The management of greater trochanteric pain syndrome: A systematic literature review

Musculoskeletal mimics for lumbosacral radiculopathy. Part 2: Specific disorders

Lumbosacral radiculopathy is a common disorder evaluated by the electrodiagnostic medicine (EDX) consultant. Making this task difficult is the abundance of radiculopathy mimics. Peripheral neurologic mimics are common, but musculoskeletal mimics are not rare and may be less familiar to many EDX consultants. Awareness of the most common musculoskeletal mimickers-particularly key historical and physical examination features that can distinguish them from radiculopathies-can lead to an accurate diagnosis for the patient and referring provider. Part 1 of this monograph covered theoretical issues surrounding why radiculopathy mimics occur. This second part reviews the most common musculoskeletal mimics, including facet arthropathy, myofascial pain syndrome, hip pathology, greater trochanteric pain syndrome, piriformis syndrome, sacroiliac joint dysfunction, hamstring pathology, iliotibial band syndrome, and plantar fasciitis. Diagnosis of these musculoskeletal mimickers is complicated by nonspecific physical examination and imaging findings, and diagnostic injections are frequently necessary to confirm the diagnosis. Treatment for most mimickers includes physical therapy, anti-inflammatory medications, guided injections, and other conservative measures, only rarely followed by surgical intervention. EDX consultants can efficiently incorporate a few high-yield maneuvers into their physical examination based on the location of the pain to provide answers to patients presenting with a musculoskeletal mimic of a lumbosacral radiculopathy.

Implementing group consultations in a lower limb musculoskeletal outpatient service to improve efficiency and maintain positive patient outcomes

BACKGROUND

Group consultations (GCs) in healthcare have been shown to improve clinical outcomes with greater efficiency. This project aimed to develop a more efficient musculoskeletal (MSK) physiotherapy-led GC approach for common lower limb problems. This was to help manage an anticipated increase in demand while maintaining high patient satisfaction and ensuring clinical effectiveness.

METHODS

Three 'Plan-Do-Study-Act' (PDSA) cycles were undertaken to test out the new approach of virtual group consultations (VGCs) and face-to-face GCs with MSK patients. These two approaches were tested and refined on four common lower limb conditions: patellofemoral pain syndrome, Achilles tendinopathy, plantar fasciopathy and knee osteoarthritis. We measured the number of patients seen, staff time, patients' experience and patient outcome scores.

RESULTS

Each patient used 45 min of physiotherapy time via the traditional one-to-one physiotherapy consultation approach, this was reduced to 22 min in the VGCs and 12 min for the face-to-face GCs. We found a significant increase in EQ-5D scores (PDSA 1: +0.19, p=0.004 and PDSA 2: +0.17, p=0.002) and the Visual Analogue Score for Pain (PDSA 1: -1.95, p=0.001 and PDSA 2: -2.6, p=0.007) from the first to the second virtual GC sessions.

CONCLUSION

GCs were shown to be an efficient way of providing physiotherapy to patients with lower limb conditions. Feedback from patients attending GCs has shown a good level of effectiveness and patient satisfaction. This alternative way to review and treat patients has yielded a reduction in physiotherapist contact time per patient, improving the efficiency of our MSK service. We did not compare these groups to the one-to-one face-to-face consultations, therefore whether they are better, is unknown.

Commentary: The Effect of Corticosteroid Injection in the Treatment of Greater Trochanter Pain Syndrome

Greater Trochanteric Pain Syndrome is a broad term employed to characterize lateral hip pain originating from the structures attached to the greater trochanter of the femur. The documented decrease in work participation, elevated levels of pain and dysfunction impeding physical activity, and diminished quality of life align with those observed in individuals with severe hip osteoarthritis. Effectively managing Greater Trochanteric Pain Syndrome can present considerable challenges. Generally, patients with Greater Trochanteric Pain Syndrome tend to respond favourably to conservative management. However, regarding the conservative approach of using corticosteroid injections there is still some debate regarding the specific estimation of effect. A recent systematic review by Wang et al. (2022) was undertaken to explore the effect of corticosteroid injection in the treatment of Greater Trochanteric Pain Syndrome. This commentary seeks to critically assess the methodologies employed in the review conducted by Wang et al. (2022) and provide a broader understanding of the findings in the context of the four pillars of advanced practice; clinical practice, leadership, education and research.

Greater Trochanteric Pain Syndrome and the Efficacy of Platelet-Rich Plasma Injections: A Systematic Review

Greater trochanteric pain syndrome (GTPS) is one of the most prevalent causes of lateral hip pain. The incidence rate is as high as 1.8 patients per 1000 annually, with females predominantly affected. We compared and analysed the effectiveness of platelet-rich plasma (PRP) injections in treating GTPS. Literature search was carried out on PubMed, Embase and Cochrane by two independent reviewers using the terms: 'Greater Trochanteric Pain syndrome' and 'Platelet-rich plasma'. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Cochrane risk of bias tool and Methodological Index for Non-Randomized Studies (MINORS) tool were used to assess bias. Nine studies were shortlisted and reviewed for patient sample size, diagnostic modalities, the presence of tendinopathy or bursitis, the number of PRP injections administered, and the length of symptom relief achieved. We analysed nine studies between 2013 to 2024 comprising of a total of 508 patients who received treatment with PRP injections for lateral hip pain. There was an improvement and sustained relief in symptoms in eight studies, while one reported no change. Many studies indicated PRP injections to be more effective than corticosteroid injections (CSI) in treating GTPS. PRP appears to be an effective injectable treatment option for GTPS, which does not respond to conservative therapy. However, due to the limitations of the current literature, there is a need for more large-scale, high-quality randomized clinical trials to assess further the effectiveness of PRP for treating GTPS.

Ultrasound-Guided Blockade of the Lateral Cutaneous Branch of the Iliohypogastric Nerve to Differentiate Neuropathy From Greater Trochanteric Pain Syndrome: Cadaver Study and Initial Case Series

OBJECTIVE

Neuropathy of the lateral cutaneous branch of the iliohypogastric nerve (LCBIN) may represent a differential diagnosis for greater trochanteric pain syndrome (GTPS). Ultrasound-guided neural blockade of the LCBIN may lead to diagnosis of this neuropathy. The aim of this study was to evaluate the accuracy of ultrasound-guided nerve block in cadavers and to present a first clinical case series of patients with neuropathy of the LCBIN where the workup for GTPS remained unremarkable. Ultrasound-guided nerve block led to pain relief in these patients, indicating LCBIN neuropathy.

METHODS

First, ultrasound-guided injections at the LCBIN were performed bilaterally in 24 fresh, non-frozen, non-embalmed body donors. Accuracy and nerve localization were validated by anatomic dissection. Second, a clinical case series of nine patients with suspected GTPS who underwent ultrasound-guided diagnostic LCBIN blockade was retrospectively analyzed.

RESULTS

Ultrasound-guided injections at the LCBIN yielded 91.7% accuracy (95% confidence interval: 0.80-0.98). On the right side the nerve was found within a range of 3-14 cm from the anterior superior iliac spine, and within a range of 7-15 cm on the left side. This clinical case series indicates that ultrasound-guided blockade at the LCBIN provides temporary pain relief and indicates the presence of LCBIN neuropathy.

CONCLUSION

Ultrasound has demonstrated high accuracy for localization and injection guidance in the examination of LCBIN. Ultrasound-guided injection of local anesthetics may help to identify LCBIN neuropathy as a differential diagnosis in patients with suspected GTPS.

Comparable Pain Levels and Functional Outcomes With and Without the Use of Dermal Allograft Augmentation in Endoscopic Gluteus Medius Repair

PURPOSE

To compare retrospectively the clinical outcomes of patients undergoing endoscopic gluteal tendon repair with and without the use of dermal allograft augmentation.

METHODS

A retrospective review of prospectively collected data, single-surgeon cohort study was performed on all patients undergoing endoscopic gluteus medius repair (GMR) and GMR with augmentation (GMR-A) between April 2017 and April 2022. Dermal allograft augmentation was used in cases where intraoperative gluteus tissue quality was poor. An electronic survey of patient-reported outcome measures (PROMs) was completed at a minimum of 1 year postoperatively. PROMs included a visual analog scale (VAS) for pain; the University of California, Los Angeles (UCLA) Activity Scale; the modified Harris Hip Score (mHHS); the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS); and the Single Assessment Numeric Evaluation (SANE). The proportion of patients achieving the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for each PROM were compared between groups.

