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Kjeldsen T, Hvidt KJ, Bohn MB, Mygind-Klavsen B, Lind M, Semciw AI, Mechlenburg I. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy 2024; 123:69-80. [PMID: 38295551 DOI: 10.1016/j.physio.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To estimate the effectiveness of exercise at end of treatment and long-term follow-up compared to a control condition or other conservative treatments in patients with Greater Trochanteric Pain Syndrome (GTPS). METHODS Databases were searched September 2021 and updated September 2023. Randomized controlled trials (RCT) comparing exercise interventions for patients with GTPS, to a control condition; corticosteroid injection; shock wave therapy; or other types of exercise programs were included. Risk of bias was assessed using the ROB2 tool. Meta-analyses were performed using a random-effects model. The certainty of the evidence was rated by the GRADE approach. RESULTS Six RCTs including a total of 733 patients with GTPS were included. Three trials compared exercise to sham exercise or wait-and-see control groups, two trials compared exercise to corticosteroid injection, two trials compared exercise to shockwave therapy, and one trial compared exercise to another type of exercise. Meta-analyses showed that in the long term, exercise slightly reduces hip pain and disease severity, while slightly improving patient-reported physical function and global rating of change compared to a control condition. No serious adverse events were reported. Compared to corticosteroid injection, exercise improves long-term global rating of change. CONCLUSION The current evidence supports a strong recommendation for exercise as first line treatment in patients clinically diagnosed with GTPS. Compared to corticosteroid injection, exercise is superior in increasing the likelihood that a patient experiences a meaningful global improvement. These results are based on few trials and a moderate number of patients. REGISTRATION This review was prospectively registered in the PROSPERO database of systematic reviews (ID: CRD42021261380). CONTRIBUTION OF PAPER.
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Affiliation(s)
- Troels Kjeldsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | | | - Marie Bagger Bohn
- H-HiP, Department of Orthopaedic Surgery, Horsens Regional Hospital, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Martin Lind
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Adam Ivan Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Australia; Department of Allied Health, Northern Health, Australia
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
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Domb BG, Owens JS, Maldonado DR, Harris WT, Perez-Padilla PA, Sabetian PW. Favorable and Durable Outcomes at 10-Year Follow Up After Endoscopic Gluteus Medius Repair With Concomitant Hip Arthroscopy. Arthroscopy 2023:S0749-8063(23)00915-5. [PMID: 37967732 DOI: 10.1016/j.arthro.2023.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To evaluate 10-year patient-reported outcome (PRO) scores following endoscopic surgery for gluteus medius partial and full-thickness tears with concomitant hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome (FAIS). METHODS Prospectively collected data on patients followed for a minimum of 10 years after endoscopic gluteus medius repair with concomitant hip arthroscopy performed by a single surgeon were retrospectively analyzed. Patients with preoperative and 10-year follow-up for the following PROs were included: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS) score for pain. RESULTS There were 13 patients eligible for inclusion, 11 (84.6%) of whom had 10-year follow up, with a mean of 127.6 months (range: 120.0-140.2 months). The group consisted of 10 females (90.9%) and one male (9.1%) with a mean age at surgery of 60.1 years (range: 46.2-74.8 years). PRO scores improved from preoperative to 10-year follow-up as follows: mHHS from 60.4 to 88.0 (P = .011); NAHS from 50.1 to 90.6 (P < .001); HOS-SS from 37.5 to 85.1 (P = .001); and VAS from 4.8 to 1.2 (P = .006). Mean patient satisfaction rating was 8.3. Patients achieved PASS and MCID for mHHS and HOS-SSS at a rate of 81.8%. There was no significant decline in PROs or satisfaction between 2, 5, and 10 years postoperatively. All patients underwent concomitant hip arthroscopy and labral treatment (debridement or repair). One patient, who had arthroscopic findings of acetabular and femoral outerbridge grade 4 lesions, subsequently underwent total hip arthroplasty; however, the GM was assessed during the THA, and it was verified that the repair was intact. There were no clinical failures, secondary operations, or complications. CONCLUSIONS Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - W Taylor Harris
