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Lim DP, Lazaro LE, Kyhos JF, Chau MM, Ladnier KJ, Nelson TJ, Eberlein SA, Banffy MB, Metzger MF. Contributions of the Abductor Muscles to Rotational and Distractive Stability of the Hip in a Biomechanical Cadaveric Model. Orthop J Sports Med 2024; 12:23259671241231984. [PMID: 38444567 PMCID: PMC10913509 DOI: 10.1177/23259671241231984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 03/07/2024] Open
Abstract
Background The gluteus minimus (GMin) and gluteus medius (GMed) are important dynamic stabilizers of the hip, but quantitative data on their biomechanical roles in stabilizing the hip are currently lacking. Purpose To (1) establish a reproducible biomechanical cadaveric model of the hip abductor complex and (2) characterize the effects of loading the GMin and GMed on extraneous femoral rotation and distraction. Study Design Controlled laboratory study. Methods A total of 10 hemipelvises were tested in 4 muscle loading states: (1) unloaded, (2) the GMin loaded, (3) the GMed loaded, and (4) both the GMin and GMed loaded. Muscle loads were applied via cables, pulleys, and weights attached to the tendons to replicate the anatomic lines of action. Specimens were tested under internal rotation; external rotation; and axial traction forces at 0°, 15°, 30°, 60°, and 90° of hip flexion. Results When loaded together, the GMin and GMed reduced internal rotation motion at all hip flexion angles (P < .05) except 60° and reduced external rotation motion at all hip flexion angles (P < .05) except 0°. Likewise, when both the GMin and GMed were loaded, femoral distraction was decreased at all angles of hip flexion (P < .05). Conclusion The results of this study demonstrated that the GMin and GMed provide stability against rotational torques and distractive forces and that the amount of contribution depends on the degree of hip flexion. Clinical Relevance Improved understanding of the roles of the GMin and GMed in preventing rotational and distractive instability of the hip will better guide treatment of hip pathologies and optimize nonoperative and operative therapies.
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Affiliation(s)
- Daniel P. Lim
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lionel E. Lazaro
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Justin F. Kyhos
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael M. Chau
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karen J. Ladnier
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor J. Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samuel A. Eberlein
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael B. Banffy
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Melodie F. Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Kinsella R, Semciw AI, Hawke LJ, Stoney J, Choong PFM, Dowsey MM. Diagnostic Accuracy of Clinical Tests for Assessing Greater Trochanteric Pain Syndrome: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2024; 54:26-49. [PMID: 37561820 DOI: 10.2519/jospt.2023.11890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE: We aimed to evaluate the accuracy of clinical tests that are used to diagnose greater trochanteric pain syndrome (GTPS) in clinical practice. DESIGN: Diagnostic test accuracy systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CINAHL, AMED, and SPORTDiscus were searched using key words mapped to diagnostic test accuracy for GTPS. STUDY SELECTION CRITERIA: Studies with published or derivable diagnostic accuracy data were included. DATA SYNTHESIS: Risk of bias was assessed using the QUADAS-2 tool, and certainty of evidence, via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MetaDTA "R" random-effects models were used to summarize individual and pooled data including sensitivity, specificity, likelihood ratios, and pretest/posttest probabilities. RESULTS: From a database yield of 858 studies, 23 full texts were assessed. We included 6 studies for review, involving 15 tests and 272 participants (314 hips). Overall certainty of evidence ranged from very low to moderate. Meta-analysis of 6 tests revealed sequenced test clusters able to significantly shift pretest-posttest probability for or against a GTPS diagnosis. In people reporting lateral hip pain, a negative gluteal tendon (GT) palpation test followed by a negative resisted hip abduction test significantly reduced the posttest probability of GTPS from 59% to 14%. In those with a positive GT palpation test followed by a positive resisted hip abduction test, the posttest probability of GTPS significantly shifted from 59% to 96%. CONCLUSION: The value of magnetic resonance imaging for diagnosing GTPS is debated. We have identified a straightforward, clinically useful diagnostic test cluster to help confirm or refute the presence of GTPS in people reporting lateral hip pain. J Orthop Sports Phys Ther 2024;54(1):1-24. Epub 10 August 2023. doi:10.2519/jospt.2023.11890.
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Teng WH, Ditta A, Webber J, Pearce O. Excision of trochanteric bursa during total hip replacement: Does it reduce the incidence of post-operative trochanteric bursitis? World J Orthop 2023; 14:533-539. [PMID: 37485424 PMCID: PMC10359745 DOI: 10.5312/wjo.v14.i7.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Trochanteric bursitis is a common complication following total hip replacement (THR), and it is associated with high level of disability and poor quality of life. Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.
AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.
METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital. Between January 2010 and December 2020, 954 patients underwent elective primary THR by two contemporary arthroplasty surgeons, one excising the bursa and the other not (at the time of THR). All patients received the same post-operative rehabilitation and were followed up for 1 year. We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis. Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.
RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not. A total of 5 patients (incidence 0.5%) developed trochanteric bursitis following THR; 4 of whom had undergone bursectomy as part of their surgical approach, 1 who had not. There was no statistically significant difference between the two groups (Z value 1.00, 95%CI: -0.4% to 1.3%, P = 0.32). There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR; all of whom were treated with THR and synchronous trochanteric bursectomy, and 7 had resolution of their lateral buttock pains but 1 did not.
CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis. However, it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.
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Affiliation(s)
- Wai-Huang Teng
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Adeel Ditta
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Jane Webber
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Oliver Pearce
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
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Schenk P, Dimitriou D, Rahm S, Zimmermann SM, Finsterwald M, Higashigaito K, Sutter R, Zingg PO. Natural History of Degenerative Hip Abductor Tendon Lesions. Am J Sports Med 2023; 51:160-168. [PMID: 36412545 PMCID: PMC9810830 DOI: 10.1177/03635465221135759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The best treatment of degenerative hip abductor tendon lesions remains largely unknown, as the natural course of the disease has not yet been reported. The aim of the present study was to investigate the natural history of symptomatic degenerative hip abductor lesions. HYPOTHESIS Nonoperatively treated hip abductor lesions progress over time, resulting in refractory hip pain and low functional outcomes. STUDY DESIGN Case series (prognosis); Level of evidence, 4. METHODS Consecutive patients with greater trochanteric pain syndrome and degenerative changes on magnetic resonance imaging (MRI) of the symptomatic hip were included. Bilateral hip MRI scans and a clinical examination were performed at a minimum follow-up of 36 months to study the type and location of hip abductor lesion. Progression of a lesion was defined as a more severe lesion as compared with the initial MRI results or if the lesion extended to another, initially not involved, trochanteric facet. The muscle's fatty infiltration (FI) was also described. RESULTS From 106 patients identified, 58 patients (64 hips) aged 66 ± 14 years (mean ± SD) agreed to return to the clinic for follow-up MRI and met the inclusion criteria. At a mean 71-month follow-up, an overall 34% (22/64) of lesions had progressed over time: from trochanteric bursitis to tendinopathy (9/64, 14%) or partial tear (5/64, 8%), from tendinopathy to partial tear (4/64, 6%), from a partial to complete tear (3/64, 4.5%), and with 1 complete tear (1/64, 1.5%) extending to another trochanteric facet. Interestingly, 90% of partial tears remained stable or transformed into a scar. Although patients with a progressive lesion experienced more trochanteric pain (visual analog scale, 4.6 vs 2.8; P = .001), the functional outcomes were comparable with patients with a stable lesion. The majority of hips with a partial tear (64%) demonstrated a progression of gluteus minimus FI from a median grade of 1 to 2, whereas only 1 hip (3%) progressed from grade 2 to 3. Only 3 hips (9%) with a partial tear had a progression of gluteus medius FI, which did not differ significantly from the contralateral unaffected side. CONCLUSION Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle FI and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions.