RESULTS

Sixty-four patients were reached for follow-up (26 GMR, 38 GMR-A). No differences were found between the groups in terms of demographics. There was a significantly longer time to follow-up in the GMR group (39.4 ± 26.9 vs 24.2 ± 11.7 months, P = .003). There were no differences between the GMR and GMR-A groups in terms of postoperative PROMs including VAS (3.3 ± 2.6 vs 3.3 ± 2.8, P = .99), UCLA (5.8 ± 2.1 vs 5.1 ± 2.0, P = .17), mHHS (70.1 ± 18.1 vs 68.9 ± 17.8, P = .80), HOS-SSS (67.7 ± 28.9 vs 62.5 ± 30.2, P = .50), and SANE (71.7 ± 27.9 vs 71.3 ± 22.8, P = .95). A significantly greater proportion of patients in the GMR group achieved a PASS for UCLA (64% vs 34%, P = .02). One patient each in the GMR (3.8%) and GMR-A (2.6%) groups underwent revision gluteus medius repair with dermal allograft augmentation at the final follow-up.

CONCLUSIONS

Our study demonstrates comparable clinical outcomes with and without the use of dermal allograft augmentation in endoscopic gluteus medius repairs.

LEVEL OF EVIDENCE

Level III, retrospective comparative series.

Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials

BACKGROUND

Greater trochanteric pain syndrome (GTPS) affects 17.6% of adults aged 50 to 79 years, particularly women. While exercise therapy and corticosteroid injections (CSIs) are common treatments, their limitations include inadequate pain control and potential tendon weakening. Extracorporeal shockwave therapy (ESWT) is an emerging alternative for GTPS. This systematic review assessed ESWT's efficacy in GTPS by evaluating pain and functional outcomes at different follow-up intervals.

METHODS

A literature search of PubMed, Embase, and Web of Science for randomized clinical trials (RCTs) was conducted comparing ESWT with other GTPS treatments up to March 1, 2024. Two reviewers independently extracted data, assessing study quality using the Cochrane risk-of-bias tool. A random-effects pairwise meta-analysis compared ESWT with other treatments.

RESULTS

Eight RCTs involving 754 patients (169 male, 585 female patients) were included. Seven RCTs were deemed high risk of bias, and 1 RCT had some concerns. Five RCTs investigated focused on focused ESWT, and 3 examined radial ESWT. ESWT provided significantly lower pain scores than other treatments at 2 to 4 months (standardized mean difference = -0.431; 95% confidence interval [CI], -0.82 to -0.039; I2 = 83%). Functional improvement (Lower Extremity Functional Scale) was significantly higher at 6 months (weighted mean difference = 6.68; 95% CI, 3.11-10.25; I2 = 0%) but did not exceed the minimal clinically important difference. Focused ESWT provided greater pain reduction than radial ESWT.

CONCLUSION

Three weekly ESWT sessions offer short-term pain relief at 2 to 4 months for patients with GTPS, especially with focused ESWT. Functional improvements at 6 months were notable but not clinically significant. These findings suggest ESWT may complement or serve as an alternative to CSIs and exercise. However, caution is needed when interpreting these results due to high risk of bias with the included RCTs and heterogeneity across the studies. Further high-quality trials are needed to confirm ESWT's long-term benefits over other treatments.

LEVEL OF EVIDENCE

Level II. See Instructions for Authors for a complete description of levels of evidence.

Endoscopic management of greater trochanteric pain syndrome (GTPS): a comprehensive systematic review

BACKGROUND

Greater trochanteric pain syndrome (GTPS) presents challenges in clinical management due to its chronic nature and uncertain etiology. Historically attributed to greater trochanteric bursitis, current understanding implicates abductor tendinopathy as the primary cause. Diagnosis usually involves a clinical examination and additional tests such as imaging and provocative testing. Surgical intervention may be considered for cases refractory to conservative therapy, with endoscopic techniques gaining ground over open procedures.

MATERIALS AND METHODS

A systematic review was conducted adhering to the PRISMA guidelines. Relevant studies were searched in four databases: Pubmed, Scopus, Embase, and Medline. The selected articles were evaluated according to the criteria of levels of evidence (LoE). The Coleman methodology score (mCMS) was used to analyze the retrospective studies. This systematic review was registered in the International Prospective Registry of Systematic Reviews.

RESULTS

Surgical success rates ranged from 70.6-100%, significantly improving pain and function. Complications were generally mild, mainly hematomas and seromas, while recurrence rates were low. However, limitations such as the retrospective design and the absence of control groups warrant cautious interpretation of the results.

CONCLUSIONS

Endoscopic surgery emerges as a promising option for refractory GTPS, offering effective symptom relief and functional improvement. Despite limitations, these results suggest a favorable risk-benefit profile for endoscopic procedures. Further research is needed, particularly prospective randomized trials, to confirm these findings and optimize surgical techniques to improve patient outcomes.

Value of MR arthrography for evaluation of children and adolescents with clinically suspected intraarticular cause of hip pain

PURPOSE

To evaluate the distribution of intra- and extraarticular MRI findings in children and adolescents with clinically suspected intraarticular cause of hip pain in order to assess the need for additional intraarticular contrast administration.

MATERIAL AND METHODS

Database was searched over a period of 34 months retrospectively for consecutive hip MR arthrography in young patients (8-17 years) with suspected intraarticular cause of hip or groin pain. Exclusion criteria were prior hip surgery, follow-up examination due to known intraarticular pathology, incomplete examination, qualitatively non-diagnostic examinations, and missing informed consent. Reports of fellowship-trained MSK radiologists were searched for intraarticular versus extraarticular findings explaining hip or groin pain.

RESULTS

Seventy patients (68% female; median age: 14.5 years; range:10.8-16.9 years) were analyzed. No reason for pain was found in 30 (42.9%) hips, extraarticular reasons in 20 (28.6%) cases, intraarticular in 14 (20.0%), and both (intra- and extraarticular) in 6 (8.6%) hips. Most common extraarticular reasons were apophysitis (14.3%), other bony stress reactions (12.9%), intramuscular edema (7%), tendinitis (5.7%), and trochanteric bursitis (4.3%). Labral pathology was the most common intraarticular finding (overall:34.3%; partial tear:15.7%, complete tear:15.7%), most frequent at the anterosuperior position (81.8%). Cartilage defects (1.4%), intraarticular neoplasia (1.4%), and tear of the femoral head ligament (2.8%) were rarely found. Synovitis and loose bodies were not observed. Cam-(37.1%) and pincer-configurations (47.1%) were common while hip dysplasia was rare (5.7%).

CONCLUSION

MRI in children and adolescents with hip pain should be done primarily without intraarticular contrast administration since most cases show an extraarticular pain reason or no diagnosis detectable with MRI.

Three-dimensional Volumetric Visceral and Subcutaneous Fat Analysis on Opportunistic Computed Tomography Imaging of Patients With Greater Trochanteric Pain Syndrome Compared With Those With Predominant Osteoarthritis: A Case-Control Study

OBJECTIVE

This study aimed to address the gap in knowledge assessing the impact of visceral and subcutaneous body fat on 3-dimensional computed tomography imaging in patients with greater trochanteric pain syndrome (GTPS) in comparison with those primarily diagnosed with osteoarthritis (OA).

MATERIALS AND METHODS

We evaluated adult patients with a confirmed diagnosis of GTPS from our institutional hip-preservation clinic spanning 2011 to 2022. Selection criteria included their initial clinic visit for hip pain and a concurrent pelvis computed tomography scan. These patients were age- and sex-matched to mild-moderate OA patients selected randomly from the database. Visceral and subcutaneous fat areas were measured volumetrically from the sacroiliac joint to the lesser trochanter using an independent software. Interreader reliability was also calculated.

RESULTS

A total of 93 patients met the study criteria, of which 37 belonged to the GTPS group and 56 belonged to the OA group. Both groups were sex and race matched. Average age in GTPS and OA groups was 59.3 years and 56 years, respectively. For GTPS group, average body mass index was 28.9 kg/m 2 , and for the OA group, average body mass index was 29.9 kg/m 2 , with no significant difference ( P > 0.05). Two-sample t test showed no significant differences in the visceral fat, subcutaneous fat, or the visceral fat to total fat volume ratio between the GTPS and OA groups. There was excellent interreader reliability.

CONCLUSIONS

Our results indicate that there is no significant difference in fat distribution and volumes among GTPS and OA patients. This suggests that being overweight or obese may not be directly linked or contribute to the onset of GTPS. Other factors, such as gluteal tendinopathy, bursitis, or iliotibial band syndrome, might be responsible and need further investigation.

Current and future advances in practice: tendinopathies of the hip

Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.

Translation, reliability, and validity of the Turkish version of the Victorian Institute of Sports Assessment For Gluteal Tendinopathy (VISA-G) questionnaire in individuals with greater trochanteric pain syndrome

BACKGROUND

Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain.

