1
|
Atilano L, Martin N, Iglesias G, Martin JI, Mendiola J, Aiyegbusi A, Bully P, Rodriguez-Palomo M, Andia I. Sonographic pathoanatomy of greater trochanteric pain syndrome. J Ultrasound 2024; 27:501-510. [PMID: 38082193 PMCID: PMC11333682 DOI: 10.1007/s40477-023-00836-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/11/2023] [Indexed: 08/21/2024] Open
Abstract
AIMS To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. MATERIALS AND METHODS Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models. RESULTS Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002). CONCLUSION GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.
Collapse
Affiliation(s)
- Leire Atilano
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Nerea Martin
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
- Department of Orthopedic Surgery, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Gotzon Iglesias
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Jose Ignacio Martin
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Josu Mendiola
- Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Ayoola Aiyegbusi
- Department of Physiotherapy, Faculty of Clinical Sciences College of Medicine, University of Lagos, Lagos, Nigeria
| | - Paola Bully
- Methodological and Statistical Consulting, Sopuerta, Spain
| | - Manuel Rodriguez-Palomo
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain
- Department of Orthopedic Surgery, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Isabel Andia
- Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain.
| |
Collapse
|
2
|
Foxcroft B, Stephens G, Woodhead T, Ayre C. What factors influence pain scores following Corticosteroid injection in patients with Greater Trochanteric Pain Syndrome? A systematic review. BMC Musculoskelet Disord 2024; 25:149. [PMID: 38365672 PMCID: PMC10874005 DOI: 10.1186/s12891-024-07217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/20/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Cortico-Steroid Injections (CSI) are commonly used to treat patients with Greater Trochanteric Pain Syndrome (GTPS) but it is unclear which patients will experience improvements in pain. OBJECTIVES To identify factors that influence improvements in pain for patients with GTPS treated with CSI. DESIGN Systematic review. METHODS A search was undertaken of AMED, CINAHL, Cochrane Library, EMBASE, Medline and PEDro databases. Studies were eligible for inclusion if they investigated factors that influenced changes in pain experienced by patients with GTPS who received a CSI. Studies needed to include relevant summary statistics and tests of clinical significance. Risk Of Bias in Non-randomised Trials Of Interventions (ROBINS-I) and Risk Of Bias 2 (ROB2) tools were used to assess bias. RESULTS The search identified 466 studies, 8 were included in the final review with a total of 643 participants. There was no association between demographic variables such as age, sex, symptom duration or obesity and pain outcomes post-CSI. Having a co-existing musculoskeletal (MSK) condition such as knee osteoarthritis or sacroiliac/lumbar spine pain was associated with less pain reduction post-CSI. Injections into the Trochanteric Bursa were associated with longer lasting pain reduction than Gluteus Medius Bursa or extra-bursal injections. Image guidance of CSI maintained lower pain scores at six months but did not increase the duration of the therapeutic effect past six months. The presence of specific ultrasound scan features was not associated with differences in pain scores. CONCLUSIONS Patients with co-existing MSK conditions may not respond to CSI as well as those without. Injections into the Greater Trochanteric Bursa may have longer lasting benefit. Further research is needed on the use of USS imaging findings and image guidance.
Collapse
Affiliation(s)
- Ben Foxcroft
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, The University of Leeds, Leeds, UK.
- Leeds Community Healthcare NHS Trust, Leeds, UK.
| | - Gareth Stephens
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Colin Ayre
- The University of Bradford, Bradford, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, UK
| |
Collapse
|
3
|
Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part IV, hip. Eur Radiol 2021; 32:551-560. [PMID: 34146140 PMCID: PMC8660721 DOI: 10.1007/s00330-021-07997-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 12/01/2022]
Abstract
Objectives Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. Methods In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. Results Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. Conclusions This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. Key Points • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07997-5.
Collapse
|