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Affiliation(s)
- Pascal Schenk
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland,Dimitris Dimitriou, MD, Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich,
Switzerland ()
| | - Stefan Rahm
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Stefan M. Zimmermann
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Michael Finsterwald
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Kai Higashigaito
- Department of Radiology, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
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Flores DV, Umpire DF, Sampaio ML, Cresswell ME, Pathria MN. US and MRI of Pelvic Tendon Anatomy and Pathologic Conditions. Radiographics 2022; 42:1433-1456. [PMID: 35960665 DOI: 10.1148/rg.220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The bony pelvis serves as the attachment site for a large number of powerful muscles and tendons that drive lower extremity movement. Organizing the pelvic tendons into groups that share a common function and anatomic location helps the radiologist systematically evaluate these structures for injury, which can be caused by repetitive stress, acute trauma, or failure of degenerated tissues. Tears of the anteromedial adductors around the pubic symphysis and anterior flexors traversing anterior to the hip principally affect younger male athletes. Tears of the lateral abductors and posterior extensors are more common in older individuals with senescent tendinosis. The deep external rotators are protected and rarely injured, although they can be impinged. Imaging of the pelvic tendons relies primarily on US and MRI; both provide high spatial and contrast resolution for soft tissues. US offers affordable point-of-care service and dynamic assessment, while MRI allows simultaneous osseous and articular evaluation and is less operator dependent. While the imaging findings of pelvic tendon injury mirror those at appendicular body sites, radiologists may be less familiar with tendon anatomy and pathologic conditions at the pelvis. The authors review pertinent anatomy and imaging considerations and illustrate common injuries affecting the pelvic tendons. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Dyan V Flores
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Marcos Loreto Sampaio
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mark Edward Cresswell
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mini N Pathria
- From the Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., M.L.S.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (M. E.C.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
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Chalidis BE, Sachinis NP, Hawdon G, McMahon S. Lateral trochanteric bursa repair improves early hip function after posterior approach total hip arthroplasty: a prospective randomized control trial. ARTHROPLASTY 2022; 4:26. [PMID: 35668516 PMCID: PMC9169311 DOI: 10.1186/s42836-022-00127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The trochanteric bursa (TB) is an anatomic structure, which is dissected during posterior/lateral hip approaches in Total Hip Arthroplasty (THA). Some surgeons prefer to simply resect the bursa as they believe that it may be responsible for postoperative lateral trochanteric pain (LTP). Others advocate that this tissue acts as a buffer minimizing friction between soft tissue and bone, and therefore its repair may prevent LTP after THA. AIM The purpose of this prospective randomized controlled trial was to compare the clinical results of either resecting or repairing the TB during posterior approach THA. METHODS Forty-two patients with primary hip osteoarthritis undergoing THA via a posterior hip approach were randomly assigned to two groups; Group A, or TB resection group and Group B, or TB repair group. All patients in both groups were evaluated postoperatively in terms of hip function, measured by the Harris Hip Score (HHS), at 6 weeks, 3 months, 6 months, and 12 months after surgery, as well as LTP during daily routine activities and lying on the operative side. RESULTS Forty patients completed the study. Postoperative difference in terms of leg length and femoral offset was similar among the two groups (P = 0.467 and P = 0.39, respectively). At 6 weeks, patients in Group B had higher HHS (P = 0.052) and experienced less LTP when lying on the operative side (P = 0.046) but not during activities (P = 0.759). Thereafter, all functional parameters measured had comparable values in both groups. Subgroup analysis failed to identify any correlation between high offset stems and LTP. CONCLUSION TB repair in posterior approach THA improves hip functional recovery as well as patients' ability to lie on the operative side during the early postoperative period.
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Affiliation(s)
- Byron E. Chalidis
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
| | - Nick P. Sachinis
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
| | - Gabrielle Hawdon
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
| | - Stephen McMahon
- Malabar Orthopaedic Clinic, 43 The Avenue, Windsor, Melbourne, 3181 Australia
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8
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Flury A, Aregger F, Rahm S, Hoch A, Zingg PO. Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers. Hip Int 2022; 33:525-532. [PMID: 35067083 PMCID: PMC10170563 DOI: 10.1177/11207000211071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The purpose of this study was to investigate the greater trochanter's (GT) behaviour in simulated subtrochanteric osteotomy. MATERIALS AND METHODS Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°. RESULTS With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2 = 0.866, p < 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02-1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p < 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12-30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4-1.71 cm) and 2.6 ± 0.6 cm (range 1.8-3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2 = 0.946; p < 0.001). CONCLUSIONS Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.
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Affiliation(s)
- Andreas Flury
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Fabian Aregger
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | | | - Armando Hoch
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Patrick O Zingg
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
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9
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White LM, Oar DA, Naraghi AM, Griffin A, Safir OA. Gluteus minimus tendon: MR imaging features and patterns of tendon tearing. Skeletal Radiol 2021; 50:2013-2021. [PMID: 33779785 DOI: 10.1007/s00256-021-03745-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To highlight the spectrum of pathology and patterns of gluteus minimus tendon tearing observed on MR imaging of the hip. METHODS AND MATERIALS Retrospective review of consecutive hip MRI exams with findings of gluteus minimus tendon (GMin) pathology. A total of 194 exams in 178 patients (148 female, mean age 61) were reviewed. MRI exams are assessed for GMin: tendinopathy, partial, or complete tendon tears. GMin muscular fatty atrophy, enthesopathic cortical irregularities of the greater trochanter (GT), and peri-trochanteric edema or bursal fluid collections were assessed in all cases. In all cases of complete GMin tendon tearing, position and relationship of GMin tendon were assessed relative to its normal insertion site and adjacent soft tissues. RESULTS Clinical indications for MR imaging included hip pain (n = 151), and weakness or altered gait (n = 13). Insertional GMin tendinopathy was seen in 72, partial tearing in 81, and complete tendon tearing in 40 cases. Complete tendon tearing without proximal retraction was observed in 38/40 cases with soft tissue continuity visualized between distal tendon fibers and the proximal vastus lateralis muscle. Peri-trochanteric bursal fluid (n = 61), osseous irregularities of the GT (n = 118), and fatty atrophy GMin (n = 102) were statistically associated with partial or complete GMin tendon tearing (p < 0.001). CONCLUSIONS The spectrum of GMin tendon pathology observed on MR imaging ranges from tendinopathy to complete tears. The majority of complete distal GMin tendon tears from the greater trochanter show continuity of distal tendon fibers with the proximal vastus lateralis, distally tethering and limiting proximal tendon retraction.
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Affiliation(s)
- Lawrence M White
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada. .,Joint Department of Medical Imaging, Mount Sinai Hospital, 600 University Ave, Rm 562-A, Toronto, Ontario, M5G 1X5, Canada.
| | - David A Oar
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital, 600 University Ave, Rm 562-A, Toronto, Ontario, M5G 1X5, Canada
| | - Ali M Naraghi
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital, 600 University Ave, Rm 562-A, Toronto, Ontario, M5G 1X5, Canada
| | - Anthony Griffin
- Department of Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Oleg A Safir
- Department of Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Multimodality imaging of greater trochanter lesions. Pol J Radiol 2021; 86:e401-e414. [PMID: 34429787 PMCID: PMC8369823 DOI: 10.5114/pjr.2021.107814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Greater trochanter (GT) lesions are relatively uncommon. They can be traumatic, infective including tuber-culosis, inflammatory, and neoplastic (primary and metastatic osseous lesions). Although imaging of greater trochanter lesions remains essential for differential diagnoses, an image-guided biopsy is a mainstay for diagnosis and to guide subsequent management. Material and methods A retrospective search for the word ‘greater trochanter’ was performed of a computerised radiology information system (CRIS) of a tertiary referral centre for orthopaedic oncology over a period of 12 years (2007-2019). This revealed 6019 reports with 101 neoplasms. The imaging, histology, and demography were reviewed by a dedicated musculoskeletal radiologist. Results We identified 101 GT neoplasms with a mean age of 51.5 years (range 6 to 85 years) and a slight female predominance of 1.2 : 1 (46 males and 55 females). Using 30 years of age as a cut-off, we further segregated the patient cohort into 2 groups: 26 (25.74%) lesions in patients less than 30 years age and the remaining 75 (74.26%) lesions in patients over 30 years old. Chondroblastoma was the most common neoplasm in patients below 30 years of age, and metastases were the most common neoplasms in patients over 30 years of age. Conclusions Greater trochanter pathologies show a broad spectrum of aetiologies. Imaging including radiographs, computed tomography, magnetic resonance imaging, and nuclear medicine scans help to narrow down the differen-tials diagnosis.
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De Grove V, Buls N, Vandenbroucke F, Shahabpour M, Scafoglieri A, de Mey J, De Maeseneer M. MR of tendons about the hip: A study in asymptomatic volunteers. Eur J Radiol 2021; 143:109876. [PMID: 34419731 DOI: 10.1016/j.ejrad.2021.109876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Tendon pathology around the hip is a common entity. The aim of this study was to detect tendon abnormalities around the hip in a population of asymptomatic volunteers. MATERIALS AND METHODS Fifty volunteers (100 hips) referred for non-musculoskeletal conditions were evaluated with an additional coronal STIR-weighted MRI imaging on a 1.5 MR unit. This group was composed of 27 women and 23 men with a mean age of 52 (19-91 years). The images were interpreted independently by 2 musculoskeletal radiologists. All tendons around the hip were given a score from 0 to 4, with a score 0 corresponding to no abnormality, score 1 to signal alteration around the tendon, score 2 to minimal signal abnormality in the tendon, score 3 partial tear and score 4 complete rupture. The trochanteric bursa was also evaluated and its size was measured. It was also given a score from 0 to 3 (0: no abnormality, 1: slight hypersignal, 2: bursitis < 10 mm, 3: bursitis ≥ 10 mm). RESULTS High intratendinous signal was commonly found at the joined insertion of biceps femoris and semitendinosus (18% L, 20% R), the semimembranosus (24% L, 20% R), gluteus minimus (6% L, 11% R) and rectus femoris (9% L, 3% R). A small trochanteric bursa was seen in 33% of the volunteers on the left side and 32% on the right side. The interobserver correlation was very good with an intraclass correlation coefficient of 0.79 (CI: 0.74-0.85). CONCLUSION Slight signal alterations might be found in the insertions of the rectus femoris, hamstrings and gluteus minimus tendons. A small to moderate trochanteric bursitis might also be seen. This suggests that care should be taken when interpreting MR scans to attribute symptoms to these findings.