OBJECTIVE

The objectives of this study were to translate the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) questionnaire into the Turkish language and to examine its reliability and validity.

METHODS

108 individuals (45 female, 63 male) participated in the translation and the reliability and validity analysis. The original VISA-G questionnaire was translated into Turkish language using Beaton guidelines. The Turkish version of the VISA-G, Harris Hip Score (HHS), Oswestry Disability Index (ODI), Oxford Hip Score (OHS), and International Physical Activity Questionnaire (IPAQ) were applied to 108 individuals with GTPS for convergent validity. The VISA-G was retested to investigate its reliability after one week.

RESULTS

The VISA-G had a good correlation with HHS (r = 0.694, p < .001), ODI (r = -0.659, p < .001), OHS (r = 0.678, p < .001), and IPAQ (r = 0.440, p < .001). The reliability and internal consistency were excellent (ICC (2,1) value = 0.943; Cronbach's α = 0.946, respectively). And no floor and ceiling effects were revealed related VISA-G.

CONCLUSION

The Turkish version of the VISA-G has good validity and excellent reliability. It can be used in clinical and research practices in the Turkish population with GTPS.

Low-dose radiotherapy for greater trochanteric pain syndrome-a single-centre analysis

PURPOSE

To determine predictive factors associated with a good response (GR) to and efficacy of low-dose radiotherapy (LDRT) in patients with greater trochanteric pain syndrome (GTPS).

METHODS

Patients with GTPS were irradiated on a linear accelerator with 0.5-1.0 Gy per fraction to a total dose of 3.0-4.0 Gy per series. The endpoint was subjective good response (GR) to treatment 2 months after completion of the last LDRT series, defined as complete pain relief or marked improvement assessed using the von Pannewitz score. A positive response to steroid injection (SI) was defined as pain relief of at least 7 days. Patient and treatment-related characteristics were evaluated with respect to LDRT outcomes.

RESULTS

Outcomes were assessed for 71 peritrochanteric spaces (PTSs; 65 patients, 48 females, with mean age of 63 [44-91] years). Prior SI had been given to 55 (77%) PTSs and 40 PTSs received two series of LDRT. Two months after completion of LDRT, GR was reported in 42 PTSs (59%). Two series of LDRT provided a significantly higher rate of GR than one series (72.5 vs. 42% PTSs, p = 0.015). Temporary pain relief after prior SI predicted GR to LDRT compared with PTSs which had not responded to SI (73 vs. 28% PTSs, p = 0.001). A regional structural abnormality, present in 34 PTSs (48%), was associated with a reduction of GR to LDRT (44 vs. 73% PTSs, p = 0.017).

CONCLUSION

LDRT is an effective treatment for GTPS. Administration of two LDRT series, prior response to SI, and absence of structural abnormalities may predict significantly better treatment outcomes.

Treatment of Greater Trochanteric Pain Syndrome With Ultrasound-Guided Bipolar Pulsed Radiofrequency of the Trochanteric Branches of the Femoral Nerve: A Case Series of Nine Patients

BACKGROUND

Greater trochanteric pain syndrome (GTPS) is a prevalent cause of lateral hip pain that often leads to significant functional limitations. Conservative treatment options include physical therapy, pharmacological treatment, and more invasive techniques such as corticosteroid injections. However, despite the high success rates reported with corticosteroid injections, a significant number of patients have their symptoms persist or recur.

OBJECTIVES

In this case series, we present the outcomes of nine patients with GTPS who underwent ultrasound-guided bipolar pulsed radiofrequency targeting the trochanteric branches of the femoral nerve. We aim to discuss the effectiveness and safety of this approach.

MATERIAL AND METHODS

Eligible patients referred to our centre underwent ultrasound-guided bipolar pulsed radiofrequency aimed at the trochanteric branches of the femoral nerve. The procedure consisted of one cycle at 42°C for six minutes, followed by the injection of ropivacaine (0.2%, 3 mL) and dexamethasone (12 mg). The Brief Pain Inventory - Short Form (BPI-sf) and Lequesne Algofunctional Index (LAI) were used before the procedure and at the third and sixth months post-procedure. We monitored immediate and late complications, as well as adverse effects.

RESULTS AND DISCUSSION

Our results indicate a favourable outcome for most patients, with an average pain reduction of 76.51% according to their report of the BPI-sf. Additionally, eight out of nine patients experienced at least 50% relief. These findings align with a previous case series, which reported a similar average pain reduction. Before the procedure, most patients were classified as "extremely severe" in the LAI, with an average score of 18.17. Although there was only a slight reduction of 16.84% at the six-month follow-up, this suggests a potential improvement in their functional status. We did not observe any immediate complications or adverse effects after the procedure, nor were any reported at the subsequent follow-ups, which is consistent with existing literature.

CONCLUSIONS

Our study suggests that ultrasound-guided bipolar pulsed radiofrequency treatment is a promising minimally invasive technique for GPTS, especially for patients who do not respond to conservative treatments. Although our case series provides some evidence of effectiveness and safety, further controlled studies on a larger scale are necessary, particularly to compare this intervention with the use of corticosteroid injections alone.

Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review

Extracorporeal shock waves are high-intensity mechanical waves (500-1000 bar) of a microsecond duration with a morphology characterized by a rapid positive phase followed by a negative phase.

BACKGROUND

Extracorporeal shock waves have been used for pain treatment for various sub-acute and chronic musculoskeletal (MSK) problems since 2000. The aim of this article is to update information on the role of extracorporeal shock wave therapy (ESWT) in the treatment of various pathologies that cause MSK pain.

METHODS

Given that in the last two years, articles of interest (including systematic reviews and meta-analyses) have been published on less known indications, such as low back pain, nerve entrapments, osteoarthritis and bone vascular diseases, a literature search was conducted in PubMed, the Cochrane Database, EMBASE, CINAHL and PEDro, with the aim of developing a narrative review of the current literature on this topic. The purposes of the review were to review possible new mechanisms of action, update the level of evidence for known indications and assess possible new indications that have emerged in recent years.

RESULTS

Although extracorporeal shock waves have mechanical effects, their main mechanism of action is biological, through a phenomenon called mechanotransduction. There is solid evidence that supports their use to improve pain in many MSK pathologies, such as different tendinopathies (epicondylar, trochanteric, patellar, Achilles or calcific shoulder), plantar fasciitis, axial pain (myofascial, lumbar or coccygodynia), osteoarthritis and bone lesions (delayed union, osteonecrosis of the femoral head, Kienbock's disease, bone marrow edema syndrome of the hip, pubis osteitis or carpal tunnel syndrome). Of the clinical indications mentioned in this review, five have a level of evidence of 1+, eight have a level of evidence of 1-, one indication has a level of evidence of 2- and two indications have a level of evidence of 3.

CONCLUSIONS

The current literature shows that ESWT is a safe treatment, with hardly any adverse effects reported. Furthermore, it can be used alone or in conjunction with other physical therapies such as eccentric strengthening exercises or static stretching, which can enhance its therapeutic effect.

Gluteal Tendinopathy: Critical Analysis Review of Current Nonoperative Treatments

» Gluteal tendinopathy/greater trochanteric pain syndrome (GTPS) is the most prevalent of all lower limb tendinopathies, affecting 1 in 4 women older than 50 years and commonly individuals within their fifth and sixth decades of life regardless of activity level.» The condition is believed to originate from age-related degenerative changes about the hip abductor tendon insertions and the surrounding bursae, and is exacerbated by congenital and acquired abnormal hip biomechanics.» Treatment of gluteal tendinopathy/GTPS often begins with noninvasive nonoperative modalities such as activity modifications, nonsteroidal anti-inflammatory drugs, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies have been used; however, there remains a lack of comparative efficacy between these adjunct treatments.» In this article, we examine the available literature regarding the nonoperative management of gluteal tendinopathy/GTPS and provide insight into the effectiveness of current treatment modalities.

Management of Hip Abductor Tears and Recalcitrant Trochanteric Bursitis in Native Hips

Hip abductor tears have recently gained recognition as a more prevalent injury than previously thought. This article will detail the pathophysiology of injury, physical symptoms commonly found at presentation, diagnostic imaging to best diagnose tears and when they should be ordered, and how to properly classify the injury and finally summarize the treatment options available with expert opinions about which are most successful.