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
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Meghpara MB, Yelton MJ, Annin S, Rosinsky PJ, Shapira J, Maldonado DR, Lall AC, Domb BG. Return to Activity After Gluteus Medius Repair in Active Patients Older Than 50 Years. Orthop J Sports Med 2021; 9:2325967120967968. [PMID: 33553438 PMCID: PMC7844460 DOI: 10.1177/2325967120967968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Gluteus medius (GM) tears are a known cause of dysfunction and disability predominantly in older women. Purpose To report on return to activity, patient-reported outcomes (PROs), and a uniquely calculated minimal clinically important difference (MCID) at a minimum 2-year follow-up for active patients who had undergone either an endoscopic or an open GM repair. Study Design: Case series; Level of evidence, 4. Methods: Patients were considered eligible if they (1) underwent a GM repair with or without concomitant central and peripheral compartment procedures; (2) had baseline preoperative and minimum 2-year scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain; and (3) participated in a physical activity or sport within 1 year before their surgery. Return to activity was defined as the patient being able to participate in his or her activity at a minimum of 2 years postoperatively. Results: Of 87 eligible patients, 84 (96.6%) met all inclusion criteria. The mean follow-up was at 44.5 months. Six patients (7.1%) underwent an open GM repair, while the remaining 78 (92.9%) underwent an endoscopic GM repair. Concomitant central and peripheral compartment arthroscopic procedures were performed in 69 patients (82.1%). All PROs significantly (P < .001) improved as follows: mHHS, from 59.0 to 85.8; NAHS, from 57.9 to 84.0; HOS-SSS, from 32.6 to 63.7; and VAS pain, from 5.4 to 1.9. A total of 57 patients (67.9%) returned to their preoperative activity at the 2-year follow-up. The MCID was calculated for the mHHS, NAHS, and HOS-SSS to be 7.5, 7.4, and 10.9, respectively, with 79.3%, 86.4%, and 70.2% of patients achieving the MCID for each respective PROs. Conclusion: Active patients over the age of 50 years may benefit from endoscopic or open repair of GM tears, as the majority of patients in our cohort were able to return to their activity of choice. All measured PROs had significantly improved at a minimum 2-year follow-up, with high survivorship, satisfaction, and clinical effectiveness. Patients with partial-thickness tears compared with full-thickness tears and those who underwent isolated GM repair compared with GM repair with concomitant procedures had similar return to activity rates and PROs at the latest follow-up.
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Affiliation(s)
- Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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Kattimani R, Bayley M. Is greater trochanteric pain syndrome influenced by pelvic anatomy? A radiological review. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pérez-Barbosa L, Garza-Elizondo MA, Vega-Morales D, Esquivel-Valerio JA, Peláez-Ballestas I, Vázquez-Fuentes BR, Galarza-Delgado DÁ. High frequency of rheumatic regional pain syndromes in first-degree relatives of patients with rheumatoid arthritis. Clin Rheumatol 2020; 39:3303-3307. [PMID: 32388744 DOI: 10.1007/s10067-020-05029-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 01/08/2023]
Abstract
First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) have a higher risk for the development of RA. In the stages prior to the development of arthritis, nonspecific musculoskeletal (MSK) manifestations may occur. The aim of the study is to describe the frequency of rheumatic regional pain syndromes (RRPS) in FDR of RA patients. A cross-sectional study was carried out from July 2016 to September 2018. Parents, offspring, and siblings of RA patients completed the Community Oriented Program in the Rheumatic Diseases (COPCORD) questionnaire. Rheumatoid factor (RF) IgG, IgM, and IgA; anticitrullinated peptide antibodies (ACPAs); C-reactive protein (CRP); and erythrocyte sedimentation rate (ESR) were determined. All subjects with a positive COPCORD (defined by the presence of musculoskeletal pain) were evaluated and classified. Three hundred thirty-five FDRs participated, 75.8% were female, mean age of 44.15 years; 138 (41.2%) were diagnosed with at least one RRPS; 72 (21.5%) had rotator cuff tendinitis, 51 (15.2%) pes anserine bursitis, and 39 (11.6) lateral epicondylitis; RA was diagnosed in 24 (7.16%) subjects, undifferentiated arthritis (UA) in 30 (8.9%) and inflammatory arthralgia (AI) in 104 (31%). We found anti-CCP positivity in 6.8%, RF IgA in 22.3%, RF IgM in 48.6%, and RF IgG in 8.9%. The presence of RRPS was higher in this RA-FDR group compared to general population. Clinical evaluation of this risk group should include screening for RRPS.