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Affiliation(s)
- Veerle De Grove
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium; Brugmann University Hospital, Department of Radiology, Brussels, Belgium
| | - Nico Buls
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | | | - Maryam Shahabpour
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | | | - Johan de Mey
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium
| | - Michel De Maeseneer
- Universitair Ziekenhuis Brussel, Department of Radiology, Brussels, Belgium.
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12
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Weber P, Harrasser N, Twardy V, Gollwitzer H, Banke IJ. [Avulsion injuries of the gluteus medius and gluteus minimus muscles]. Unfallchirurg 2021; 124:526-535. [PMID: 34170360 DOI: 10.1007/s00113-021-01034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
Avulsion injuries of the gluteus medius and gluteus minimus muscles represent a diagnostic and therapeutic challenge. Such injuries are rarely to be expected in high-energy trauma. Degenerative damage or iatrogenic injuries in the context of hip surgery are more frequently identified as the cause. Clinically, in addition to lateral hip pain, limping is an important finding and depends on the extent of the tendon damage. In addition to the medical history and clinical examination, imaging by means of sonography and, above all, magnetic resonance imaging (MRI, possibly with artifact-reduced sequences in the presence of an endoprosthesis) are diagnostically groundbreaking. Therapeutically, a stepwise approach is indicated according to the extent of rupture and quality of the gluteal tendon and muscle tissues. Specific conservative training regimens, mini-open/endoscopic anatomic reconstruction techniques in cases of gluteal muscle integrity and muscle transfer techniques as salvage option with chronic mass ruptures are available. The common goal is the restoration of everyday occupational and private activities to regain the quality of life.
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Affiliation(s)
- P Weber
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland
| | - N Harrasser
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland.,Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.,MVZ ATOS, Effnerstr. 38, 81925, München, Deutschland
| | - V Twardy
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - H Gollwitzer
- ECOM Excellent Center of Medicine, Arabellastr. 17, 81925, München, Deutschland
| | - I J Banke
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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13
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Weidekamm C, Teh J. [Inflammatory changes of the hip joint]. Radiologe 2021; 61:307-320. [PMID: 33575819 PMCID: PMC7910364 DOI: 10.1007/s00117-021-00811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
Die Osteoarthrose ist die häufigste Ursache für den Hüftschmerz des Erwachsenen. Daher wird anderen Ursachen wie z. B. Entzündungen weniger Beachtung für den Gelenkschmerz in der Erstdiagnose geschenkt. Dieser Artikel gibt eine Übersicht von unterschiedlichen rheumatologischen Erkrankungen der Hüfte und deren Interpretation in der Bildgebung. Die Vor- und Nachteile der einzelnen bildgebenden Verfahren werden anhand der pathologischen Befunde für die rheumatologischen Erkrankungen erläutert.
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Affiliation(s)
- Claudia Weidekamm
- Universitätsklinik für Radiologie und Nuklearmedizin, Klinische Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090, Wien, Österreich.
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, OX3 7LD, Oxford, Großbritannien
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14
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Abstract
Athletic injuries of the hip often require radiographs and advanced imaging for diagnosis. Plain radiographs evaluate for osseous injury, provide a structural context behind an athlete's symptoms and examination, and offer a backdrop for interpretation of advanced imaging. An understanding of normal anatomy, imaging findings, and radiographic measurements allows for recognition of pathoanatomy and ability to diagnose accurately. Advanced imaging modalities, including magnetic resonance imaging, computed tomography, and ultrasonography, each play a role in evaluation of the athlete's hip. Although MRI and CT provide high-resolution imaging of the hip, ultrasonography offers the unique ability to perform dynamic imaging and guided injections.
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Affiliation(s)
- Timothy P Lancaster
- Department of Orthopaedic Surgery, University of Virginia Medical Center, PO Box 800159, Charlottesville, VA 22908, USA
| | - Christopher C Chung
- Department of Orthopaedic Surgery, University of Virginia Medical Center, PO Box 800159, Charlottesville, VA 22908, USA
| | - Winston F Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Medical Center, PO Box 800159, Charlottesville, VA 22908, USA.
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15
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Pathogenesis and contemporary diagnoses for lateral hip pain: a scoping review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2408-2416. [PMID: 33341914 PMCID: PMC8298339 DOI: 10.1007/s00167-020-06354-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/26/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Recent advances in diagnostic imaging techniques and soft tissue endoscopy now allow for precise diagnosis and management of extra-articular hip pathology. The aim of this scoping review is to present an evidence-based update of the relevant literature focussing only on the pathoanatomy, clinical assessment and the diagnosis of pathology in the peritrochanteric space. METHODS A literature search was performed on PubMed to include articles which reported on the anatomy and diagnosis of greater trochanteric pain syndrome, trochanteric bursitis, gluteus medius tears and external snapping hip syndrome. RESULTS A total of 542 studies were identified, of which 49 articles were included for full text analysis for the scoping review. Peritrochanteric space pathology can be broadly classified into (1) greater trochanteric pain syndrome (GTPS), (2) abductor tears and (3) external snapping hip syndrome. Anatomically, gluteus medius, gluteus minimus and tensor fascia lata work in conjunction to abduct and internally rotate the hip. The anterolateral part of the gluteus medius tendon is more prone to tears due to a thin tendinous portion. Increased acetabular anteversion has also been shown to be associated with gluteal and trochanteric bursitis. In terms of clinical examination, tests which were found to be most useful for assisting in the diagnoses of lateral hip pain were the single-leg stance, resisted external derotation of the hip, hip lag sign and the Trendelenburg's test. Dynamic ultrasound along with guided injections and MRI scan do assist in differentiating the pathology and confirming the diagnosis in patients presenting with lateral hip pain. Finally, the assessment of baseline psychological impairment is essential in this group of patients to ensure outcomes are optimised. CONCLUSION Lateral hip pain used to be a poorly defined entity, but advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation and management of this cohort of patients. A thorough appreciation of the anatomy of the abductor musculature, specific clinical signs and imaging findings will lead to an appropriate diagnosis being made and management plan instituted. LEVEL OF EVIDENCE IV.
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16
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Zhu MF, Smith B, Krishna S, Musson DS, Riordan PR, McGlashan SR, Cornish J, Munro JT. The pathological features of hip abductor tendon tears - a cadaveric study. BMC Musculoskelet Disord 2020; 21:778. [PMID: 33243210 PMCID: PMC7690166 DOI: 10.1186/s12891-020-03784-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
Background The hip abductors are crucial in maintaining pelvic stability. Tears in these tendons are common and often debilitating. There is uncertainty regarding both the histological and macroscopic features of hip abductor tears. This study aims to clarify both the macroscopic and microscopic features of the tendon and enthesis in hip abductor tendon tears. Methods Thirty-six cadavers with an average age of 81 were dissected, and the hip abductor mechanisms removed en-bloc. The presence, location and size of the tears were recorded and analysed. The samples were processed into histological blocks and viewed using both transmitted and polarised light. Tendon histology was graded using the modified Movin’s score in three sections (deep, middle and superficial layers) and the enthesis graded separately using 5-point criteria. Analysis of variance was used to confirm histological features associated with tears. Results Tears were found in 24 of 36 samples (67%). The most common finding was an isolated tear in the gluteus minimus (46%), followed by concurrent gluteus medius and gluteus minimus tears (33%). Histology revealed significantly more degeneration in both the tendon (p = 0.0005) and enthesis (p = 0.0011) when tears were present. Furthermore, these changes were concentrated in the deeper layers of the tendon (p = 0.0002) and enthesis (p = 0.003). Conclusion This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. Degenerative changes occur in both the tendon and enthesis, with the deeper layers predominantly affected. These findings are important for guiding surgical repair techniques and to aid the development of novel materials and biologics. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03784-3.
