Does Ultrasound Correlate with Surgical or Histologic Findings in Greater Trochanteric Pain Syndrome? A Pilot Study

• Published in: Clinical orthopaedics and related research Vol. 468; no. 7; pp. 1838 - 1844
• Main Authors: Fearon, A. M., Scarvell, J. M., Cook, J. L., Smith, P. N.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2010; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Arthralgia - diagnosis; Arthralgia - etiology; Arthralgia - surgery; Basic Research; Biological and medical sciences; Bursitis - complications; Bursitis - diagnosis; Bursitis - surgery; Conservative Orthopedics; Disability Evaluation; Diseases of the osteoarticular system; Femur - diagnostic imaging; Femur - pathology; Femur - surgery; Hip Joint - diagnostic imaging; Hip Joint - pathology; Hip Joint - surgery; Medical sciences; Medicine; Medicine & Public Health; Muscle Strength; Orthopedics; Pain, Intractable - diagnosis; Pain, Intractable - etiology; Pain, Intractable - surgery; Pilot Projects; Predictive Value of Tests; Range of Motion, Articular; Reconstructive Surgical Procedures; Sports Medicine; Surgery; Surgical Orthopedics; Syndrome; Tendon Injuries - complications; Tendon Injuries - diagnosis; Tendon Injuries - surgery; Treatment Outcome; Ultrasonography; Oswestry Disability Index; Tendon Tear; Gluteus Medius; Great Trochanteric Pain Syndrome; Gluteus Minimus; Histology; Pain; Treatment; Ultrasound; Surgery; Orthopedics
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-009-1174-2

Background Greater trochanteric pain syndrome can be severely debilitating. Ideal imaging modalities are not established, treatments are not reliably evaluated, and the underlying pathology is not well understood. Questions/purposes Using surgical and histopathology findings as a gold standard, we therefore determined the positive predictive value of preoperative ultrasound assessment for greater trochanteric pain syndrome recalcitrant to nonoperative management. In addition, we report the outcomes of gluteal tendon reconstructive surgery using validated clinical and functional outcome tools and evaluate the contribution of the tendon and bursa to greater trochanteric pain syndrome. Patients and Methods We reviewed 24 patients who had combined gluteal tendon reconstruction and bursectomy. Preoperative ultrasound imaging was compared with surgical findings. In the absence of a greater trochanteric pain syndrome specific outcome tool, surgical outcomes for pain and function were assessed via a 100-mm visual analog scale, the modified Harris hip score, and the Oswestry Disability Index. Strength also was measured. The tendon and bursa tissue collected at surgery was histopathologically reviewed. Results In our small study, ultrasound had a high positive predictive value for gluteal tendon tears (positive predictive value = 1.0). Patients reported high levels of pain relief and function after surgery; tendon and bursa showed pathologic changes. Conclusions Ultrasound appears to be clinically useful in greater trochanteric pain syndrome; reconstructive surgery seems to relieve pain and the histopathologic findings show tendinopathy and bursa pathology coexist in greater trochanteric pain syndrome. Level of Evidence Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.