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Affiliation(s)
- Lorena Pérez-Barbosa
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Mario Alberto Garza-Elizondo
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico.
| | - David Vega-Morales
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Ingris Peláez-Ballestas
- Rheumatology Unit, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, 06720, México City, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Dionicio Ángel Galarza-Delgado
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
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Musculoskeletal Injuries and Regenerative Medicine in the Elderly Patient. Phys Med Rehabil Clin N Am 2017; 28:777-794. [DOI: 10.1016/j.pmr.2017.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. J Orthop Sports Phys Ther 2017; 47:232-239. [PMID: 28257614 DOI: 10.2519/jospt.2017.6994] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Prospective, randomized, partially blinded. Background Greater trochanteric pain syndrome (GTPS) is the current terminology for what was once called greater trochanteric or subgluteal bursitis. Cortisone (corticosteroid) injection into the lateral hip has traditionally been the accepted treatment for this condition; however, the effectiveness of injecting the bursa with steroids is increasingly being questioned. An equally effective treatment with fewer adverse side effects would be beneficial. Objective To investigate whether administration of dry needling (DN) is noninferior to cortisone injection in reducing lateral hip pain and improving function in patients with GTPS. Methods Forty-three participants (50 hips observed), all with GTPS, were randomly assigned to a group receiving cortisone injection or DN. Treatments were administered over 6 weeks, and clinical outcomes were collected at baseline and at 1, 3, and 6 weeks. The primary outcome measure was the numeric pain-rating scale (0-10). The secondary outcome measure was the Patient-Specific Functional Scale (0-10). Medication intake for pain was collected as a tertiary outcome. Results Baseline characteristics were similar between groups. A noninferiority test for a repeated-measures design for pain and averaged function scores at 6 weeks (with a noninferiority margin of 1.5 for both outcomes) indicated noninferiority of DN versus cortisone injection (both, P<.01). Medication usage (P = .74) was not different between groups at the same time point. No adverse side effects were reported. Conclusion Cortisone injections for GTPS did not provide greater pain relief or reduction in functional limitations than DN. Our data suggest that DN is a noninferior treatment alternative to cortisone injections in this patient population. Level of Evidence Therapy, level 1b. Registered December 2, 2015 at www.clinicaltrials.gov (NCT02639039). J Orthop Sports Phys Ther 2017;47(4):232-239. Epub 3 Mar 2017. doi:10.2519/jospt.2017.6994.
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Wang MY, Wang XB, Sun XH, Liu FL, Huang SC. Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis. Exp Ther Med 2016; 12:3035-3040. [PMID: 27882112 DOI: 10.3892/etm.2016.3695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/19/2016] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis and management improve the outcome of patients with rheumatoid arthritis (RA). The present study explored the application of high-frequency ultrasound (US) and magnetic resonance imaging (MRI) in the detection of early RA. Thirty-nine patients (20 males and 19 females) diagnosed with early RA were enrolled in the study. A total of 1,248 positions, including 858 hand joints and 390 tendons, were examined by high-frequency US and MRI to evaluate the presence of bone erosion, bone marrow edema (BME), synovial proliferation, joint effusion, tendinitis and tendon sheath edema. The imaging results of the above abnormalities, detected by US, were compared with those identified using MRI. No statistically significant overall changes were observed between high-frequency US and MRI in detecting bone erosion [44 (5.1%) vs. 35 (4.1%), respectively; P>0.05], tendinitis [18 (4.6%) vs. 14 (1.5%), respectively; P>0.05] and tendon sheath edema [37 (9.5%) vs. 30 (7.7%), respectively; P>0.05]. Significant differences were observed between high-frequency US and MRI with regards to the detection of synovial proliferation [132 (15.4%) vs. 66 (7.7%), respectively; P<0.05] and joint effusion [89 (10.4%) vs. 52 (6.1%), respectively; P<0.05]. In addition, significant differences were identified between the detection of BME using MRI compared with high-frequency US (5.5 vs. 0%, respectively; P<0.05). MRI and high-frequency US of the dominant hand and wrist joints were comparably sensitive to bone erosion, tendinitis and tendon sheath edema. However, MRI was more sensitive in detecting bone marrow edema in early RA, while US was more sensitive in the evaluation of joint effusion and synovial proliferation. In conclusion, US and MRI are promising for the detection and diagnosis of inflammatory activity in patients with RA.