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Affiliation(s)
- Mark F Zhu
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand. .,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand.
| | - Brittany Smith
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Sanjeev Krishna
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - David S Musson
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Peter R Riordan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Sue R McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Jillian Cornish
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Jacob T Munro
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand
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17
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Mao LJ, Crudup JB, Quirk CR, Patrie JT, Nacey NC. Impact of fluoroscopic injection location on immediate and delayed pain relief in patients with greater trochanteric pain syndrome. Skeletal Radiol 2020; 49:1547-1554. [PMID: 32361853 DOI: 10.1007/s00256-020-03451-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECT The purpose of this study was to assess whether fluoroscopically guided corticosteroid injections into the extrabursal tissues, trochanteric (subgluteus maximus) bursa, or subgluteus medius bursa provide better immediate and short-term pain relief. MATERIALS AND METHODS All fluoroscopically guided corticosteroid injections performed over a 67-month period for greater trochanteric pain syndrome were retrospectively reviewed. Procedural images were reviewed by two musculoskeletal radiologists to determine the dominant injection site based on final needle positioning and contrast spread pattern, with discrepancies resolved by consensus. Statistical analysis of the association between pain score reduction and dominant injection site was performed. RESULTS One hundred forty injections in 121 patients met the inclusion criteria. The immediate and 1-week post-injection pain reduction was statistically significant for trochanteric bursa, subgluteus medius bursa, and non-bursal injections. However, there was no statistically significant difference in the degree of pain reduction between the groups. There was statistically significant increase in the 1-week post-injection mean pain score compared with immediate post-injection mean pain score in the subgluteus medius bursa and non-bursal injection groups (p < 0.01) but not in the trochanteric bursa group. CONCLUSION Fluoroscopy is frequently chosen over blind injection or ultrasound guidance for trochanteric steroid injections in patients with a high body mass index. Our results indicate that fluoroscopically guided steroid injections into the trochanteric bursa and subgluteus medius bursa significantly reduced immediate and 1-week post-injection pain scores, as do non-bursal injections. Steroid injection into the subgluteus medius bursa and non-bursal sites may be less effective in maintaining pain reduction at 1-week post-injection.
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Affiliation(s)
- Lisa J Mao
- Kaiser Permanente Northern California, Sacramento, CA, USA
| | | | - Cody R Quirk
- Medical University of South Carolina, Charleston, SC, USA
| | - James T Patrie
- University of Virginia Public Health Sciences, Charlottesville, VA, USA
| | - Nicholas C Nacey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
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18
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Egiazaryan KA, Sirotin IV, Chizhikova IO, Lazishvili GD, Ratjev AP, But-Gusaim AB. Clinical significance of the musculus gluteus minimus in total hip arthroplasty. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dislocation of the acetabular component is one of the most frequent complications of total hip arthroplasty. It is commonly attributed to implant malpositioning. However, not all dislocations can be explained by this hypothesis. The aim of our study was to elucidate the role of intraoperative injury to hip abductors (m. gluteus minimus in the first place, since it is reportedly an important hip stabilizer) in the development of postoperative hip dislocation. The experiment was conducted in 4 male and 3 female cadavers. A total of 12 THA were performed. The Hardinge and Watson-Jones approaches were used in equal proportion. On plain radiography, acetabular inclination was 40–47°, anteversion was 10–22°; technically and biomechanically, these values were within the normal range and did not depend on the type of surgical approach (for inclination, p = 0.94; for anteversion, p = 0.63), ruling out implant malpositioning as a risk factor for hip dislocation. Nevertheless, implant stability was significantly disrupted following transection of the anterior or posterior fascicle of m. gluteus minimus, leading to the dislocation of the acetabular component in standard rotation and flexion tests. Thus, our study shows the significant role of m. gluteus minimus in stabilizing the hip joint. Preservation or adequate repair of this muscle during surgery will reduce the risk or dislocation and help to restore the anatomy and biomechanics of the operated joint.
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Affiliation(s)
- KA Egiazaryan
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - IV Sirotin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - IO Chizhikova
- Bureau of Forensic Medical Expertise, Moscow Department of Health, Moscow, Russia
| | - GD Lazishvili
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - AP Ratjev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - AB But-Gusaim
- Pirogov Russian National Research Medical University, Moscow, Russia
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19
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Magnetic resonance imaging of the hip: anatomy and pathology. Pol J Radiol 2020; 85:e489-e508. [PMID: 33101554 PMCID: PMC7571513 DOI: 10.5114/pjr.2020.99414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this review is to outline the normal anatomy of the hip and to discuss common painful conditions of the hip that affect the general adult population. Hip pain is a common complaint with many different etiologies. In this review, hip pathologies are divided by location into osseous, intra-articular and extra-articular lesions. Magnetic resonance imaging (MRI) is the modality of choice for investigating painful hip conditions due to its multiplanar capability and high contrast resolution. This review focuses on the characteristic MRI features of common traumatic and pathologic conditions of the hip.
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20
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Abstract
Hip abductor tendon tear is a difficult problem to manage. The hip abductor mechanism is made up of the gluteus medius and minimus muscles, both of which contribute to stabilising the pelvis through the gait cycle. Tears of these tendons are likely due to iatrogenic injury during arthroplasty and chronic degenerative tendinopathy. Ultrasound and magnetic resonance imaging have provided limited clues regarding the pattern of disease and further work is required to clarify both the macro and microscopic pattern of disease. While surgery has been attempted over the last 2 decades, the outcomes are variable and the lack of high-quality studies have limited the uptake of surgical repair. Hip abductor tendon tears share many features with rotator cuff tears, hence, innovations in surgical techniques, materials and biologics may apply to both pathologies.
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Affiliation(s)
- Mark F Zhu
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
| | | | | | - Simon W Young
- The University of Auckland, Auckland, New Zealand.,North Shore Hospital, Auckland, New Zealand
| | - Jacob T Munro
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
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21
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Imaging of chronic male pelvic pain: what the abdominal imager should know. Abdom Radiol (NY) 2020; 45:1961-1972. [PMID: 31834458 DOI: 10.1007/s00261-019-02353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chronic pelvic pain is an important but underrecognized cause of morbidity in men. While there is abundant literature discussing female pelvic pain and the diagnostic role of imaging, much less attention has been given to imaging of non-gynecologic causes of chronic pelvic pain. Chronic pelvic pain in men can be a challenge to diagnose as pain may arise from visceral, musculoskeletal, or neurovascular pathology. Imaging of the pelvic viscera has been covered in detail elsewhere in this edition and therefore will not be reviewed here. We will focus upon topics less familiar to the abdominal radiologist, including imaging of pelvic floor, musculoskeletal, and neurovascular pathology.
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22
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Dynamic ultrasound-guided trochanteric bursal injection. Skeletal Radiol 2020; 49:1155-1158. [PMID: 32232500 DOI: 10.1007/s00256-020-03411-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/22/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
Injection of steroid and anesthetic into the greater trochanteric bursa is commonly performed for trochanteric bursitis, gluteus medius/minimus tendinopathy, or as a part of a barbotage procedure for gluteus medius or minimus calcific tendonosis. Trochanteric bursal injection is widely performed both with and without image guidance, and is typically viewed as low-difficulty; however optimum needle tip position can be challenging. We discuss a simple dynamic technique to aid the practitioner in optimal needle placement.
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23
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Sun X, Zhu X, Zeng Y, Zhang H, Zeng J, Feng W, Li J, Zeng Y. The effect of posterior capsule repair in total hip arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:263. [PMID: 32316961 PMCID: PMC7175585 DOI: 10.1186/s12891-020-03244-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/27/2020] [Indexed: 01/11/2023] Open
Abstract
Background Prior studies have compared the posterior capsule repair group in primary total hip arthroplasty by posterior approach with the control group without posterior capsule repair suggesting that the posterior capsule repair group had better clinical outcomes. However, it is still a controversy which treatment is more helpful for hip diseases. The purpose of our article is to obtain the postoperative outcomes between the 2 procedures. Methods We performed a systematic search by browsing the MEDLINE, EMBASE, Cochrane Library. There is no restriction on the date of publication. Before we submit our manuscript, we have re-searched the literatures again, including the articles which directly compared the postoperative outcomes of the 2 procedures. Results A total of 8 comparative studies were included in our meta-analysis. The posterior capsule repair group showed less dislocation rate, higher HHS, and even less postoperative bleeding volume. Meanwhile, there is no significant difference in ROM between 2 groups. Conclusion In conclusion, according to current evidences, repairing posterior capsule during primary THA may have better functional outcomes, less dislocation incidence, and less loss of blood.
