alexa Greater trochanteric pain syndrome: does imaging-identified pathology influence the outcome of interventions?


Journal of Pain & Relief

Author(s): Wilson SA, Shanahan EM, Smith MD

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Abstract AIM: To assess the outcomes for patients seen in a rheumatology service presenting with features of the greater trochanteric pain syndrome (GTPS) and the impact of imaging results on the outcomes of treatment. METHODS: Retrospective audit, using a phone interview was performed to establish links between results of imaging undertaken in the diagnostic work-up of patients with lateral hip pain and clinical outcomes for these patients. Patient perceptions of the effectiveness of interventions were also assessed. RESULTS: Forty-five patients were included (82\% female, mean age 69.6 years). Sixty-nine percent underwent radiological work-up, including plain X-rays (55\%), computed tomography scans (64\%), magnetic resonance imaging (48\%) and ultrasound (90\%). Coexistent trochanteric bursitis (TB) and gluteal tendinopathy were the most commonly elucidated pathologies accounting for the symptomatic presentation of 40\% of patients. Forty-one patients underwent some form of intervention, most commonly injection of local anesthetic and corticosteroid (LACS) into the region of the TB (87\%), two-thirds of which were undertaken under radiological guidance. Pain reduction was maximal following the third injection, with a significantly better response to unguided interventions and levels of symptomatic relief following the first injection being a good indicator of the probability of complete remission. Radiological demonstration of isolated TB correlated with a greater reduction in lateral hip symptoms following LACS TB injections both in the immediate post-injection phase and in the long-term. CONCLUSION: The results of this audit suggest that the management of GTPS has reasonable patient outcomes; however, a prospective study with greater patient numbers is needed to confirm these results. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd. This article was published in Int J Rheum Dis and referenced in Journal of Pain & Relief

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