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Affiliation(s)
- Ming-Yu Wang
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Xian-Bin Wang
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Xue-Hui Sun
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Feng-Li Liu
- Department of Rheumatology and Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Sheng-Chuan Huang
- Department of Rheumatology and Ultrasonography, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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Mellor R, Grimaldi A, Wajswelner H, Hodges P, Abbott JH, Bennell K, Vicenzino B. Exercise and load modification versus corticosteroid injection versus 'wait and see' for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskelet Disord 2016; 17:196. [PMID: 27139495 PMCID: PMC4852446 DOI: 10.1186/s12891-016-1043-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/20/2016] [Indexed: 11/17/2022] Open
Abstract
Background Lateral hip pain is common, particularly in females aged 40–60 years. The pain can affect sleep and daily activities, and is frequently recalcitrant. The condition is often diagnosed as trochanteric bursitis, however radiological and surgical studies have revealed that the most common pathology is gluteus medius/minimus tendinopathy. Patients are usually offered three treatment options: (a) corticosteroid injection (CSI), (b) physiotherapy, or (c) reassurance and observation. Research on Achilles and patellar tendons has shown that load modification and exercise appears to be more effective than other treatments for managing tendinopathy, however, it is unclear whether a CSI, or a load modification and exercise-based physiotherapy approach is more effective in gluteal tendinopathy. This randomised controlled trial aims to compare the efficacy on pain and function of a load modification and exercise-based programme with a CSI and a ‘wait and see’ approach for gluteal tendinopathy. Methods Two hundred one people with gluteal tendinopathy will be randomly allocated into one of three groups: (i) CSI; (ii) physiotherapist-administered load modification and exercise intervention; and (iii) wait and see approach. The CSI therapy will consist of one ultrasound (US) guided CSI around the affected tendons and advice on tendon care. Education about load modification will be delivered in physiotherapy clinics and the exercise programme will be both home-based and supervised. The group allocated the wait and see approach will receive basic tendon care advice and reassurance in a single session by a trial physiotherapist. Outcomes will be evaluated at baseline, 4, 8, 12, 26 and 52 weeks using validated global rating of change, pain and physical function scales, psychological measures, quality of life and physical activity levels. Hip abductor muscle strength will be measured at baseline and 8 weeks. Economic evaluation will be performed to investigate the cost-effectiveness of the active interventions compared with the wait and see approach. Analyses will be conducted on an intention-to-treat basis using logistic and linear mixed regression models and the economic evaluation will report incremental cost-utility ratios. The trial reporting will comply with CONSORT guidelines. Discussion This study will provide clinicians with directly applicable evidence of the relative efficacy of three common approaches to the management of gluteal tendinopathy. Trial registration Australia New Zealand Clinical Trials Registry ACTRN12612001126808. Date Registered: 22/10/2012. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1043-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, 4072, Australia
| | | | - Henry Wajswelner
- Department of Physiotherapy & Lifecare Physiotherapy, LaTrobe University, Bundoora, VIC, 3086, Australia
| | - Paul Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, 4072, Australia
| | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, NZ, 9054, New Zealand
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, 4072, Australia.
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Chen HS, Lin MT, Hong CZ, Hsieh YL, Chou LW. Percutaneous Fascia Release for Treating Chronic Recurrent Gluteal Myofascial Pain—A Pilot Study of a New Technique. Rehabil Process Outcome 2015. [DOI: 10.4137/rpo.s30483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the therapeutic effectiveness of percutaneous fascia release to treat chronic recurrent gluteal myofascial pain related to recurrent tendonitis or bursitis at the attachment sites. Methods Five patients (three males, two females; aged 48.6 ± 8.9 years) with myofascial trigger points in the gluteus medius muscle were treated. Outcome measures, including pain intensity, pressure pain threshold, and the relative strength of hip abduction, were assessed before, immediately after, and six months after the treatment. The data measured before and after treatment (different times) on visual analog scale, pressure pain threshold, and relative hip abduction strength were analyzed by Wilcoxon signed-rank test and paired t-test, respectively, for the comparisons between time points. Results Reduction in pain intensity and increase in the pressure pain threshold and the relative hip abduction strength were found in all five patients after treatment when compared with those of before treatment ( P < 0.05). Moreover, all of these improvements existed for at least six months ( P > 0.05). Conclusions Percutaneous fascia release of gluteal muscle insertion sites can be used to treat chronic gluteal pain related to subtrochanteric bursitis to avoid recurrence, if other treatment cannot control the recurrence, although this was demonstrated only on a small sample size without control and blind assessment in the pilot study.
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Affiliation(s)
- Hsin-Shui Chen
- Department of Physical Medicine and Rehabilitation, China Medical University Beigang Hospital, Yunlin, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Ta Lin
- Kuan-Ta Rehabilitation and Pain Clinic, Taichung, Taiwan
| | | | - Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
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Takahashi H, Yamashita H, Kubota K, Miyata Y, Okasaki M, Morooka M, Takahashi Y, Kaneko H, Kano T, Mimori A. Differences in fluorodeoxyglucose positron emission tomography/computed tomography findings between elderly onset rheumatoid arthritis and polymyalgia rheumatica. Mod Rheumatol 2014; 25:546-51. [DOI: 10.3109/14397595.2014.978936] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schwartsmann CR, Loss F, de Freitas Spinelli L, Furian R, Silva MF, Zanatta JM, Boschin LC, Gonçalves RZ, Yépez AK. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2014; 49:267-70. [PMID: 26229811 PMCID: PMC4511649 DOI: 10.1016/j.rboe.2014.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
Abstract
Objective this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty. Methods sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically. Results there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histologically in nine patients (14.5%), of whom six were female (66.7%) and three were male (33.3%). Conclusions 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients.