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Affiliation(s)
- Xiaobo Sun
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China.,Ganzhou Hospital of Traditional Chinese Medicine, Xijin Road 16#, District Zhanggong, Ganzhou, Jiangxi, China
| | - Xingyang Zhu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yuqing Zeng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Haitao Zhang
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Wenjun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jie Li
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, 510405, Guangdong, China.
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24
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Hoffman DF, Sellon JL, Moore BJ, Smith J. Sonoanatomy and Pathology of the Gluteus Minimus Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:647-657. [PMID: 31705714 DOI: 10.1002/jum.15156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/07/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
Gluteus minimus disorders are a potential source of greater trochanteric or anterior hip pain. Disorders of the gluteus minimus tendon most commonly occur in conjunction with gluteus medius tendon abnormalities but can also occur in isolation. Understanding the sonoanatomy of the gluteus minimus muscle-tendon unit is a prerequisite for recognizing and characterizing gluteus minimus tendon disorders, which, in turn, guides treatment for patients with greater trochanteric or anterior hip pain syndromes.
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Affiliation(s)
- Douglas F Hoffman
- Departments of Radiology and Orthopedics, Essentia Health, Duluth, Minnesota, USA
| | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
| | - Brittany J Moore
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
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25
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Gluteus medius muscle pathologies - A case series & pictorial review. J Orthop 2020; 21:270-274. [PMID: 32336894 DOI: 10.1016/j.jor.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Gluteus medius lesions are rare and can present with lateral hip pain. We present a spectrum of pathologies involving the gluteus medius and discuss the imaging features. Material and methods A search of our oncology database at tertiary orthopaedic oncology service was performed. The imaging features of these were analysed. Results There were nine cases involving the gluteus medius, which included soft tissue sarcomas, lipomas, infection and trauma with an average age of 62 years. Conclusion Gluteus medius lesions are rare and one should be aware of these as these can present as lateral hip pain.
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Abstract
Members of the International Skeletal Society compiled a glossary of terms for musculoskeletal radiology. The authors also represent national radiology or pathology societies in Asia, Australia, Europe, and the USA. We provide brief descriptions of musculoskeletal structures, disease processes, and syndromes and address their imaging features. Given the abundance of musculoskeletal disorders and derangements, we chose to omit most terms relating to neoplasm, spine, intervention, and pediatrics. Consensus agreement was obtained from 19 musculoskeletal radiology societies worldwide.
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27
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Wang H, Gu J, Liu X, Liu N, Luan F, Yin H, Liu R, Li H, Wang W. Variation in greater trochanteric lateroversion: a risk factor for femoral stem varus in total hip arthroplasty. Hip Int 2020; 30:33-39. [PMID: 30761922 DOI: 10.1177/1120700018825248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Correct implant positioning is required to achieve adequate biomechanics. The greater trochanter is more medially or laterally positioned in some patients, known as trochanteric lateroversion. However, studies have not identified correlations between postoperative coronal alignment and variation in greater trochanteric lateroversion. The purpose of this study was to identify the effects of variation in greater trochanteric lateroversion on postoperative stem coronal alignment and to investigate other factors related to stem coronal alignment. METHODS A total of 213 hips in 149 patients who underwent total hip arthroplasty were included in this prospective study. The greater trochanters were categorised into 5 groups according to the degree of variation in greater trochanteric lateroversion, and the stem coronal alignment angle and stem fit were measured on anteroposterior radiographs. RESULTS Postoperative stem varus was positively correlated with greater trochanteric lateroversion (r = 0.26065, p = 0.0001) and negatively correlated with the stem fit (r = -0.16568, p = 0.0155). DISCUSSION Excessive variation in greater trochanteric lateroversion was a risk factor for femoral stem varus, and the stem varus position was always accompanied by inadequate canal filling. When the tip of the trochanteric overhang exceeded the centreline of the femoral canal, the influence of lateroversion of the greater trochanter on the femoral stem remarkably increased. Appropriate measures should be implemented to avoid a stem varus position and inappropriate stem fit.
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Affiliation(s)
- Haojun Wang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Jiaao Gu
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Xin Liu
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Ning Liu
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Feiyu Luan
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Haorong Yin
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Ruixuan Liu
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Hang Li
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
| | - Wenbo Wang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Harbin Medical University, Harbin, Heilongjaing Province, China
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Blaichman JI, Chan BY, Michelin P, Lee KS. US-guided Musculoskeletal Interventions in the Hip with MRI and US Correlation. Radiographics 2020; 40:181-199. [DOI: 10.1148/rg.2020190094] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jason I. Blaichman
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
| | - Brian Y. Chan
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
| | - Paul Michelin
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
| | - Kenneth S. Lee
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
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Ortiz-Declet V, Chen AW, Maldonado DR, Yuen LC, Mu B, Domb BG. Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears. J Hip Preserv Surg 2019; 6:398-405. [PMID: 32015892 PMCID: PMC6990389 DOI: 10.1093/jhps/hnz046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/23/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination for detection of gluteus medius (GM) tears. A case group of 50 patients undergoing arthroscopy with GM repair was compared with a control group of 50 patients undergoing arthroscopy who had no peritrochanteric symptoms. Both groups were examined clinically, had magnetic resonance imaging studies performed and underwent arthroscopic surgery. Recorded clinical examinations included abnormal gait (Trendelenburg), tenderness to palpation of the greater trochanter, resisted abduction and the test being studied, resisted internal rotation. For all clinical tests, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates were calculated and compared with the arthroscopic and MRI data for the case group, and the MRI data for the control group. The resisted internal rotation test had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 88% in the detection of GM tears, with a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of Trendelenburg gait, showed inferior rates. Trendelenburg gait had a higher specificity, but much lower sensitivity. The resisted internal rotation test aides in the detection of GM pathology. Due to the good results of the resisted internal rotation test in all the diagnostic parameters, we recommend incorporating it on the physical exam of patients with hip pain.
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Affiliation(s)
- Victor Ortiz-Declet
- Department of Orthopaedics, Kayal Orthopedics, 250 Old Hook Road, Westwood, NJ 07675, USA
| | - Austin W Chen
- Department of Orthopaedics, Boulder Center for Orthopedics, 4740 Pearl Parkway, Boulder, CO 80301, USA
| | - David R Maldonado
- Department of Orthopaedics, American Hip Institute, 999 E Touhy Ave Suite 450, Des Plaines, IL 60018, USA
| | - Leslie C Yuen
- Department of Medicine, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Brian Mu
- Department of Medicine, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064, USA
| | - Benjamin G Domb
- Department of Orthopaedics, American Hip Institute, 999 E Touhy Ave Suite 450, Des Plaines, IL 60018, USA
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Ivanoski S, Nikodinovska VV. Sonographic assessment of the anatomy and common pathologies of clinically important bursae. J Ultrason 2019; 19:212-221. [PMID: 31807327 PMCID: PMC6856779 DOI: 10.15557/jou.2019.0032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 07/25/2019] [Indexed: 12/19/2022] Open
Abstract
High-resolution ultrasonography has many advantages in the imaging of the musculoskeletal system, when compared to other imaging methods, particularly in superficial, easily accessible parts of the body. It is a perfect diagnostic tool for visualizing the most common pathologies of the musculoskeletal system, including the bursae. Inflammation of bursae is frequent, and it can mimic other diseases of the musculoskeletal system. Therefore, knowledge of normal ultrasound anatomy of the bursae, their exact location in the human body, and the sonographic signs of their most common pathologies is essential for establishing a quick and accurate diagnosis by ultrasound. Common conditions affecting bursae, leading to bursitis, include acute trauma, overuse syndromes, degenerative diseases, inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, gout etc.), infections such as tuberculosis, synovial tumors and tumor-like conditions (pigmented villonodular synovitis, osteochondromatosis), and many more. This review article presents and explains ultrasound examples of the most frequent pathological conditions affecting bursae. Images include normal and pathological conditions of bursae around the shoulder joint, elbow, hip, knee, and ankle joint.
