Gluteal Tendinopathy: Difference between revisions
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===Examination=== | ===Examination=== | ||
The most important sign is pain on palpation of the greater trochanter.<ref name=":1" /> Absence of pain on palpation would indicate an alternate diagnosis.<ref name=":1" /> Lateral hip pain reproduced on 30s single-leg stance test was a sensitivity and specificity of 100% and 97.3% respectively for gluteal tendinopathy.<ref name=":1" /> The high utility of the test is only maintained if lateral displacement of the hip is avoided.<ref name=":1" /> The examiner may provide gentle fingertip support to steady the patient.<ref name=":1" /> The FABER test is useful in the differential diagnosis as limited range of movement is associated with hip joint pathology but not gluteal tendinopathy.<ref name=":1" /> The Ober's test has been shown to lack diagnostic utility for gluteal tendinopathy.<ref name=":1" /> | |||
==Investigations== | ==Investigations== | ||
MRI and ultrasound are useful Imaging tools to evaluate abnormalities of the lateral hip. | MRI and ultrasound are useful Imaging tools to evaluate abnormalities of the lateral hip. | ||
Revision as of 14:54, 3 April 2022
Greater trochanteric pain syndrome (GTPS) constitute a large number of musculoskeletal related presentations at the physicianās office. GTPS is an umbrella term encompassing different clinical entities that may contribute to chronic intermittent lateral hip pain. Multiple labels such as ātrochanteric bursitisā and ātronchanteritisā have been used in the past which is now regarded as a misnomer. Invariably, the inflamed or enlarged bursa due to friction (sub-gluteal minimus/medius) is secondary or co-exist with an underlying pathology. Gluteal tendinopathy is identified as one of the major culprits of GTPS along with iliotibial band (ITB) and tensor fascia lata (TFT) as potential causes.
Aetiology and Pathophysiology
Gluteal tendinopathy is caused by exposure to load that the tendon did not have adequate adaption or recovery time in order manage.[1][2] This could be due to a traumatic event (e.g. direct blow) or a frequent and repeated exposure to a load (e.g. jumping athlete).[2][1] Three continuous stages of disease have been described: normal to reactive tendinopathy to tendon dysrepair to degenerative tendinopathy.[1] This is explained in more detail in Tendinopathy. It is difficult because pain is not closely connected to progression of pathology.[2]
Epidemiology and Risk Factors
Common condition with prevalence highest in women over 40 years old.[1] One study reporting 23.5% of females and 8.5% of men between 50-79 years being affected in community-based population.[3] A rapid increase in intensity and/or frequency of on gluteal tendons puts individuals at risk.[2] Both athletes and sedentary individuals are affected.[1]
Clinical Features
History
Lateral hip pain over greater trochanter.[1] Onset typically slow but can occur following a traumatic event (fall, forceful sporting action).[1] Pain typically worsened with time and can be associated with a change in physical activity.[1] Pain can radiate around the trochanter and down the lateral thigh.[1] Associated symptom of stiffness of hip on standing or walking following sitting.[1] Sleep can be significantly disturbed as pain is typically worse at night time and pain makes it difficult for sleeping on side.[1] Pain can cause significant disability, particularly with single leg standing activities e.g. dressing, walking and going up stairs or hills.[1]
Examination
The most important sign is pain on palpation of the greater trochanter.[1] Absence of pain on palpation would indicate an alternate diagnosis.[1] Lateral hip pain reproduced on 30s single-leg stance test was a sensitivity and specificity of 100% and 97.3% respectively for gluteal tendinopathy.[1] The high utility of the test is only maintained if lateral displacement of the hip is avoided.[1] The examiner may provide gentle fingertip support to steady the patient.[1] The FABER test is useful in the differential diagnosis as limited range of movement is associated with hip joint pathology but not gluteal tendinopathy.[1] The Ober's test has been shown to lack diagnostic utility for gluteal tendinopathy.[1]
Investigations
MRI and ultrasound are useful Imaging tools to evaluate abnormalities of the lateral hip.
Imaging Findings
Other Investigations
Diagnosis
Differential Diagnosis
Treatment
Acute cases (<3 months) tend to be responsive to conservative measures such as physiotherapy, strengthening exercises, acupuncture, shock-wave therapy, corticosteroid injections and NSAIDs.[4]
Ultrasound can be used for needle guidance. The injectate is deposited directly on the bone and around the injections or into the tendon itself.
CSI may provide benefit in the short term but with a high recurrence rate and poorer results in the long term. Given the paucity of treatments for chronic gluteal tendinopathy (>3 months) and transient amelioration effect of CSI, there is interest whether biologic products such as PRP may provide better long-term outcomes for this condition[5]
The use of PRP has been controversial, especially in tendinopathies given its slower onset of action to see its efficacy. Some tendons respond differently to PRP. Technician skills, type on condition being treated and type of PRP used are all variables that can affect its effectiveness.
Activity Modification
Avoid compression.
Exercise
Leap Trial
Surgery
Gluteal tendon reconstruction is experimental with no standardised techniques.[4]
Follow Up and Prognosis
Large number of patients fail non-operative treatment with significant levels of dysfunction making important to find novel treatment strategies.
Summary
Downloads
Links
How physiotherapists treat gluteal tendinopathy by Dr Alison Grimaldi
References
- ā 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Grimaldi, Alison; Mellor, Rebecca; Hodges, Paul; Bennell, Kim; Wajswelner, Henry; Vicenzino, Bill (2015-05-13). "Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management". Sports Medicine. 45 (8): 1107ā1119. doi:10.1007/s40279-015-0336-5. ISSN 0112-1642.
- ā 2.0 2.1 2.2 2.3 Cook, J L; Purdam, C R (2008-09-23). "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy". British Journal of Sports Medicine. 43 (6): 409ā416. doi:10.1136/bjsm.2008.051193. ISSN 0306-3674.
- ā Segal, Neil A.; Torner, James; Xie, Hui; Felson, David; Curtis, Jeffrey R.; Nevitt, Michael (2006-11-01). "PR_092: Greater Trochanteric Pain Syndrome: Epidemiology and Associated Factors". Archives of Physical Medicine and Rehabilitation (in English). 87 (11): e20. doi:10.1016/j.apmr.2006.08.114. ISSN 0003-9993.
- ā 4.0 4.1 Koulischer, Simon; Callewier, Antoine; Zorman, David (June 2017). "Management of greater trochanteric pain syndrome : a systematic review". Acta Orthopaedica Belgica. 83 (2): 205ā214. ISSN 0001-6462. PMID 30399983.
- ā Fitzpatrick, Jane; Bulsara, Max K.; OāDonnell, John; Zheng, Ming Hao (April 2019). "Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up". The American Journal of Sports Medicine (in English). 47 (5): 1130ā1137. doi:10.1177/0363546519826969. ISSN 0363-5465.
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
