Spinopelvic parameters in greater trochanteric pain syndrome: a retrospective case-control study

Patients with operative gluteus medius tears often present with a concomitant history of lumbar pathology

Background

Studies have indicated a correlation between patients presenting with decreased gluteus medius function and a history of lumbar pathology (LP). However, literature investigating the relationship between the prevalence of lumbar pathology in patients with gluteus medius tears is lacking. The purpose of this study is to determine if patients undergoing repair for gluteus medius tears have concomitant lumbar pathology.

Materials and methods

Patients aged 18-80 who underwent endoscopic gluteus medius repair by one fellowship-trained surgeon between May 2016 and May 2020 for peritrochanteric pain/tenderness, abductor weakness, and MRI findings consistent with a gluteus medius tear were identified. Pre-operative and post-operative data were gathered using the Visual Acuity Scale (VAS), and post-operative data was gathered using the Abbreviated International Hip Outcome Tool (iHOT-12) and Hip Outcome Score - Activities of Daily Living (HOS-ADL). Outcomes were compared between patients with and without a history of lumbar pathology.

Results

Of 23 hips, 19 (82.6%) presented with a prior history of lumbar pathology. Twenty (87.0%) patients identified were female. A total of 19 hips were included with completed PROM scores. Patients with lumbar pathology had similar pre and post-operative patient reported outcomes.

Conclusions

This study demonstrates a high incidence of lumbar pathology in patients presenting for operative gluteus medius tears, which may suggest an association between lumbar disease and the development of gluteus medius weakness and tears.

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

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.