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Affiliation(s)
- Carlos Roberto Schwartsmann
- Serviço de Ortopedia e Traumatologia do Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
- Corresponding author.
| | - Felipe Loss
- Serviço de Ortopedia e Traumatologia do Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Leandro de Freitas Spinelli
- Serviço de Ortopedia e Traumatologia do Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Roque Furian
- Serviço de Ortopedia e Traumatologia do Complexo Hospitalar da Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marcelo Faria Silva
- Departamento de Fisioterapia da Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Schwartsmann CR, Loss F, de Freitas Spinelli L, Furian R, Faria Silva M, Mazzuchello Zanatta J, Carbonera Boschin L, Zilles Gonçalves R, Kerbes Yépez A. Associação entre bursite trocantérica, osteoartrose e artroplastia total do quadril. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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McMahon SE, Smith TO, Hing CB. A systematic review of imaging modalities in the diagnosis of greater trochanteric pain syndrome. Musculoskeletal Care 2012; 10:232-9. [PMID: 22764065 DOI: 10.1002/msc.1024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To identify the most effective imaging modality in the investigation of greater trochanteric pain syndrome (GTPS). METHODS A narrative review of the available literature was conducted. A total of 326 studies were identified by a literature search, ten of which were included for review. Seven studies investigated magnetic resonance imaging (MRI), one ultrasound scan (USS), one plain radiography and one bone scintigraphy. RESULTS On analysis, MRI was found consistently to have the highest correlation with clinical and intraoperative findings. USS and plain radiography provided encouraging results. However, conclusions drawn from this were limited by the paucity of data. CONCLUSIONS The study provided encouraging results, although conclusions drawn from them were limited by the paucity of data. We believe that MRI should be the current investigation of choice for GTPS. However, further study is required in the form of multicentre, randomized controlled trials to confirm the validity of the conclusions presented here.
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Affiliation(s)
- Samuel E McMahon
- Manchester Medical School, University of Manchester, Manchester, UK.
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Blank E, Owens BD, Burks R, Belmont PJ. Incidence of greater trochanteric pain syndrome in active duty US military servicemembers. Orthopedics 2012; 35:e1022-7. [PMID: 22784894 DOI: 10.3928/01477447-20120621-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although greater trochanteric pain syndrome is thought to be a common musculoskeletal disorder, little has been reported on the incidence rates of the disorder. The purpose of this study was to determine the incidence and demographic risk factors of greater trochanteric pain syndrome in a United States military population. Multivariate Poisson regression analysis was used to estimate the rate of greater trochanteric pain syndrome per 1000 person-years, controlling for sex, race, age, rank, and branch of service. The overall unadjusted incidence rate of greater trochanteric pain syndrome was 2.03 per 1000 person-years. Women had a significantly increased adjusted incidence rate ratio for greater trochanteric pain syndrome of 5.03 (95% confidence interval [CI], 4.91-5.16). The adjusted incidence rate ratio for White servicemembers compared with Black servicemembers was 1.36 (95% CI, 1.32-1.40). The adjusted incidence rate ratio for the 40+ age group compared with the 25 to 29 age group was 2.81 (95% CI, 2.68-2.95). Compared with junior officers, junior and senior enlisted ranks had an increased adjusted incidence rate ratio of 1.94 (95% CI, 1.84-2.04) and 1.17 (95% CI, 1.12-1.23), respectively. Compared with the Navy, each branch of service had an increased adjusted incidence rate ratio, with the Army at 2.90 (95% CI, 2.80-3.01), the Marines at 1.96 (95% CI, 1.87-2.07), and the Air Force at 1.33 (95% CI, 1.27-1.38). Female servicemembers had a five-fold greater incidence of greater trochanteric pain syndrome. Increasing age, enlisted rank groups, and service in the Army, Marines, or Air Force were also significant risk factors.
