During last winter several elves slipped on ice and landed heavily. Although initially embarrassed, most forgot the incident but a few still struggle with lateral hip pain when climbing stairs or sleeping in bed.
Previously known as trochanteric bursitis, this condition is now defined as Greater Trochanteric Pain Syndrome (GTPS). This umbrella term covers a range of disorders such as enthesiopathy, muscle tears, and soft tissue dysfunctions causing pain on the outside of the hip. It is not always associated with trauma; abnormal hip biomechanics, osteoarthritis, obesity and specific sporting activities can contribute to GTPS. Affecting 10-25% of the population, rising to 35% where leg length discrepancy is present and more prevalent in women aged between 40 -60 years, it can be a debilitating condition. This review reported the outcomes of patients undergoing conservative or surgical management of GTPS.
Here’s what they did
They searched databases from inception to June 2011 for studies published in English, Spanish, French and Italian reporting clinical, functional and imaging outcomes for patients managed for GTPS. Outcomes and success rates for interventions were extracted and methodological quality was evaluated using the Coleman Methodology Score (CMS) (Coleman et al. 2000).
Here’s what they found
Fifty two potential studies were identified and 14 included. Conservative interventions included; corticosteroid injection, home training exercises and shock wave therapy (SWT). Surgical interventions were; open surgical procedures, open gluteal repair, arthroscopy, and endoscopic gluteal repair. Outcome measures reported in studies were Harris Hip Score, VAS, Likert Scale and Merle d’Auberge scale. Statistical assessment was not possible due to heterogeneous and poorly reported data.
- Corticosteroid injection provided short term results compared with SWT and home training exercise at one month, but at 15 months both SWT and home exercise were significantly more successful than steroid injection.
- Good results were reported after open and closed surgical procedures but study numbers were small and results difficult to compare and interpret.
- Relative difference between home training and SWT was not significant in the long term.
The authors concluded
The optimal management for GTPS was unclear. Given the wide variety of isolated and concomitant disorders involved, focus on pre-treatment diagnosis is essential. They recommended:
“Further investigation should focus on subjects with acute presentation to ascertain whether a wait-and-see policy leads to results comparable with home training.”
The Musculoskeletal Elf’s view
Unfortunately the small sample sizes in the included studies reduce the strength of findings for surgical management, and the application of different outcome measures across studies made comparison of results difficult. However, the findings of only short term improvement with corticosteroid injection correlate with another recent systematic review examining efficacy of these injections in the management of tendinopathy (Coombes et al. 2010). The MSK Elf agrees with the authors that recent advances in understanding pain mechanisms and chronic tendinopathy may result in different approaches to the management of GTPS in the future.
- Do these findings correlate to your experience of GTPS?
- What approaches have you found beneficial in the management of this condition?
- Have you used a pain management approach with chronic GTPS?
- Send us your views on this blog and become part of the Musculoskeletal Elf community.
- Del Buono A, Papalia R, Khanduja V, Denaro V, Maffulli N. Management of the greater trochanteric pain syndrome: a systematic review Br Med Bull. 2012 Jun;102:115-31. Epub 2011 Sep 4.
- Coombes B K, Bisset L, Vicenzino B, 2010, Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials, The Lancet, Volume 376, Issue 9754, pp 1751 – 1767
- Coleman BD, Khan KM, Maffulli n et al. 2000 Studies of surgical outcome after patella tendinopathy:clinical significance of methodological deficiencies and guidelines for future studies. Scandinavian Journal of Medicine & Science in Sports, 10(1) pp2-11