The reliability and validity of the Norwegian version of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire (VISA-G-Norwegian) for patients with greater trochanteric pain syndrome

BACKGROUND

Greater Trochanteric Pain Syndrome (GTPS) is a common chronic musculoskeletal condition that may affect physical function, quality of life and sleep. The Victorian Institute of Sport Assessment-Gluteal questionnaire (VISA-G) has been developed as a Patient-Reported Outcome Measurement (PROM) to address pain, everyday activities, physical activities, and difficulty with weight bearing activities. The aim of the study was to test the reliability, validity and floor and ceiling effects of the Norwegian version of the VISA-G (VISA-G-Norwegian) in a population with GTPS in a specialist health care setting.

METHODS

This psychometric evaluation of the VISA-G-Norwegian questionnaire were conducted with a prospective observational design. The VISA-G was translated into Norwegian following recommended guidelines. A subgroup repeated the VISA-G-Norwegian a week after the initial submission. For the reliability, the Intraclass Correlation Coefficient (ICC2.1), Standard Error of the Measurement (SEM) and the Smallest Detectable Change (SDC95%) were calculated. Internal consistency was measured using a Cronbach´s alpha. Floor and ceiling effects were evaluated, and construct validity was assessed with three a priori hypotheses.

RESULTS

78 participants were included in the study of which 47 stable participants undertook the test-retest reliability arm of the study. The ICC2.1 for the total score was 0.85 (95% CI 0.68, 0.92), SEM was 6.6 points and SDC95% 18.4 points. Cronbach`s alpha was 0.77 (95% CI 0.69, 0.84). No floor or ceiling effects were found in the total score, but ceiling effect was found in three of the eight items. For construct validity, one of the three hypotheses were confirmed. VISA-G-Norwegian correlated to the modified Harris Hip Score (mHHS), Oswestry Disability Questionnaire (ODI) and Numeric Pain Rating Scale (NPRS), 0.64, -0.75 and - 0.63 respectively.

CONCLUSION

The VISA-G-Norwegian has acceptable reliability and validity, despite ceiling effect of individual items. The large SDC95% should be considered when measuring change in similar cohorts with GTPS. For a potential future version, it would be recommended to consider response options for questions with ceiling effect and the comprehensibility of question eight.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov the 28/02/2020 (NCT04289922).

The Gluteus Medius Experiences Significant Excursion With Hip Flexion

Purpose

To evaluate the effect of hip flexion and rotation on excursion of the gluteus medius (Gmed) and minimus (Gmin) myotendinous unit.

Methods

Seven hips from 4 cadaveric specimens (males, 68.5 ± 18.3 years old) were dissected to isolate the Gmed posterior and lateral insertions and the Gmin proximal and distal insertions. Sutures were placed from tendon insertions through origins created in the iliac fossa to simulate the myotendinous unit. A load of 10N was applied. Myotendinous excursion was measured at 10° hip extension and 0°, 45°, and 90° of hip flexion in neutral rotation, and from maximum internal and external rotation in 90° flexion. The amount of abduction and rotation was also measured at each flexion position with 20N applied to each tendon. Repeated-measures analysis of variance with Tukey post hoc was used for statistics.

Results

Gmed-lateral excursion ranged from 2.4 ± 0.4 mm in 10° of hip extension to 23.0 ± 1.5 mm in 90° of flexion (P < .001), and Gmed-posterior excursion ranged from 0.92 ± 0.5 mm in 10° of extension to 38.1 ± 1.1 mm in 90° of flexion (P < .001). Gmin excursion shortened with hip flexion from 4.2 ± 0.3 mm in 10° of extension to -0.2 ± 1.5 mm in 90° of flexion (Gmin-prox: P = .525, Gmin-distal: P < .001). At 90° flexion from maximum internal to maximum external rotation, Gmin-distal and proximal demonstrated a 92.6% and 51.3% increase in excursion, respectively (P < .001). Gmed-lateral and Gmed-posterior demonstrated 49.4% and 23.1% increase in excursion with external rotation, respectively (P < .001).

Conclusions

The Gmed myotendinous unit undergoes significant excursion with hip flexion, whereas both Gmed and Gmin had significant excursion with femoral external rotation in 90° flexion.

Clinical Relevance

It is important to understand whether active or passive hip flexion or rotation in the early postoperative period causes excessive strain to an abductor tendon repair. We found that consideration should be given to limit flexion after Gmed repair and external rotation after Gmed or Gmin repairs.

Shock Waves and Therapeutic Exercise in Greater Trochanteric Pain Syndrome: A Prospective Randomized Clinical Trial with Cross-Over

This study aimed to verify the comparative effectiveness of shock wave therapy versus therapeutic exercise, including the possibility of combining both therapies, in patients who did not respond to the first treatment. A prospective randomized clinical trial was carried out, predicting the possibility of a cross-over between the two treatment options, with patients who did not respond to either treatment. Treatments were, respectively, eccentric therapeutic exercise consisting of 30 min sessions of stretching and strengthening exercises, 5 days a week for 4 weeks (Groups A and D) and Extracorporeal Shock Waves Therapy (ESWT) according to a protocol of three sessions, one per week, each of 2000 pulses at a 4 Hz frequency and administering an energy flux density (EFD) varying between 0.03 mJ/mm² and 0.17 mJ/mm² (Groups B and C). Patients were evaluated at baseline (T0), 2 (T1), 4 (T2) and 6 months (T3) after the last session, using the Numeric Rating Scale (NRS), Low Extremity Functional Scale (LEFS) and Roles and Maudsley Scale (RMS). The whole study population demonstrated a progressive clinical reduction in pain according to NRS, a recovery from disability according to LEFS and a perception of recovery according to RMS within 6 months, with no significant differences between the four protocols (exercise; ESWT; exercise + ESWT; and ESWT + exercise). Both therapies are therefore valid options in patients with trochanteritis; the combination of the two therapies could be evaluated for those patients who do not respond to the single treatment.

The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis

BACKGROUND

Greater trochanteric pain syndrome (GTPS) possesses a harmful influence on quality of life. Numerous conservative management modalities with varying success have been proposed for patients with GTPS. However, it is not clear which treatment is more effective for reducing pain. The purpose of this Bayesian analysis was to assess the current evidence for the effectiveness of conservative treatments on improving Visual Analog Scale (VAS) pain scoring of GTPS and to determine the most effective treatment protocol.

METHODS

A comprehensive study search was performed from inception until July 18, 2022, via the electronic databases PubMed, the Cochrane Library, and Web of Science for potential research. The risk of bias assessment for the included studies was independently performed based on the Cochrane Collaboration Risk of Bias Tool. Bayesian analysis was conducted by using ADDIS software (v1.16.5). The DerSimonian-Laird random effects model was used to perform the traditional pairwise meta-analysis.

RESULTS

Eight full-text articles with a total of 596 patients with GTPS were included in the analysis. In comparing ultrasound-guided platelet-rich plasma application (PRP-U) to ultrasound-guided corticosteroid injection (CSI-U), patients who received PRP therapy experienced reduced pain as the VAS decreased significantly (MD, -5.21; 95% CI, -6.24 to -3.64). VAS score in group of extracorporeal shockwave treatment (ESWT) was significant improved than that in exercise (EX) group (MD, -3.17; 95% CI, -4.13 to -2.15). There were no statistically significantly different VAS scores between the CSI-U group and the CSI under landmark (CSI-B) group. The treatment efficacy rankings of the different treatments on improving VAS scores showed that the most likely efficacious treatment was PRP-U (99%) followed by ESWT (81%), CIS-U (58%), usual care (48%), CIS-B (54%), and EX (84%).

CONCLUSION

Bayesian analysis revealed that PRP injection and ESWT are relatively safe and effective in the treatment of GTPS. More multicenter high-quality randomized clinical trials with large sample sizes are still needed in the future to provide further evidence.

Good functional outcomes after endoscopic treatment for greater trochanteric pain syndrome

PURPOSE

Greater trochanteric pain syndrome (GTPS) is a term covering different conditions generating lateral hip pain. Recalcitrant cases may require surgery but there are only a few studies evaluating endoscopic treatment. This study aimed to evaluate the outcome of endoscopically treated GTPS at minimum two years postoperatively using patient-reported outcome measures (PROMs), and to assess the complication rate associated with endoscopic surgery.

METHODS

A total of 33 patients, mean age 43.2 years, 88% women, with a mean symptom duration of 3.5 years, were included in the study. A total of 36 operated hips were included. Pre- and at minimum two years postoperatively the patients completed questionnaires consisting of the International Hip Outcome Tool (iHOT-12) and the Hip Sports Activity scale (HSAS), the Visual analogue scale for overall hip function (VAS-OHF), the Copenhagen Hip and Groin Outcome Score (HAGOS), the EuroQoL-5 Dimension Questionnaire (EQ-5D) and the EQ-VAS. Complications were assessed using the Clavien-Dindo classification.