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Affiliation(s)
- Elizabeth Blank
- Orthopaedic Surgery Service, General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri, USA
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Del Buono A, Papalia R, Khanduja V, Denaro V, Maffulli N. Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull 2012; 102:115-31. [PMID: 21893483 DOI: 10.1093/bmb/ldr038] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Greater trochanteric pain syndrome (GTPS) is a debilitating condition characterized by lateral hip pain located at or around the greater trochanter. SOURCE OF DATA We performed a comprehensive search of Pubmed, Medline, Ovid, Google Scholar and Embase databases, from inception of the database to 20th of June 2011, using a variety of keywords. We identified 52 relevant abstracts of articles published in peer-reviewed journals. Fourteen studies reporting the outcomes of patients undergoing conservative and surgical management of GTPS were selected. AREAS OF AGREEMENT Significant pain relief and improved outcomes were observed after conservative and surgical management of GTPS. The modified Coleman methodology score averaged 44.7 (range from 14 to 82), evidencing an overall low-to-moderate quality of the studies. Repetitive low-energy radial shock wave therapy and home training approach provide beneficial effect over months, with almost 80% success rate at 15 months. AREAS OF CONTROVERSY Poor available data extracted from small studies do not allow definitive conclusions to be drawn on the best treatment for GTPS. GROWING POINTS Further multi-centre prospective studies are necessary to confirm the general validity of the findings reported. AREAS TIMELY FOR DEVELOPING RESEARCH Future research and trials should focus on the application and effectiveness of the various conservative modalities for management of GTPS. CONCLUSION The effectiveness of the various treatment modalities needs to be tested in carefully conducted randomized controlled trials.
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Affiliation(s)
- Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Italy
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Ilizaliturri VM, Camacho-Galindo J, Evia Ramirez AN, Gonzalez Ibarra YL, McMillan S, Busconi BD. Soft tissue pathology around the hip. Clin Sports Med 2011; 30:391-415. [PMID: 21419963 DOI: 10.1016/j.csm.2010.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Snapping hip syndromes have been treated with open surgery for many years. Recently, endoscopic techniques have been developed for treatment of snapping hip syndromes with results that are at least comparable if not better than those reported for open procedures. The greater trochanteric pain syndrome is well known by orthopedic surgeons. However, deep understanding of the pathologic conditions generating pain in the greater trochanteric region and endoscopic access to it has only recently been described. Although evidence regarding endoscopic techniques for the treatment of the greater trochanteric pain syndrome is mainly anecdotal, early published reports are encouraging.
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Affiliation(s)
- Victor M Ilizaliturri
- National Rehabilitation Institute of Mexico, Universidad Nacional Autónoma de México, Avenue México Xochimilco 289, Col. Arenal de Guadalupe, Mexico City, Mexico.
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Abstract
Bursitis is a common cause of musculoskeletal pain and often prompts orthopaedic consultation. Bursitis must be distinguished from arthritis, fracture, tendinitis, and nerve pathology. Common types of bursitis include prepatellar, olecranon, trochanteric, and retrocalcaneal. Most patients respond to nonsurgical management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs. In cases of septic bursitis, oral antibiotics may be administered. Local corticosteroid injection may be used in the management of prepatellar and olecranon bursitis; however, steroid injection into the retrocalcaneal bursa may adversely affect the biomechanical properties of the Achilles tendon. Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis.
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Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med 2009; 37:1981-90. [PMID: 19439758 DOI: 10.1177/0363546509334374] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are no controlled studies testing the efficacy of various nonoperative strategies for treatment of greater trochanter pain syndrome. Hypothesis The null hypothesis was that local corticosteroid injection, home training, and repetitive low-energy shock wave therapy produce equivalent outcomes 4 months from baseline. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 2. METHODS Two hundred twenty-nine patients with refractory unilateral greater trochanter pain syndrome were assigned sequentially to a home training program, a single local corticosteroid injection (25 mg prednisolone), or a repetitive low-energy radial shock wave treatment. Subjects underwent outcome assessments at baseline and at 1, 4, and 15 months. Primary outcome measures were degree of recovery, measured on a 6-point Likert scale (subjects with rating completely recovered or much improved were rated as treatment success), and severity of pain over the past week (0-10 points) at 4-month follow-up. RESULTS One month from baseline, results after corticosteroid injection (success rate, 75%; pain rating, 2.2 points) were significantly better than those after home training (7%; 5.9 points) or shock wave therapy (13%; 5.6 points). Regarding treatment success at 4 months, radial shock wave therapy led to significantly better results (68%; 3.1 points) than did home training (41%; 5.2 points) and corticosteroid injection (51%; 4.5 points). The null hypothesis was rejected. Fifteen months from baseline, radial shock wave therapy (74%; 2.4 points) and home training (80%; 2.7 points) were significantly more successful than was corticosteroid injection (48%; 5.3 points). CONCLUSION The role of corticosteroid injection for greater trochanter pain syndrome needs to be reconsidered. Subjects should be properly informed about the advantages and disadvantages of the treatment options, including the economic burden. The significant short-term superiority of a single corticosteroid injection over home training and shock wave therapy declined after 1 month. Both corticosteroid injection and home training were significantly less successful than was shock wave therapy at 4-month follow-up. Corticosteroid injection was significantly less successful than was home training or shock wave therapy at 15-month follow-up.