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Affiliation(s)
- Slavcho Ivanoski
- Special Hospital for Orthopedic Surgery and Traumatology "St. Erasmus", Ohrid, Macedonia
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Docking SI, Cook J, Chen S, Scarvell J, Cormick W, Smith P, Fearon A. Identification and differentiation of gluteus medius tendon pathology using ultrasound and magnetic resonance imaging. MUSCULOSKELETAL SCIENCE & PRACTICE 2019; 41:1-5. [PMID: 30763889 DOI: 10.1016/j.msksp.2019.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/23/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND It has been suggested that imaging findings play a role in directing treatment for Greater Trochanteric Pain Syndrome. Structural diagnoses associated with Greater Trochanter Pain Syndrome include gluteal tendinosis, and partial- or full-thickness gluteal tendon tears. However, few studies have compared imaging to confirmed tendon pathology observed during surgery. OBJECTIVE To investigate the ability of magnetic resonance and ultrasound imaging to identify the presence of a pathological gluteus medius tendon in comparison to surgical and histological findings. STUDY DESIGN Cross-sectional study. METHODS 26 participants undergoing gluteal tendon reconstruction surgery or hip arthroplasty were included. Prior to surgery, participants underwent both magnetic resonance (MR) (n = 23) and ultrasound (US) (n = 25) imaging. A radiologist (MR) and nuclear physicians (US) classified the gluteus medius tendon as normal, tendinosis (no tear), partial-thickness tear, or full-thickness tear. RESULTS Ultrasound identified 17 out of the 19 pathological gluteus medius tendons correctly. However, 5 of the 6 normal tendons were incorrectly identified as exhibiting pathology on ultrasound. Magnetic resonance rated 11 out of 17 pathological tendons as abnormal, with 4 out of 6 normal tendons identified correctly. Both imaging modalities were poor at identifying and differentiating between tendinosis and partial-thickness tears. CONCLUSION Both imaging modalities showed a reasonable ability to identify tendon pathology. While limited by sample size, these early findings suggest that both imaging modalities may be limited in identifying specific pathoanatomical diagnoses, such as partial-thickness tears. These limitations may misdirect treatment.
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Affiliation(s)
- Sean Iain Docking
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, 3086, Australia.
| | - Jill Cook
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, 3086, Australia
| | | | - Jennie Scarvell
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, 2617, Australia
| | - Wes Cormick
- Canberra Specialist Ultrasound, Canberra, 2617, Australia
| | - Paul Smith
- Division of Surgery, The Canberra Hospital, Canberra, 2605, Australia; College of Medicine and Health Sciences, Australian National University, Canberra, 0200, Australia
| | - Angela Fearon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, 2617, Australia; Research Institute for Sport and Exercise, University of Canberra, 2617, Australia
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Kahlenberg CA, Nwachukwu BU, Jahandar H, Meyers KN, Ranawat AS, Ranawat AS. Single- Versus Double-Row Repair of Hip Abductor Tears: A Biomechanical Matched Cadaver Study. Arthroscopy 2019; 35:818-823. [PMID: 30733037 DOI: 10.1016/j.arthro.2018.10.146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were (1) to evaluate the percentage of gluteus medius and minimus tendon footprint restoration that can be achieved with fixation using single-row repair versus double-row repair and (2) to evaluate the yield load of a repair of the gluteus medius and minimus tendon using single-row versus double-row repair techniques. METHODS Twelve human fresh-frozen cadaveric hip specimens (6 matched pairs, 4 female, mean age 47.5 ± 14.5 years) were tested. Specimens were excluded if they had any prior hip surgery or injury, if any abnormality of the tendon was noted on dissection, or if they had a body mass index <20 or >35 or a T-score <2.0 on dual-energy x-ray absorptiometry scanning. Matched pairs were randomized to receive either double-row repair with 2 standard suture anchors and 2 knotless anchor devices or a single-row repair with suture anchors only. The percentage of the footprint area covered after repair was determined using a computer-assisted digitization algorithm. With a mechanical testing system, each repaired specimen was tested for mechanical strength first with cyclic loading and then load to failure testing. RESULTS Footprint coverage of the lateral facet was significantly greater for double-row repair (mean 76.6%) compared with single-row repair (mean 50.3%) (P = .03). There was no significant difference between single- and double-row repair for posterior-superior or anterior facet coverage. Mechanical testing showed a higher mean yield load for double-row anchor repair (197.6 ± 61.7 N vs 163.5 ± 35.4 N for single-row repair), but this did not reach statistical significance (P = .15). The predominant mode of failure was suture pullout through the musculotendinous unit (9/12 specimens: 5 double-row and 4 single-row). CONCLUSIONS For hip abductor tears, double-row suture repair yields improved footprint coverage compared with single-row repair. Although it did not reach statistical significance, there was a higher mean yield load in the double-row group. CLINICAL RELEVANCE Double-row suture fixation technique for hip abductor tears maximizes strength and footprint coverage of the repair.
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Affiliation(s)
- Cynthia A Kahlenberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kathleen N Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Amar S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Tsutsumi M, Nimura A, Akita K. The Gluteus Medius Tendon and Its Insertion Sites: An Anatomical Study with Possible Implications for Gluteus Medius Tears. J Bone Joint Surg Am 2019; 101:177-184. [PMID: 30653048 DOI: 10.2106/jbjs.18.00602] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Gluteus medius tears are a common hip disorder. Despite this, the etiology of these tears and the anatomical background of the gluteus medius tendon remain unclear. This study aimed to clarify the characteristics of the gluteus medius tendon. We hypothesized that the tendinous portions of the gluteus medius have a nonuniform structure contributing to the tear etiology. METHODS Twenty-five hips from 15 Japanese cadavers were analyzed. Twenty-one of the hips were analyzed macroscopically, and the other 4 were analyzed histologically. In all of the specimens, the 3-dimensional (3D) morphology of the greater trochanter was examined using microcomputed tomography (micro-CT). In 10 of the 21 hips analyzed macroscopically, the local thickness of the gluteus medius tendon, detached from the greater trochanter, was measured. RESULTS The posterior and anterolateral parts of the gluteus medius tendons were roughly distinguished on the basis of the aspects of the iliac origins. The posterior part of the gluteus medius tendon ran in a fan-like shape and converged onto the superoposterior facet of the greater trochanter. The anterolateral part ran posteroinferiorly toward the lateral facet of the greater trochanter. The thickness was greater in the posterior part than in the anterolateral part, and the border between these 2 parts was relatively thin compared with the other parts. The histological study showed that both the posterior and anterolateral parts inserted onto the greater trochanter via fibrocartilage. CONCLUSIONS The gluteus medius tendon consists of thick posterior and thin anterolateral parts, which were identified by the facet or aspect of the bone structures and thinness of their border region. CLINICAL RELEVANCE Our findings indicate that, given the nonuniform structure of the gluteus medius tendon, the thin anterolateral part may be more prone to tears than the thick posterior part is and tears may generally be limited to the anterolateral part.
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Affiliation(s)
- Masahiro Tsutsumi
- Departments of Clinical Anatomy (M.T. and K.A.) and Functional Joint Anatomy (A.N.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Departments of Clinical Anatomy (M.T. and K.A.) and Functional Joint Anatomy (A.N.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Departments of Clinical Anatomy (M.T. and K.A.) and Functional Joint Anatomy (A.N.), Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability, which allows both static and dynamic evaluation as well as guidance of point-of-care interventions such as fluid aspiration and steroid injection. Accurate diagnosis of hip injuries is often challenging, given the complex soft-tissue anatomy of the hip and the wide spectrum of injuries that can occur. To conduct a skillful US evaluation of hip injuries, physicians must have pertinent knowledge of the normal anatomy and should make judicious use of surface anatomy landmarks while using a compartmentalized diagnostic approach. In this article, common sports-related injuries of the anterior, lateral, and posterior hip compartments are discussed. This review includes assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. Principles of care management and current knowledge on imaging findings that may affect return to activity are also presented. Using an oriented US examination technique and having knowledge of the normal hip anatomy will help physicians characterize US findings of common sports-related hip injuries and make accurate diagnoses. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Eugen Lungu
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Johan Michaud
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Nathalie J Bureau
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
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Seo KH, Lee JY, Yoon K, Do JG, Park HJ, Lee SY, Park YS, Lee YT. Long-term outcome of low-energy extracorporeal shockwave therapy on gluteal tendinopathy documented by magnetic resonance imaging. PLoS One 2018; 13:e0197460. [PMID: 30016333 PMCID: PMC6050036 DOI: 10.1371/journal.pone.0197460] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022] Open
Abstract
Background Previous outcome studies for extracorporeal shock wave therapy (ESWT) have included clinically diagnosed greater trochanteric pain syndrome (GTPS). The purpose of this study is to investigate outcome of ESWT on GTPS with gluteal tendinopathy documented by magnetic resonance imaging (MRI). Methods Medical records of 38 consecutive patients were retrospectively reviewed, who underwent ESWT for GTPS with MRI-documented gluteal tendinopathy (> 6 months). ESWT was conducted (1/week) when the Roles-Maudsley score (RMS) showed “Poor” or “Fair” grade after conservative treatment until RMS had reached “Good” or “Excellent” grade (treatment success) or until 12 treatments had been applied. Numeric rating scale (NRS) and RMS were evaluated before, 1 week after (immediate follow-up) and mean 27 months after ESWT program (long-term follow-up). Success rate was calculated at each follow-up point. Results Initial NRS (5.9 ± 1.6) significantly decreased at immediate (2.5 ± 1.5, p< 0.01) and long-term follow-up (3.3 ± 3.0, p< 0.01), respectively. Success rates were 83.3% (immediate) and 55.6% (long-term), respectively. There was no correlation among age, symptom duration and NRS. Conclusion Low-energy ESWT can be an effective treatment for pain relief in chronic GTPS with MRI-documented gluteal tendinopathy. However, its long-term effect appears to decrease with time.