RESULTS

Median follow-up time was 24.5 months postoperatively. Statistically significant improvements were seen for the following PROMs (p < 0.05); iHOT-12 (36.3 vs 54.0), HAGOS different subscores (40.8 vs 59.0, 46.5 vs 62.6, 29.9 vs 53.1, 33.5 vs 51.4, 20.7 vs 41.4, 23.4 vs 43.3), EQ-VAS (55.9 vs 63.3) and EQ-5D (0.392 vs 0.648). VAS-OHF and HSAS did not reach significance. There was a 71% satisfaction rate with the surgery. Three Clavien-Dindo grade 1 and one grade 2 complications were registered postoperatively, with 41% of patients achieving PASS for iHOT-12 at two years follow-up.

CONCLUSION

Endoscopic surgery for greater trochanteric pain syndrome improved patient-reported outcomes and the procedure was associated with low risk of complications.

LEVEL OF EVIDENCE

Level IV.

The effect of iliotibial band surgery at the hip: a systematic review

BACKGROUND

Current literature presents a variety of surgical interventions aimed at modifying the iliotibial band (ITB) at the hip to relieve lateral hip pain (LHP). However, a focus towards the hip abductors as a main driver in LHP has evolved in the last decade, which could influence the indications for isolated ITB surgery. No previous review has been undertaken to evaluate isolated ITB surgery in LHP cases.

PURPOSE

The purpose of this systematic review was to evaluate isolated ITB surgery in LHP patients in relation to pain, snapping, use of non-surgical treatments postoperatively, and repeated surgery.

METHODS

The study was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The study was registered in Prospero (CRD42021216707) prior to initiation. A systematic search of literature on PubMed and Embase as well as bibliography screening on adult patients undergoing isolated ITB surgery with or without additional bursectomies was performed. Due to the lack of reliable data, no meta-analysis was performed.

RESULTS

A total of 21 studies (360 patients) were considered eligible for inclusion. The snapping and non-snapping group consisted of 150 and 210 patients, respectively. The mean follow-up time in the snapping group was 30 months and 19 months in the non-snapping group. Utilizing different surgical techniques, complete pain relief was not achieved in 12% of patients in the snapping group and 36% of the patients in the non-snapping group. In the snapping group, snapping was eliminated in 95% of patients, and five of 150 patients (3%) had repeated surgery. Eight of nine non-snapping studies reported information regarding repeated surgery, in which seven of 205 patients (3%) received repeated surgery.

CONCLUSION

ITB surgery at the hip remains widely adopted, although only level 4 studies are available, and little information exists on the long-term clinical, as well as patient reported outcomes. Based on the available data, we found indication of a positive short-term outcome in LHP with snapping regarding elimination of snapping, pain reduction, reuse of non-surgical treatment, and repeated surgery. In LHP with no snapping, we found limited evidence supporting ITB surgery based on current literature.

Ilizaliturri Jr. V, Kohlrieser D, Laskovski J, Lifshitz L, P. McGovern R, Monnington K, O’Donnell J, Takla A, Tyler T, Voight M, Wuerz T, Martin RL. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement

The 2022 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS) was intended to present a physiotherapy consensus on the assessment and surgical and non-surgical physiotherapy management of patients with GTPS. The panel consisted of 15 physiotherapists and eight orthopaedic surgeons. Currently, there is a lack of high-quality literature supporting non-operative and operative physiotherapy management. Therefore, a group of physiotherapists who specialize in the treatment of non-arthritic hip pathology created this consensus statement regarding physiotherapy management of GTPS. The consensus was conducted using a modified Delphi technique to guide physiotherapy-related decisions according to the current knowledge and expertise regarding the following: (i) evaluation of GTPS, (ii) non-surgical physiotherapy management, (iii) use of corticosteroids and orthobiologics and (iv) surgical indications and post-operative physiotherapy management.

Endoscopic treatment of gluteus medius tendon tear

Tears in the gluteus medius and minimus tendons are a common cause of greater trochanter pain syndrome (GTPS). Given the non-specific clinical signs and imaging findings, they are often misdiagnosed, with delayed treatment. The lesions can show several aspects: trochanteric bursitis, simple tendinopathy, partial or full-thickness tear, tendon retraction, or fatty degeneration. Non-surgical treatment associates physical rehabilitation and activity modification, oral analgesics, anti-inflammatories and peri-trochanteric injections (corticosteroids, PRP). In the event of symptoms recalcitrant to medical treatment, surgery may be indicated. A 5-stage classification according to intraoperative observations and elements provided by MRI is used to guide technique: isolated bursectomy with microperforation, single or double row tendon repair, or palliative surgery such as muscle transfer (gluteus maximus with or without fascia lata). The development of conservative hip surgery now makes it possible to perform all of these surgical techniques endoscopically, with significant improvement in functional scores and pain in the short and medium term and a lower rate of complications than with an open technique. However, tendon retraction and fatty degeneration have been reported to be factors of poor prognosis for functional results and tendon healing and palliative tendon transfer gives mixed results for recovery of tendon strength. It is therefore preferable not to wait for the onset of Trendelenburg gait to propose endoscopic repair of the gluteus medius tendon in case of pain with a tear visible on MRI and failure of more than 6 months' medical treatment. Based on expert opinion, this article provides an update on the diagnosis of gluteus medius lesions, treatment, and in particular the place of endoscopy, indications and current results. LEVEL OF EVIDENCE: V.

"I feel I have been taken seriously" Women's experience of greater trochanteric pain syndrome treatment-A nested qualitative study

BACKGROUND

Women experiencing greater trochanteric pain syndrome (GTPS) report high levels of pain and reduced quality of life. Exploring how they manage GTPS in a daily life context can provide important knowledge about individual coping strategies. Education, extracorporeal shockwave therapy (ESWT) and exercise have good group level evidence for efficacy in clinical trials and are increasingly used in routine care for patients with GTPS. Exploring women's experiences of such treatment may help understand the mechanisms underpinning these positive results and inform treatment strategies. We therefore aimed to explore how women with GTPS experience and manage their daily life, and their experience of the combined treatment of education, ESWT and exercises.

METHODS

This qualitative study was nested within a cohort study based in a hospital outpatient clinic and a physiotherapy clinic in Denmark assessing the combined treatment of education, ESWT and exercises. Data was collected from eleven women using in-person, individual, semi-structured interviews which were audio recorded. Transcripts were coded and analysed using an inductive thematic analysis approach.

FINDINGS

Five themes were identified: (1) Daily life was controlled and structured by pain; (2) The condition was acknowledged and taken seriously by treating professionals; (3) The participants´ experiences of the intervention-information is key; (4) Improved capability and autonomy in pain management and (5) The women´s perspectives on improving and expanding the intervention. Learning how to manage pain was experienced as the most important element of the program to the women to be able to minimize pain and manage daily life.

CONCLUSION

Exploration of how women with greater trochanteric pain syndrome experienced and managed daily hip pain, and how they experienced and adapted to treatment are important novel findings that will inform clinical practice. This new knowledge may be used to inform an individualized patient education, treatment and evaluation strategy for women with the painful and debilitating condition of GTPS.

Motor control exercises versus general exercises for greater trochanteric pain syndrome: A protocol of a randomized controlled trial

Introduction

Greater trochanteric pain syndrome is an overarching term used to define pain and tenderness in the greater trochanteric region of the femur, which is more common in women. Abnormal control of lower limb movements and deficient neuromuscular parameters may lead to greater trochanteric pain syndrome; however, no studies have used neuromuscular training as a treatment strategy. Thus, this study aims to compare the effect of a protocol of general exercises versus a program of motor control training on pain at baseline and after treatment in women with greater trochanteric pain syndrome.

Methods

The study was approved by the Research Ethics Committee (CAAE: 87372318.1.0000.5406) and has been prospectively registered on the Brazilian Registry of Clinical Trials (RBR-37gw2x). Sixty participants will be randomized to receive motor control exercises or general exercises. The application will be performed twice a week for 8 weeks. The participants will be evaluated before the treatment (T0), after 8 weeks of intervention (T8) and after 60 weeks of intervention (T60). The primary outcome measures will be the hip pain intensity, and secondary outcomes will be muscle strength, kinesiophobia, global perceived effect, pain catastrophization, central sensitization and quality of life.

Conclusions

Studies have suggested that greater trochanteric pain syndrome may be related to poor hip and pelvic control, however, no study has investigated an exercise protocol focused on increasing the strength of the abductor and extensor muscles of the hip associated with pelvic control training, especially in positions of unilateral support, such as gait. This study will help determine whether greater trochanteric pain syndrome is related to abnormal control of lower limb movements.