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Affiliation(s)
- Jan D Rompe
- OrthoTrauma Evaluation Center, Mainz, Germany.
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Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 2009; 108:1662-70. [PMID: 19372352 DOI: 10.1213/ane.0b013e31819d6562] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Greater trochanteric pain syndrome (GTPS) is a term used to describe chronic pain overlying the lateral aspect of the hip. This regional pain syndrome, once described as trochanteric bursitis, often mimics pain generated from other sources, including, but not limited to myofascial pain, degenerative joint disease, and spinal pathology. The incidence of greater trochanteric pain is reported to be approximately 1.8 patients per 1000 per year with the prevalence being higher in women, and patients with coexisting low back pain, osteoarthritis, iliotibial band tenderness, and obesity. Symptoms of GTPS consist of persistent pain in the lateral hip radiating along the lateral aspect of the thigh to the knee and occasionally below the knee and/or buttock. Physical examination reveals point tenderness in the posterolateral area of the greater trochanter. Most cases of GTPS are self-limited with conservative measures, such as physical therapy, weight loss, nonsteroidal antiinflammatory drugs and behavior modification, providing resolution of symptoms. Other treatment modalities include bursa or lateral hip injections performed with corticosteroid and local anesthetic. More invasive surgical interventions have anecdotally been reported to provide pain relief when conservative treatment modalities fail.
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Affiliation(s)
- Bryan S Williams
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Rush University Medical Center, Chicago, Illinois 60612-3833, USA.
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Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis. INTERNATIONAL ORTHOPAEDICS 2009; 33:1223-7. [PMID: 19214507 DOI: 10.1007/s00264-009-0727-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 12/19/2008] [Accepted: 12/20/2008] [Indexed: 10/21/2022]
Abstract
This article presents a simple technique for fascia lata lengthening that is less aggressive, can be performed under local anaesthetic with little morbidity and disability, and has excellent results. Eleven patients (13 hips) were enrolled in this study. Mean age was 54.6 years, there was one man and ten women. Outcomes were assessed by using a visual analog pain scale, Harris hip score and Lickert scale (satisfaction). There was a mean follow-up time of 43 months (range 15-84). All patients were scored by the Harris hip scale with a mean improvement from 61 (range 48-77) to 91 (range 76-95) after surgery. The mean visual analogue scale (VAS) score improved from 83 (range 60-99) to 13 (range 0-70). We had 12 of 13 patients reporting a good result. Mean surgical time was 15 min, and only one seroma was reported as a complication. No inpatient management was needed. In conclusion, distal "Z" lengthening of the fascia lata appears to be a good alternative for treatment of this condition.
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Abstract
BACKGROUND AND OBJECTIVES Greater trochanteric (GT) bursitis is a common cause of hip pain. Previously, the etiology of the trochanteric pain syndrome was thought to be caused by inflammation of the subgluteus maximus bursa (i.e., bursitis). Recently, MRI and ultrasound studies have brought into serious doubt the idea that bursitis is the etiology for trochanteric pain. To our knowledge, no histologic study of GT bursitis has been reported to date. The purpose of this study is to evaluate the histopathology of patients with and without the clinical syndrome of GT bursitis to assess for the presence of bursal inflammation. DESIGN AND METHODS This is a prospective, case-controlled, blinded study of the histopathologic features of controls and patients with GT bursitis. We recruited patients who required total hip arthroplasty (THA) for rheumatoid or osteoarthritis. Inclusion criteria for the study consisted of the following: needing THA as standard of care; THA secondary to OA or RA; age greater than 18; and minimal risk for surgery by the American Heart Association Criteria. We excluded anyone who received a GT bursa injection 9 months before surgery. Eligible participants were then stratified as cases or controls using the 1985 clinical criteria for GT bursitis. The harvesting of the bursa required no modification of the surgical procedure. The specimens were then examined by 2 independent pathologists who were blinded as to the patients' clinical status. RESULTS Six bursal specimens were evaluated by 2 blinded surgical pathologists revealing primarily fibroadipose tissue with no signs of acute or chronic inflammation. There were 3 bursas in the control group and 2 specimens with clinical GT bursitis. No significant differences were found between the specimens of the 2 groups. CONCLUSIONS The results of this small prospective observational histologic study, along with recent MRI and ultrasound studies on the topic, strongly suggest that there is no etiologic role of bursal inflammation in the trochanteric pain syndrome.