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Affiliation(s)
- Kyoung-Ho Seo
- Department of Physical Medicine & Rehabilitation, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Joon-Youn Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungjae Yoon
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Geol Do
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Sook Park
- Department of Physical & Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: ,
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Batailler C, Weidner J, Wyatt M, Dalmay F, Beck M. Position of the greater trochanter and functional femoral antetorsion: Which factors matter in the management of femoral antetorsion disorders? Bone Joint J 2018; 100-B:712-719. [PMID: 29855251 DOI: 10.1302/0301-620x.100b6.bjj-2017-1068.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Aims The primary aim of this study was to define and quantify three new measurements to indicate the position of the greater trochanter. Secondary aims were to define 'functional antetorsion' as it relates to abductor function in populations both with and without torsional abnormality. Patients and Methods Three new measurements, functional antetorsion, posterior tilt, and posterior translation of the greater trochanter, were assessed from 61 CT scans of cadaveric femurs, and their reliability determined. These measurements and their relationships were also evaluated in three groups of patients: a control group (n = 22), a 'high-antetorsion' group (n = 22) and a 'low-antetorsion' group (n = 10). Results In the cadaver group, the mean anatomical antetorsion was 14.7° (sd 8.5; 0 to 36.5) and the functional antetorsion 21.5° (sd 8.1; 3.6 to 44.3): the posterior tilt was 73.3° (sd 10.8; 46.9 to 88.7) and the posterior translation 0.59 (sd 0.2; 0.2 to 0.9). These measurements had excellent intra and interobserver agreement with a range from 0.93 to 0.99. When the anatomical antetorsion decreased, the greater trochanter was more tilted and translated posteriorly in relation to the axis of the femoral neck, and the difference between functional and anatomical antetorsion increased. The results the three patient groups were similar to those of the cadaver group. Conclusion The position of the greater trochanter and functional antetorsion varied with anatomical antetorsion. In the surgical management of femoral retrotorsion, subtrochanteric osteotomy can result in an excessively posterior position of the greater trochanter and an increase in functional antetorsion. Cite this article: Bone Joint J 2018;100-B:712-19.
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Affiliation(s)
- C Batailler
- CHU Lyon Croix-Rousse, Hospices Civils de Lyon, Lyon, France, Clinic for Orthopaedic and Trauma Surgery, Lucerne, Switzerland
| | - J Weidner
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - M Wyatt
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - F Dalmay
- Biostatistics Department, Limoges University, Limoges, France
| | - M Beck
- Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Great trochanter bursitis vs sciatica, a diagnostic–anatomic trap: differential diagnosis and brief review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1509-1516. [DOI: 10.1007/s00586-018-5486-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/10/2018] [Accepted: 01/20/2018] [Indexed: 01/01/2023]
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Outcomes and cost-effectiveness of ultrasound-guided injection of the trochanteric bursa. Rheumatol Int 2018; 38:393-401. [PMID: 29353388 DOI: 10.1007/s00296-018-3938-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/16/2018] [Indexed: 02/07/2023]
Abstract
We hypothesized that ultrasound (US) guidance improves outcomes of corticosteroid injection of trochanteric bursitis. 40 patients with greater trochanteric pain syndrome defined by pain to palpation over the trochanteric bursa were randomized to injection with 5 ml of 1% lidocaine and 80 mg of methylprednisolone using (1) conventional anatomic landmark palpation guidance or (2) US guidance. Procedural pain (Visual Analogue Pain Scale), pain at outcome (2 weeks and 6 months), therapeutic duration, time-to-next intervention, and costs were determined. There were no complications in either group. Ultrasonography demonstrated that at least a 2-in (50.8 mm) needle was required to consistently reach the trochanteric bursa. Pain scores were similar at 2 weeks: US: 1.3 ± 1.9 cm; landmark: 2.2 ± 2.5 cm, 95% CI of difference: - 0.7 < 0.9 < 2.5, p = 0.14. At 6 months, US was superior: US: 3.9 ± 2.0 cm; landmark: 5.5 ± 2.6 cm, 95% CI of difference: 0.8 < 1.6 < 2.4, p = 0.036. However, therapeutic duration (US 4.7 ± 1.4 months; landmark 4.1 ± 2.9 months, 95% CI of difference - 2.2 < - 0.6 < 1.0, p = 0.48), and time-to-next intervention (US 8.7 ± 2.9 months; landmark 8.3 ± 3.8 months, 95% CI of difference - 2.8 < - 0.4 < 2.0, p = 0.62) were similar. Costs/patient/year was 43% greater with US (US $297 ± 99, landmark $207 ± 95; p = 0.017). US-guided and anatomic landmark injection of the trochanteric bursa have similar 2-week and 6-month outcomes; however, US guidance is considerably more expensive and less cost-effective. Anatomic landmark-guided injection remains the method of choice, but should be routinely performed using a sufficiently long needle [at least a 2 in (50.8 mm)]. US guidance should be reserved for extreme obesity or injection failure.
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Abstract
Hip and groin pain often presents a diagnostic and therapeutic challenge. The differential diagnosis is extensive, comprising intra-articular and extra-articular pathology and referred pain from lumbar spine, knee and elsewhere in the pelvis. Various ultrasound-guided techniques have been described in the hip and groin region for diagnostic and therapeutic purposes. Ultrasound has many advantages over other imaging modalities, including portability, lack of ionising radiation and real-time visualisation of soft tissues and neurovascular structures. Many studies have demonstrated the safety, accuracy and efficacy of ultrasound-guided techniques, although there is lack of standardisation regarding the injectates used and long-term benefit remains uncertain.
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Hegazi TM, Belair JA, McCarthy EJ, Roedl JB, Morrison WB. Sports Injuries about the Hip: What the Radiologist Should Know. Radiographics 2017; 36:1717-1745. [PMID: 27726744 DOI: 10.1148/rg.2016160012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Injuries of the hip and surrounding structures represent a complex and commonly encountered scenario in athletes, with improper diagnosis serving as a cause of delayed return to play or progression to a more serious injury. As such, radiologists play an essential role in guiding management of athletic injuries. Familiarity with hip anatomy and the advantages and limitations of various imaging modalities is of paramount importance for accurate and timely diagnosis. Magnetic resonance (MR) imaging is often the modality of choice for evaluating many of the injuries discussed, although preliminary evaluation with conventional radiography and use of other imaging modalities such as ultrasonography (US), computed tomography, and bone scintigraphy may be supplementary or preferred in certain situations. Stress fractures, thigh splints, and posterior hip dislocations are important structural injuries to consider in the athlete, initially imaged with radiographs and often best diagnosed with MR imaging. Apophyseal injuries are particularly important to consider in young athletes and may be acute or related to chronic repetitive microtrauma. Femoroacetabular impingement has been implicated in development of labral tears and cartilage abnormalities. Tear of the ligamentum teres is now recognized as a potential cause of hip pain and instability, best evaluated with MR arthrography. Greater trochanteric pain syndrome encompasses a group of conditions leading to lateral hip pain, with US playing an increasingly important role for both evaluation and image-guided treatment. Muscle injuries and athletic pubalgia are common in athletes. Lastly, snapping hip syndrome and Morel-Lavallée lesions are two less common but nonetheless important considerations. ©RSNA, 2016.
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Affiliation(s)
- Tarek M Hegazi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Jeffrey A Belair
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Eoghan J McCarthy
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Johannes B Roedl
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - William B Morrison
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
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Ganderton C, Semciw A, Cook J, Pizzari T. Demystifying the Clinical Diagnosis of Greater Trochanteric Pain Syndrome in Women. J Womens Health (Larchmt) 2017; 26:633-643. [DOI: 10.1089/jwh.2016.5889] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Charlotte Ganderton
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Semciw
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
- Department of Physiotherapy, The University of Queensland, St Lucia, Queensland, Australia
| | - Jill Cook
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
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42
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A Visualization of the Greater Trochanter and Peritrochanteric Soft Tissues. PM R 2017; 9:318-324. [DOI: 10.1016/j.pmrj.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022]
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43
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Mu A, Peng P, Agur A. Landmark-Guided and Ultrasound-Guided Approaches for Trochanteric Bursa Injection. Anesth Analg 2017; 124:966-971. [DOI: 10.1213/ane.0000000000001864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hoffman DF, Smith J. Sonoanatomy and Pathology of the Posterior Band of the Gluteus Medius Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:389-399. [PMID: 28039889 DOI: 10.7863/ultra.16.03073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/27/2016] [Indexed: 06/06/2023]
Abstract
Greater trochanteric pain syndrome is a common clinical entity that most often results from disorders of the gluteus medius tendon. There are two distinct bands of the gluteus medius tendon, and abnormalities may affect the anterior or posterior band in isolation or simultaneously. Although abnormalities of the anterior band are more common, awareness and sonographic detection of posterior band abnormalities is essential to guide treatment in the setting of greater trochanteric pain syndrome.