Arthroscopic treatment of type I and II greater trochanteric pain syndrome

The goal of this study was to describe and evaluate endoscopic bursectomy combined with fascia lata lengthening in the treatment of type I and II greater trochanteric pain syndrome recalcitrant to conservative management. This was a retrospective study of 20 patients (7 type I, 13 type II) reviewed with a minimum follow-up of 2 years. The mean follow-up was 44±11 [26-65] months. While significant improvements in pain, mHHS and NAHS were found, 80% of patients still had hip pain graded at≥3 on VAS. The satisfaction rate was 7/10±2 [3-10]. Snapping in the hip had been eliminated in 100% of cases. No complications were observed. This is a minimally invasive surgery that is feasible in patients who have failed an optimal course of conservative treatment. But patients must be informed that pain might not be completely eliminated by this procedure. LEVEL OF EVIDENCE: IV; retrospective, case series.

The effect of corticosteroid injection in the treatment of greater trochanter pain syndrome: a systematic review and meta-analysis of randomized controlled trials

Background

corticosteroid injection (CSI) has been used to treat greater trochanter pain syndrome (GTPS) for many years. However, so far, the efficacy of CSI in the treatment of GTPS is still controversial. Therefore, the aim of this review is to evaluate the effectiveness of CSI in comparison with sham intervention, nature history, usual care, platelet-rich plasma (PRP), physiotherapy/exercise therapy, dry needling, or other nonsurgical treatment for improvements in pain and function in GTPS.

Methods

PubMed (Medline), Embase, Cochrane Library were searched from their inception until April 2021. Randomized controlled trails (RCTs) comparing CSI to nonsurgical treatment were included. Data on the effect of CSI on pain and function were extracted and checked by two review authors independently. The treatment effect was analyzed in the short term, medium term, and long term.

Results

Eight RCTs (764 patients) were included. This review suggests CSI may be superior to usual care and ‘wait and see,’ ESWT, but may not be superior to exercise, PRP, dry needling, and sham intervention in short-term pain or function improvement. In terms of medium-term pain or function improvement, CSI may be superior to usual care and ‘wait and see,’ but may not be superior to PRP. In terms of long-term pain or function improvement, CSI may be inferior to PRP and ESWT, but it may be superior to usual care and ‘wait and see’ at 12 months.

Conclusions

Due to the small sample size and lack of sufficient clinical studies, current evidence is equivocal regarding the efficacy of CSI in the treatment of GTPS. Considering the limitations, more large-sample and high-quality RCTs are needed to prove the therapeutic effect of CSI on GTPS.

Trial registration

PROSPERO registration number: CRD42021247991. Registered 09 May 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-022-03175-5.

Classification Based Treatment of Greater Trochanteric Pain Syndrome (GTPS) with Integration of the Movement System

Greater trochanteric pain syndrome (GTPS) refers to pain in the lateral hip and thigh and can encompass multiple diagnoses including external snapping hip (coxa saltans), also known as proximal iliotibial band syndrome, trochanteric bursitis, and gluteus medius (GMed) or gluteus minimus (GMin) tendinopathy or tearing. GTPS presents clinicians with a similar diagnostic challenge as non-specific low back pain with special tests being unable to identify the specific pathoanatomical structure involved and do little to guide the clinician in prescription of treatment interventions. Like the low back, the development of GTPS has been linked to faulty mechanics during functional activities, mainly the loss of pelvic control in the frontal place secondary to hip abductor weakness or pain with hip abductor activation. Therefore, an impairment-based treatment classification system. is recommended in the setting of GTPS in order to better tailor conservative treatment interventions and improve functional outcomes.

Level of Evidence

Level V, clinical commentary.

Endoscopic fascia lata release for treatment of gluteal tendinopathy: a prospective study with a follow-up of 6 months to 1 year

Greater trochanteric pain syndrome (GTPS) is clinically defined as greater trochanter pain with mechanical characteristics. The most common diagnosis is gluteal tendinopathy. Most cases of gluteal tendinopathy resolve with conservative management. In case of refractory pain endoscopic surgical treatment can resolved symptoms. This article presents a prospective study of endoscopic proximal fascia lata release associated to trochanteric bursectomy for recalcitrant trochanteric pain syndrome. 33 patients (35 hips) with refractory pain during more than six months were included. All patients were treated by endoscopic iliotibial band release and bursectomy according to Ilizaliturri. Outcomes were assessed by using Harris hip score and Womac hip score. Patients were follow-up until one year after surgery. The mean age was 53.7 years old, there was 9 men and 24 women. There were two bilateral cases in the female group. The average duration of conservative treatment was 20 months (CI95 9 to 31 months). 68% of patients were satisfied of the surgery with disappearance of pain after surgery. WOMAC and Harris hip score significantly improved after surgery until 6 months (respectively from 67 to 29 and from 40 to 76 - p<0.05). No complication was reported. Age, body mass index and duration of conservative treatment did not influence surgical results. This study showed that the endoscopic ilio tibial band (ITB) release and trochanteric bursectomy is simple, safe and easily reproductible but future prospective studies with a larger number of patients are required.

A Novel Treatment Approach of Ultrasound-Guided Radiofrequency Ablation of the Greater Trochanteric Sensory Nerve for Recalcitrant Greater Trochanteric Pain Syndrome

This report describes a novel technique for the treatment of recalcitrant greater trochanteric pain syndrome (GPTS) by radiofrequency ablation (RFA) of the greater trochanteric sensory nerve (GTsn). Here, we describe one patient suffering from recalcitrant GTPS treated with RFA of the GTsn in the outpatient pain clinic setting. Over the eight months subsequent to treatment, the patient was monitored for changes in the Numerical Pain Rating (NPR) and Lower Extremity Functional Score (LEFS). The patient demonstrated meaningful symptomatic and functional improvement as measured by both NPR and LEFS. GTsn RFA may be a viable treatment option for recalcitrant GTPS. Larger comparative trials are needed to establish improved results over conventional treatments.

Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis

INTRODUCTION

Greater trochanter pain syndrome (GTPS) is characterized by a persistent and debilitating pain around the greater trochanter. GTPS can be caused by a combination of gluteus medius or minimus tendinopathy, snapping hip or trochanteric bursitis.

SOURCE OF DATA

Recent published literatures identified from PubMed, EMBASE, Google Scholar, Scopus.

AREAS OF AGREEMENT

Platelet rich plasma (PRP) and corticosteroids (CCS) injections are useful options to manage symptoms of GTPS.

AREAS OF CONTROVERSY

Whether PRP leads to superior outcomes compared to CCS injections is unclear.

GROWING POINTS

A systematic review and meta-analysis comparing PRP versus CCS in the management of GTPS was conducted.

AREAS TIMELY FOR DEVELOPING RESEARCH

PRP injections are more effective than CCS at approximately 2 years follow-up.

Individuals with gluteal tendon repair display similar hip biomechanics to those of a healthy cohort during a sit-to-stand task

BACKGROUND

Gluteal-tendon repair (GTR) is reported to be effective for relieving pain and improving clinical function in patients with gluteal-tendon tears. The sit-to-stand (STS) task is an important activity of daily living and is often used to assess functional capacity in clinical populations. Understanding if and how STS performance is altered in individuals with gluteal tendon repair may be an effective marker of GTR outcomes as well as a possible therapeutic target for post-operative rehabilitation.

RESEARCH QUESTION

Do biomechanical parameters during STS differ between age- and sex-matched participants with and without gluteal-tendon repair?

METHODS

27 participants with a GTR and 29 healthy participants performed the STS task. Data were acquired using the three-dimensional motion capture system and forceplates. Outcomes of interest were task duration, rate of force development, trunk, pelvis, and hip joint angles, moments and powers. Differences were assessed using Generalised linear multivariate models and statistical parametric mapping.

RESULTS

GTR patients performed the STS movement significantly slower (1.4+/- 0.40 s) compared to controls (1.1+/ -0.2 s) with a significantly lower rate of force development (35.1+/- 5.7 N/kg/ms vs 30.3+/- 8.5 N/kg/ms). There were no group differences for hip, pelvis, or trunk angle over the movement cycle or for maximal or minimal values. Furthermore, there were no significant differences detected in hip joint kinetics. However, there appeared to be substantial between-subject variability indicating different patient-specific movements patterns.

SIGNIFICANCE

Individuals with a GTR performed the STS task about 20 % slower than healthy controls with a lower rate of force development. The individual variations indicate that participants likely employed different movement strategies to achieve STS. While the lack of differences between groups could suggest that GTR helps restore function and corrects the proposed underlying aetiology, it is possible that the STS task was not sufficiently challenging to discriminate between groups.