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Fujiki EN, Furlan C, Valesin Filho ES, Soutello HPF, Yamagushi EN. Bursite peritrocantérica: descrição de nova manobra semiológica para auxílio diagnóstico. ACTA ORTOPEDICA BRASILEIRA 2008. [DOI: 10.1590/s1413-78522008000500009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O estudo tem como objetivo testar a validade de nova manobra semiológica no diagnóstico de bursite peritrocantérica. Foram avaliados 30 pacientes, com diagnóstico clínico de bursite do grande trocanter. Todos os pacientes foram submetidos à radiografia de bacia AP e Perfil. Quando necessário, outros exames de imagem foram realizados, com a finalidade de descartar doenças associadas; os pacientes foram submetidos a duas manobras semiológicas no quadril são e afetado. TESTE 1: paciente em decúbito dorsal, o membro examinado é aduzido em extensão cruzando sobre o membro contralateral, com o calcâneo em contato com a maca, faz-se a flexão do quadril até aproximadamente 90º, o quadril ao final da manobra estará em flexão, adução e leve rotação externa, durante a manobra poderá ser referida dor na região do trocanter maior. TESTE 2: a posição final do TESTE 1, é a posição inicial desta, faz-se a adução forçada do quadril, pode haver referencia de dor ou exacerbação. Os resultados das manobras foram submetidos ao estudo estatístico, que demonstrou serem os exames diferentes entre si, porém complementares. O teste 2 mostrou ser positivo em 96,6%. As manobras semiológicas denominadas de TESTE 1 e 2, podem ser utilizadas como auxiliares nos diagnósticos clínicos das bursites peritrocanterianas.
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Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 2007; 88:988-92. [PMID: 17678660 PMCID: PMC2907104 DOI: 10.1016/j.apmr.2007.04.014] [Citation(s) in RCA: 242] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe the prevalence of greater trochanteric pain syndrome (GTPS); to determine whether GTPS is associated with iliotibial band (ITB) tenderness, knee osteoarthritis (OA), body mass index (BMI), or low back pain (LBP); and to assess whether GTPS is associated with reduced hip internal rotation, physical activity, and mobility. DESIGN Cross-sectional, population-based study. SETTING Multicenter observational study. PARTICIPANTS Community-dwelling adults (N=3026) ages 50 to 79 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Greater trochanteric tenderness to palpation in subjects with complaints of hip pain and no signs of hip OA or generalized myofascial tenderness. RESULTS The prevalence of unilateral and bilateral GTPS was 15.0% and 8.5% in women and 6.6% and 1.9% men. Odds ratio (OR) for women was 3.37 (95% confidence interval [CI], 2.67-4.25), but age and race were not significantly associated with GTPS. In a multivariate model, adjusting for age, sex, ITB tenderness, ipsilateral and contralateral knee OA, BMI, and LBP, ITB tenderness (OR=1.72; 95% CI, 1.34-2.19), knee OA ipsilaterally (OR=3.47; 95% CI, 2.72-4.42) and contralaterally (OR=1.74; 95% CI, 1.32-2.28), and LBP (OR=2.79; 95% CI, 2.22-3.50) were positively related to GTPS. In this complete model, BMI was not associated with GTPS (OR=1.10; 95% CI, 0.80-1.52 when comparing >or=30 with <25kg/m(2)). Hip internal rotation range of motion did not differ based on GTPS status. After multivariate adjustment, GTPS did not alter physical activity score, but bilateal GTPS was significantly associated with a higher 20-meter walk time and chair stand time. CONCLUSIONS The higher prevalence of GTPS in women and in adults with ITB pain or knee OA indicates that altered lower-limb biomechanics may be related to GTPS. Slower functional performance in those with GTPS suggests that the study of targeted rehabilitation may be useful. A longitudinal study will be necessary to identify causal factors and outcomes of interventions.
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Affiliation(s)
- Neil A Segal
- Department of Orthopaedics & Rehabilitation, University of Iowa and VA Medical Center, Iowa City, IA, USA.
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Álvarez-Nemegyei J, Canoso JJ. Nombre y clasificación de los reumatismos de tejidos blandos. ACTA ACUST UNITED AC 2007; 3:151-2. [DOI: 10.1016/s1699-258x(07)73612-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 04/26/2007] [Indexed: 11/28/2022]
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Álvarez-Nemegyei J. Eficacia del tratamiento local con glucocorticoides en los síndromes de dolor regional apendicular. Una revisión del conocimiento actual. ACTA ACUST UNITED AC 2005; 1 Suppl 2:S3-7. [DOI: 10.1016/s1699-258x(05)72767-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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