов’язано з покращенням тонусу м’язів антагоністів (м’язів-абдукторів стегна (m. gluteus medius, m. gluteus minimus, m. tensor fasciae latae), та виправ-ленням патологічної привідної контрактури у кульшовому суглобі (в ОГ інтактна – 72,3 ± 3,2та уражена – 70,2 ± 3,4 (–х ± S); в КГ – інтактна – 69,4 ± 3,5 уражена –76,3 ± 3,7, (р > 0,05). Зарезультатами обстеження виявлено покращення параметрів відеомоніторингу постави, асаме: в ОГ кількість дітей з порушеннями у сагітальній площині зменшилось на 11 осіб; пору-шення постави у сагітальній площині зберіглися у 12 (34,2 %) дітей групи. В КГ також виявленопозитивну динаміку, але лише у п’яти дітей покращився профіль постави у сагітальній площині,у решти 17 (51,5 %) дітей порушення постави у сагітальній площини зберіглися рівні первин-них значень. Висновки. Використання комплексної авторської програми фізичної реабілітації,спрямованої на усунення та зменшення проявів наслідків дисплазії кульшових суглобів, покра-щення та корекцію функціональних можливостей опорно-рухового апарату, у яких відбулисяпатологічні зміни, зміцнення суглобово-зв’язкового апарату, дозволяє більш ефективно усуну-ти прояви наслідків ДКС порівняно зі стандартними програмами реабілітації.

Gluteal atrophy and fatty infiltration in end-stage osteoarthritis of the hip

Aims The gluteus minimus (GMin) and gluteus medius (GMed) have unique structural and functional segments that may be affected to varying degrees, by end-stage osteoarthritis (OA) and normal ageing. We used data from patients with end-stage OA and matched healthy controls to 1) quantify the atrophy of the GMin and GMed in the two groups and 2) describe the distinct patterns of the fatty infiltration in the different segments of the GMin and GMed in the two groups. Methods A total of 39 patients with end-stage OA and 12 age- and sex frequency-matched healthy controls were prospectively enrolled in the study. Fatty infiltration within the different segments of the GMin and the GMed was assessed on MRI according to the semiquantitative classification system of Goutallier and normalized cross-sectional areas were measured. Results The GMin was smaller in the OA-group (p < 0.001) compared to the control group, but there was no group difference in the size of the GMed (p = 0.101). Higher levels of fatty infiltration were identified in the anterior segment of the GMin (p = 0.006) and the anterior (p = 0.006) and middle (p = 0.047) segments of the GMed in the OA group. All subjects in the control group had fatty infiltration of the anterior segment of the GMin, but all except one had no fatty infiltration in the entire GMed. Conclusion End-stage OA was associated with significant atrophy of the GMin and higher levels of fatty infiltration, particularly in the anterior segments of the GMin and GMed. Minor fatty infiltration of the anterior segment of GMin appears to be a normal part of ageing. Our study has demonstrated different patterns of atrophy and fatty infiltration between patients with end-stage OA and healthy matched peers. Cite this article: Bone Jt Open 2021;2(1):40–47.

The pathological features of hip abductor tendon tears – a cadaveric study

Background The hip abductors are crucial in maintaining pelvic stability. Tears in these tendons are common and often debilitating. There is uncertainty regarding both the histological and macroscopic features of hip abductor tears. This study aims to clarify both the macroscopic and microscopic features of the tendon and enthesis in hip abductor tendon tears. Methods Thirty-six cadavers with an average age of 81 were dissected, and the hip abductor mechanisms removed en-bloc. The presence, location and size of the tears were recorded and analysed. The samples were processed into histological blocks and viewed using both transmitted and polarised light. Tendon histology was graded using the modified Movin’s score in three sections (deep, middle and superficial layers) and the enthesis graded separately using 5-point criteria. Analysis of variance was used to confirm histological features associated with tears. Results Tears were found in 24 of 36 samples (67%). The most common finding was an isolated tear in the gluteus minimus (46%), followed by concurrent gluteus medius and gluteus minimus tears (33%). Histology revealed significantly more degeneration in both the tendon (p = 0.0005) and enthesis (p = 0.0011) when tears were present. Furthermore, these changes were concentrated in the deeper layers of the tendon (p = 0.0002) and enthesis (p = 0.003). Conclusion This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. Degenerative changes occur in both the tendon and enthesis, with the deeper layers predominantly affected. These findings are important for guiding surgical repair techniques and to aid the development of novel materials and biologics.

The pathological features of hip abductor tendon tears – a cadaveric study

Background: The hip abductors are crucial in maintaining pelvic stability. Tears in these tendons are common and often debilitating. There is uncertainty regarding both the histological and macroscopic features of hip abductor tears. This study aims to clarify both the macroscopic and microscopic features of the tendon and enthesis in hip abductor tendon tears.Methods: Thirty-six cadavers with an average age of 81 were dissected, and the hip abductor mechanisms removed en-bloc. The presence, location and size of the tears were recorded and analysed. The samples were processed into histological blocks and viewed using both transmitted and polarised light. Tendon histology was graded using the modified Movin’s score in three sections (deep, middle and superficial layers) and the enthesis graded separately using 5-point criteria. Analysis of variance was used to confirm histological features associated with tears.Results: Tears were found in 24 of 36 samples (67%). The most common finding was an isolated tear in the gluteus minimus (46%), followed by concurrent gluteus medius and gluteus minimus tears (33%). Histology revealed significantly more degeneration in both the tendon (p=0.0005) and enthesis (p=0.0011) when tears were present. Furthermore, these changes were concentrated in the deeper layers of the tendon (p=0.0002) and enthesis (p=0.003).Conclusion: This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. Degenerative changes occur in both the tendon and enthesis, with the deeper layers predominantly affected. These findings are important for guiding surgical repair techniques and to aid the development of novel materials and biologics.

The pathological features of hip abductor tendon tears – a cadaveric study

Background: The hip abductors are crucial in maintaining pelvic stability. Tears in these tendons are common and often debilitating. There is uncertainty regarding both the histological and macroscopic features of hip abductor tears. This study aims to clarify both the macroscopic and microscopic features of the tendon and enthesis in hip abductor tendon tears.Methods: Thirty-six cadavers with an average age of 81 were dissected, and the hip abductor mechanisms removed en-bloc. The presence, location and size of the tears were recorded and analysed. The samples were processed into histological blocks and viewed using both transmitted and polarised light. Tendon histology was graded using the modified Movin’s score in three sections (deep, middle and superficial layers) and the enthesis graded separately using 5-point criteria. Analysis of variance was used to confirm histological features associated with tears. Results: Tears were found in 24 of 36 samples (67%). The most common finding was an isolated tear in the gluteus minimus (46%), followed by concurrent gluteus medius and gluteus minimus tears (33%). Histology revealed significantly more degeneration in both the tendon (p=0.0005) and enthesis (p=0.0011) when tears were present. Furthermore, these changes were concentrated in the deeper layers of the tendon (p=0.0002) and enthesis (p=0.003). Conclusion: This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. Degenerative changes occur in both the tendon and enthesis, with the deeper layers predominantly affected. These findings are important for guiding surgical repair techniques and to aid the development of novel materials and biologics.