Non-surgical treatment as the first step to manage peritrochanteric space disorders

PURPOSE

Greater trochanter pain syndrome (GTPS) or lateral hip pain terms include external snapping hip, trochanteric bursitis and gluteus medius or minimus pathology. The aim of this review is to update the most recent knowledge about non-surgical management of peritrochanteric disorders.

METHODS

A literature review was performed including articles most relevant in the last years that were focused in non-surgical treatment of peritrochanteric disorders.

RESULTS

Conservative treatment still has a place and includes activity modification, NSAIDs, analgesics, physiotherapy, home training, local corticosteroid injection (CSI) and shock wave therapy (SWT). These non-surgical alternatives have demonstrated good clinical results with low rate of complications.

CONCLUSION

Most patients tend to resolve GTPS or lateral hip pain with non-surgical management in the mid-term but when everything failed, surgical options should be evaluated. The next frontier that will be a game changer is to determine an individualized treatment plan based on the exact pathology.

LEVEL OF EVIDENCE

V.

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

Background:

Gluteal tendinopathy is the most common lower limb tendinopathy. It presents with varying severity but may cause debilitating lateral hip pain.

Purpose:

To review the therapeutic options for different stages of gluteal tendinopathy, to highlight gaps within the existing evidence, and to provide guidelines for a stage-adjusted therapy for gluteal tendinopathy.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

We screened Scopus, Embase, Web of Science, PubMed, PubMed Central, Ovid MEDLINE, CINAHL, UpToDate, and Google Scholar databases and databases for grey literature. Patient selection, diagnostic criteria, type and effect of a therapeutic intervention, details regarding aftercare, outcome assessments, complications of the treatment, follow-up, and conclusion of the authors were recorded. An assessment of study methodological quality (type of study, level of evidence) was also performed. Statistical analysis was descriptive. Data from multiple studies were combined if they were obtained from a single patient population. Weighted mean and range calculations were performed.

Results:

A total of 27 studies (6 randomized controlled trials) with 1103 patients (1106 hips) were included. The mean age was 53.7 years (range, 17-88 years), and the mean body mass index was 28.3. The ratio of female to male patients was 7:1. Radiological confirmation of the diagnosis was most commonly obtained using magnetic resonance imaging. Reported treatment methods were physical therapy/exercise; injections (corticosteroids, platelet-rich plasma, autologous tenocytes) with or without needle tenotomy/tendon fenestration; shockwave therapy; therapeutic ultrasound; and surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair (with or without tendon augmentation).

Conclusion:

There was good evidence for using platelet-rich plasma in grades 1 and 2 tendinopathy. Shockwave therapy, exercise, and corticosteroids showed good outcomes, but the effect of corticosteroids was short term. Bursectomy with or without iliotibial band release was a valuable treatment option in grades 1 and 2 tendinopathy. Insufficient evidence was available to provide guidelines for the treatment of partial-thickness tears. There was low-level evidence to support surgical repair for grades 3 (partial-thickness tears) and 4 (full-thickness tears) tendinopathy. Fatty degeneration, atrophy, and retraction can impair surgical repair, while their effect on patient outcomes remains controversial.

A Current Update on Pelvifemoral Conditions That Should be in the Differential Diagnosis for Patients With Lower Extremity Radiculopathy

Patients presenting to an outpatient spine clinic frequently report symptoms of low back pain with associated buttock, groin, and lower extremity pain. While many of these individuals suffer from lumbar spine radiculopathy, a number of different orthopedic pathologies can mimic these symptoms. Management depends substantially on a detailed history and physical examination, in addition to working from a broad list of differential diagnoses when evaluating these patients. It is imperative that spine practitioners have a comprehensive understanding of the differential diagnoses that may mimic those originating from the lumbar spine, especially when a patient's symptoms are atypical from classic radicular pain. Misdiagnosis can lead to unnecessary testing and treatment, while delaying an accurate clinical assessment and treatment plan. This review highlights common orthopedic diagnoses that may present similar to lumbar spine pathologies and the evidence-based evaluation of these conditions.

Arthroscopic Treatment for Femoroacetabular Impingement Syndrome with External Snapping Hip: A Comparison Study of Matched Case Series

OBJECTIVE

To determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH).

METHODS

Retrospectively review the preoperative and minimum of 2-year follow-up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age- and gender-matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient-reported outcomes (PROs) including international Hip Outcome Tool (iHOT-33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS-pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS-satisfaction score of two groups at 2 years postoperatively were also analyzed.

RESULTS

The prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22-48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty-three age- and sex-matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT-33, mHHS, and VAS-pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P < 0.05), while there was no significant difference in these scores between the patients in FAI + ESH group and FAI group at 3-month and 24-month follow-up (73.6 ± 8.5 vs 76.1 ± 6.9, 85.3 ± 7.8 vs 84.2 ± 6.6, 0.8 ± 0.9 vs 0.6 ± 0.9; P > 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P < 0.05), whereas there was no significant difference at 24 months after surgery (101.6 ± 14.9 N vs 106.5 ± 13.7 N, P > 0.05). The VAS-satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2-year follow-up.

CONCLUSION

Although abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.

Ultrasound-guided surgery for lateral snapping hip: a novel ultraminimally invasive surgical technique

BACKGROUND

Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery.

PURPOSE

In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound.

METHODS

The surgical technique-either z-plasty or transverse section of the ITB-was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29-62).

RESULTS

The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5-9) before surgery to 0 (0-2) after 1 year. The HSS score improved from 58 points (47-72) to 96 at 1-2 years. There were no complications other than minor hematomas nor recurrences.

CONCLUSION

Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2-3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.

Changes in femoral offset is not associated with increased incidence of lateral hip pain following total hip arthroplasty

PURPOSE

Increased femoral offset following total hip arthroplasty allows for greater stability of the hip joint. However, the increase in femoral offset can cause an impingement of local structures resulting in persistent lateral hip pain. There is conflicting evidence whether changes in femoral offset increases the rates of lateral hip pain following total hip arthroplasty.

METHODS

This was a retrospective case control study that grouped patients based on the presence of persistent lateral hip pain following total hip arthroplasty. Patients were then stratified according to their change in femoral offset (<-5 mm, -5 mm < x < 5 mm, and 5 mm<). A chi squared analysis was then performed to see if there was a statistical difference in the rates of lateral hip pain amongst these groups.

RESULTS

A change in femoral offset of the implanted hip relative to the native hip was not associated with increased rates of lateral hip pain following total hip arthroplasty (p = 0.35). A change in femoral offset of the implanted hip relative to the contralateral hip was not associated with increased rates of lateral hip pain following total hip arthroplasty (p = 0.40).

CONCLUSION

This study found that there was no association between increased femoral offset and rates of postoperative lateral hip pain following total hip arthroplasty. Future investigations should look at a larger sample size with multiple institutions to further assess the impact on femoral offset changes on rates of persistent lateral hip pain.

The Collagen-Based Medical Device MD-Tissue Acts as a Mechanical Scaffold Influencing Morpho-Functional Properties of Cultured Human Tenocytes

Mechanotransduction is the ability of cells to translate mechanical stimuli into biochemical signals that can ultimately influence gene expression, cell morphology and cell fate. Tenocytes are responsible for tendon mechanical adaptation converting mechanical stimuli imposed during mechanical loading, thus affecting extracellular matrix homeostasis. Since we previously demonstrated that MD-Tissue, an injectable collagen-based medical compound containing swine-derived collagen as the main component, is able to affect tenocyte properties, the aim of this study was to analyze whether the effects triggered by MD-Tissue were based on mechanotransduction-related mechanisms. For this purpose, MD-Tissue was used to coat Petri dishes and cytochalasin B was used to deprive tenocytes of mechanical stimulation mediated by the actin cytoskeleton. Cell morphology, migration, collagen turnover pathways and the expression of key mechanosensors were analyzed by morphological and molecular methods. Our findings confirm that MD-Tissue affects collagen turnover pathways and favors cell migration and show that the MD-Tissue-induced effect represents a mechanical input involving the mechanotransduction machinery. Overall, MD-Tissue, acting as a mechanical scaffold, could represent an effective medical device for a novel therapeutic, regenerative and rehabilitative approach to favor tendon healing in tendinopathies.

Both open and endoscopic gluteal tendon repairs lead to functional improvement with similar failure rates: a systematic review

IMPORTANCE

Operative treatment of gluteal tendon tears is becomingly increasingly more common with varying surgical techniques and rehabilitation protocols.

OBJECTIVE

To perform a systematic review of gluteal tendon repair as it relates to tear characteristics, rehabilitation protocols, patient-reported outcomes, satisfaction, resolution of gait deviation and complication rates.