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Affiliation(s)
- Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jay Smith
- Departments of Physical Medicine and Rehabilitation and Radiology, Mayo Clinic College of Medicine and Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA
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Yu JS, Oh JS. Greater trochanter location measurement using a three-dimensional motion capture system during prone hip extension. J Phys Ther Sci 2017; 29:250-254. [PMID: 28265151 PMCID: PMC5332982 DOI: 10.1589/jpts.29.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/04/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The greater trochanter (GT) is an important structure in biomedical research, but the measurement methods require development. This study presents data from a new measurement method that does not use GT-marker-based measurement (No GT-m) in comparison with GT-marker based measurement (GT-m). [Subjects and Methods] We recruited 20 healthy subjects, who were asked to perform and maintain a prone position and then move to the prone hip extension. A motion capture system collected the kinematic data and the location of the GT was calculated by two measurements. [Results] GT migration distance differed significantly between the two measurements and the coefficient of the variation value was lower for the No GT-m method. Thigh lengths of the No GT-m method were comparable to the original lengths. There were significant differences between the GT-m and the other methods. [Conclusions] These data suggest that the GT-m method yielded a lower precision with a smaller GT migration distance. In the comparison of thigh length, the No GT-m method was in close agreement with the original length. We suggest that determining the location of the GT using the No GT-m has greater accuracy than the GT-m method.
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Affiliation(s)
- Ji-Su Yu
- Department of Physical Therapy, Graduate School, Inje
University, Republic of Korea
- Department of Physical Therapy, College of Biomedical
Science and Engineering, Inje University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical
Science and Engineering, Inje University, Republic of Korea
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46
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Pain, not structural impairments may explain activity limitations in people with gluteal tendinopathy or hip osteoarthritis: A cross sectional study. Gait Posture 2017; 52:237-243. [PMID: 27951482 DOI: 10.1016/j.gaitpost.2016.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
QUESTION What are the functional differences between people with greater trochanteric pain syndrome (GT), hip osteoarthritis (OA) or an asymptomatic population as measured by walking, Time Up and Go, single leg standing and strength? DESIGN Cross sectional study with blinded measurers. PARTICIPANTS 38 participants with GT, 20 with end stage hip OA and 21 asymptomatic healthy control (AS) participants. All participants were women. OUTCOME MEASURES Pain (numeric rating scale), Walking speed (m/s), cadence (steps/min) and step length (m) measured via the 10m walk test and the Timed Up and Go; balance via single leg stance (s) duration; and hip abduction, adduction, medial and lateral rotation strength, standardized to body mass (BM) via the body mass average index (BMavg), measured via a wall mounted dynamometer. RESULTS The two symptomatic groups reported similar pain levels (p=0.226), more pain then the AS group (p<0.000). Compared to the AS participants, participants with GT or hip OA demonstrated lower walking speed (10mwt and TUG, p<0.001), lower cadence and shorter duration single leg stance on the affected leg (p<0.05). Participants with GT or hip OA also demonstrated bilaterally weaker hip abduction than the AS group (p≤0.005). Compared to AS and GT participants, participants with hip OA demonstrated adduction weakness on the affected side (p=0.008 and p=0.002 respectively). CONCLUSION There is a significant level of dysfunction and impairments associated with GT and hip OA. As activity limitations do not appear to be differentiated by structural impairments, we suggest that pain, rather than the underlying pathology may be the driving impairment that leads to walking and single leg standing dysfunction.
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Jacobson JA, Yablon CM, Henning PT, Kazmers IS, Urquhart A, Hallstrom B, Bedi A, Parameswaran A. Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2413-2420. [PMID: 27663654 DOI: 10.7863/ultra.15.11046] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/06/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The purpose of this study was to compare ultrasound-guided percutaneous tendon fenestration to platelet-rich plasma (PRP) injection for treatment of greater trochanteric pain syndrome. METHODS After Institutional Review Board approval was obtained, patients with symptoms of greater trochanteric pain syndrome and ultrasound findings of gluteal tendinosis or a partial tear (<50% depth) were blinded and treated with ultrasound-guided fenestration or autologous PRP injection of the abnormal tendon. Pain scores were recorded at baseline, week 1, and week 2 after treatment. Retrospective clinic record review assessed patient symptoms. RESULTS The study group consisted of 30 patients (24 female), of whom 50% were treated with fenestration and 50% were treated with PRP. The gluteus medius was treated in 73% and 67% in the fenestration and PRP groups, respectively. Tendinosis was present in all patients. In the fenestration group, mean pain scores were 32.4 at baseline, 16.8 at time point 1, and 15.2 at time point 2. In the PRP group, mean pain scores were 31.4 at baseline, 25.5 at time point 1, and 19.4 at time point 2. Retrospective follow-up showed significant pain score improvement from baseline to time points 1 and 2 (P< .0001) but no difference between treatment groups (P= .1623). There was 71% and 79% improvement at 92 days (mean) in the fenestration and PRP groups, respectively, with no significant difference between the treatments (P >.99). CONCLUSIONS Our study shows that both ultrasound-guided tendon fenestration and PRP injection are effective for treatment of gluteal tendinosis, showing symptom improvement in both treatment groups.
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Affiliation(s)
- Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - P Troy Henning
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan USA
| | | | - Andrew Urquhart
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan USA
| | - Brian Hallstrom
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan USA
| | - Asheesh Bedi
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan USA
| | - Aishwarya Parameswaran
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan USA
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48
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Beyond the greater trochanter: a pictorial review of the pelvic bursae. Clin Imaging 2016; 41:37-41. [PMID: 27764718 DOI: 10.1016/j.clinimag.2016.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Review the MRI appearance of different bursae located throughout the pelvis, including the pertinent osseous and musculotendinous anatomy. MATERIALS AND METHODS Bursae are potential spaces that reduce friction between opposed moving components which can become inflamed, clinically mimicking internal derangement. RESULTS This series illustrates the most common as well as lesser-known pelvic bursae. Common causes of bursitis including overuse, trauma, and infection are presented. CONCLUSION Multiple bursae are located throughout the pelvis. It is important for radiologists to recognize bursitis as a potential etiology of pain and be familiar with their anatomical locations in order to guide appropriate management.
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Belair JA, Hegazi TM, Roedl JB, Zoga AC, Omar IM. Core Injuries Remote from the Pubic Symphysis. Radiol Clin North Am 2016; 54:893-911. [PMID: 27545427 DOI: 10.1016/j.rcl.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The core, or central musculoskeletal system of the torso, is essential for participating in sports and other physical activities. Core injuries are commonly encountered in athletes and active individuals. The importance of the midline pubic plate and rectus abdominis-adductor aponeurosis for core stability and function is discussed in the literature. This review article examines other important core injuries remote from the pubic symphysis, relevant clinical features, and preferred approaches to imaging. Several specific syndromes encountered in the core are reviewed. By protocoling imaging studies and identifying pathology, radiologists can add value to the clinical decision-making process and help guide therapeutic options.
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Affiliation(s)
- Jeffrey A Belair
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA.
| | - Tarek M Hegazi
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA; Department of Radiology, University of Dammam, PO Box 2114, Dammam 31451, Saudi Arabia
| | - Johannes B Roedl
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
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Disorders of the Peritrochanteric and Deep Gluteal Space: New Frontiers for Arthroscopy. Sports Med Arthrosc Rev 2016; 23:221-31. [PMID: 26524558 DOI: 10.1097/jsa.0000000000000085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Arthroscopic techniques for the hip joint have evolved into endoscopic methods for extra-articular disorders. These endoscopic strategies provide a less invasive alternative to open procedures for traditionally recognized forms of pathology. Endoscopy has defined new disorders amenable to surgical correction and has redefined some of these existing disorders. The peritrochanteric and deep gluteal regions represent 2 of the most currently active areas of exploration. Peritrochanteric problems include trochanteric bursitis, full-thickness and partial-thickness tears of the abductors including the gluteus medius and minimus, and external coxa saltans (snapping iliotibial band). Deep gluteal disorders include piriformis syndrome, and other variations of deep gluteal syndrome, and ischiofemoral impingement. Each of these evolving areas is highlighted in this chapter.
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