EVIDENCE REVIEW

A comprehensive literature search of PubMed and Embase/MEDLINE was used to identify all literature pertaining to gluteal tendon repair. A total of 389 articles were identified.

FINDINGS

A total of 22 studies (611 hips) were included in this review. The majority of tears were noted to be partial thickness (77.9% vs 22.1%). Both arthroscopic and open repair demonstrated improvements in functional outcomes. Within studies documenting gait deviation, 54% were noted to have gait deviation preoperatively, of which approximately 70% had resolution following repair. On average, abduction strength increased almost one whole grade (0.84) following repair. Overall complication rate was found to be 5.2% (20 of 388 hips). Endoscopic repair demonstrated a decreased complication rate compared with open (0.7% vs 7.8%). Retear rate was found to be 3.8%, with open repair having a slightly increased rate compared with endoscopic repair (3.4% vs 4.1%).

CONCLUSIONS AND RELEVANCE

The majority of tears tend to be partial thickness with involvement of gluteus medius in almost all cases and concomitant involvement of gluteus minimus in close to half of cases. Both endoscopic and open gluteal tendon repairs resulted in improvements in outcomes and functional improvement. Retear rates were similar between the two repair techniques, while endoscopic repair demonstrated a lower complication rate.

LEVEL OF EVIDENCE

Level IV, systematic review.

Endoscopic Transfer of Gluteus Maximus and Tensor Fascia Lata for Primary Hip Abductor Deficiency

Complete avulsion of hip abductor muscles may cause severe gait dysfunction and pain. An open surgical procedure to transfer tendons of the gluteus maximus and the tensor fasciae latae to the greater trochanter to make up for the deficient hip abductor has been proposed. The purpose of this study was to describe an endoscopic procedure to transfer gluteus maximus and the tensor fasciae latae to the greater trochanter for hip abductor deficiency.

Focused Shockwave Treatment for Greater Trochanteric Pain Syndrome: A Multicenter, Randomized, Controlled Clinical Trial

BACKGROUND

Greater trochanteric pain syndrome (GTPS) is a condition of lateral hip pain. Its physiopathology remains unknown, and there is no consensus on optimal management. The aim of this study was to assess the effectiveness of electromagnetic-focused extracorporeal shockwave treatment (F-ESWT) in patients with GTPS.

METHODS

This multicenter clinical trial included 103 patients with chronic GTPS randomly assigned to the treatment group, consisting of electromagnetic F-ESWT and a specific exercise protocol, or the control group, receiving sham F-ESWT and the same exercise protocol. Both groups were treated with 3 weekly sessions; the F-ESWT group received an energy flux density of 0.20 mJ/mm, whereas the control group received 0.01 mJ/mm. Patients were assessed at baseline and 1, 2, 3, and 6 months after treatment. A visual analogue scale (VAS) score for pain at 2 months was the primary outcome. The Harris hip score (HHS), Lower Extremity Functional Scale (LEFS), EuroQoL-5 Dimensions Questionnaire (EQ-5D), and Roles and Maudsley score were used as secondary outcomes. Complications were recorded.

RESULTS

The mean VAS score decreased from 6.3 at baseline in both groups to 2.0 in the F-ESWT group versus 4.7 in the control group at 2 months; the 2-month score differed significantly between groups (p < 0.001). All secondary outcomes at all follow-up intervals were significantly better in the F-ESWT group, except for the LEFS score at 1 month after treatment (p = 0.25). No complications were observed.

CONCLUSIONS

F-ESWT in association with a specific exercise program is safe and effective for GTPS, with a success rate of 86.8% at 2 months after treatment, which was maintained until the end of follow-up.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cross-cultural adaptation and validation of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire in Italian and investigation of the association between tendinopathy-related disability and pain

BACKGROUND

The Victorian Institute of Sports Assessment for gluteal tendinopathy (VISA-G) questionnaire has recently been proposed as a condition-specific patient reported outcome measurement tool to assess the tendinopathy-related disability.

AIM

The aim was to evaluate the reliability of the Italian version of the VISA-G questionnaire and its construct validity and to investigate the association between tendinopathy-related disability and pain.

DESIGN

It consists in a cross-sectional study.

SETTING

The location of the study was a university laboratory.

POPULATION

We evaluated patients with gluteal tendinopathy (N.=38) and healthy controls (N.=38).

METHODS

Subjects were asked to fill the VISA-G questionnaire twice to evaluate its reliability. The construct validity was evaluated by comparing the VISA score with the Oswestry Disability Index score. Moreover, pain intensity, extent and location were also investigated.

RESULTS

The VISA-G scores showed non-significant changes in the median values and the values of intraclass correlation coefficient showed very high correlation between the first and second administration (ICC>0.90 in both populations). No significant correlations were found between VISA-G score and either pain extent (R=-0.05, P=0.76), or resting pain intensity (R=-0.13, P=0.45), or palpation pain intensity (R= 0.01, P=0.97). Conversely, a high (and significant) negative correlation was obtained between VISA-G score and Oswestry Disability Index score (R=-0.80, P<0.0001).

CONCLUSIONS

These results indicated that the VISA-G Italian version presents excellent test-retest reliability.

CLINICAL REHABILITATION IMPACT

The evaluation of gluteal tendinopathy-related disability through VISA-G can be useful for the prognostic assessment and/or follow-up of tendinopathy patients in combination with the pain drawing assessment of pain extent.

Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy

Background:

Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described.

Purpose:

To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months).

Results:

The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 (P < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 (P < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) (P < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied “yes definitely,” 3 replied “yes probably,” 3 replied “maybe,” 1 replied “likely not,” and 2 replied “definitely not.” There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures.

Conclusion:

PUT is an effective treatment, with good results for patients with gluteal tendinopathy.

Translation, validation and test-retest reliability of the VISA-G patient-reported outcome tool into Danish (VISA-G.DK)

The Victorian Institute of Sport Assessment (VISA) questionnaire model is based on item response theory using a graded response (responses reflect increasing difficulty). The purpose of the VISA-G is to monitor patient outcomes and evaluate treatment strategies for people with greater trochanteric pain syndrome (GTPS). The primary aim of the current study was to translate and culturally adapt the VISA-G into a Danish context (DK) through forward and back translation and cognitive interviews. The second aim was to establish test-retest reliability and face validity of the VISA-G into a Danish context (DK). No major disagreements were observed between the original and translated versions of the questionnaire. A total of 58 heterogenous asymptomatic, and 49 symptomatic respondents (response rate: 92% and 78% respectively) completed the VISA-G.DK twice, 1 week apart. The VISA-G.DK had excellent internal consistency (Cronbach's alpha: asymptomatic = 0.86; symptomatic = 0.98). The test-retest reliability was excellent for the total score: ICC: 0.961 (95% CI [0.933-0.978]). Standard Error Measurement was calculated to be 0.6. Bland-Altman plots showed no significant or relevant differences from test to retest in the total score with mean differences below 1 (0.61). The minimal detectable change was 3.17 for both groups. The VISA-G.DK was found to be valid, reliable and acceptable for use in the Danish population.

Does low back pain or leg pain in gluteus medius syndrome contribute to lumbar degenerative disease and hip osteoarthritis and vice versa? A literature review

[Purpose] Gluteus medius syndrome is one of the major causes of back pain or leg pain and is similar to greater trochanteric pain syndrome, which also presents with back pain or leg pain. Greater trochanteric pain syndrome is associated with lumbar degenerative disease and hip osteoarthritis. The objective of this review was to demonstrate gluteus medius syndrome as a disease entity by reviewing relevant articles to elucidate the condition. [Methods] Gluteus medius syndrome was defined as myofascial pain syndrome arising from the gluteus medius. We performed a search of the literature using the following keywords: “back pain”, “leg pain”, “greater trochanteric pain syndrome”, “degenerative lumbar disease”, “hip osteoarthritis”, and “gluteus medius”. We reviewed articles related to gluteus medius syndrome and described the findings in terms of diagnosis and treatment based on the underlying pathology. [Results] A total of 135 articles were included in this review. Gluteus medius syndrome is similar as a disease entity to greater trochanteric pain syndrome, which presents with symptoms of low back pain and leg pain. Gluteus medius syndrome is also related to lumbar degenerative disease, hip osteoarthritis, knee osteoarthritis, and failed back surgery syndrome. [Conclusion] Accurate diagnosis of gluteus medius syndrome and appropriate treatment could possibly improve lumbar degenerative disease and osteoarthritis of the hip and knee, as well as hip-spine syndrome and failed back surgery syndrome.