Managing and preventing hip pathology in trochanteric pain syndrome

• Published in: The Journal of musculoskeletal medicine Vol. 25; no. 11; p. 521
• Main Authors: Dougherty, Chris, Dougherty, John J
• Format: Journal Article
• Language: English
• Published: Darien MultiMedia Healthcare Inc 01.11.2008
• ISSN: 0899-2517

Greater trochanteric pain syndrome shares pain patterns with other musculoskeletal conditions, complicating the diagnosis and treatment. Many advances in evaluating and managing hip pathology have resulted in improved outcomes. Conservative treatment includes the use of NSAIDs for reducing pain. Physical therapy is combined with stretching of the iliotibial band and hip external rotators. Successful relief of trochanteric compartment pain has been achieved with local anesthetic and corticosteroid injections. Surgical management often results in significant improvement in refractory pain. There are several ways to work toward preserving the integrity of the joint, especially maintaining an appropriate biomechanical relationship between the acetabular fossa and the femoral head. A diversified strength-training program is recommended. (J Musculoskel Med. 2008;25:521-523) Painful hip conditions are being seen in increasing frequency in all age groups, usually in women after the fourth decade. Treatment often is directed toward conservative measures, with physical therapy and NSAIDs and, when appropriate, therapeutic injections into the trochanteric bursa. Pain not relieved by conservative means or not improved by injection of local anesthetic and corticosteroids should prompt the physician to the possibility of an incorrect diagnosis and a more thorough investigation into the source of pain. Pathologies often can be managed successfully with arthroscopic and open surgical approaches based on the patient's specific condition. Physical therapy - in the form of strengthening of the hip abductors, adductors, and internal and external rotators; back extensors; and abdominals (the core) - is combined with stretching of the iliotibial band (ITB) and hip external rotators. The goal of stretching out the tissues is to relieve tension in the structures surrounding the greater trochanter and, as such, reduce friction. Local diathermy, iontophoresis, and pulsed ultrasonographic therapy for calcific tendinitis also have been successful in the management of trochanteric bursitis.1 Although pulsed ultrasonography has been used with success, there is concern about disruption to the tendon insertion during therapy. This often results in significant improvement in refractory pain (Figure). Open surgical management has been described. Division of the ITB is performed over the region of the greater trochanter. When indicated, partial tendon tears of the gluteus médius and minimus can be debrided and repaired. The primary bursa and the lesser bursa lying beneath the ITB can be evaluated and debrided. The cystic areas of the trochanter are debrided and the tendon or tendons reattached. Reduction osteotomy of the greater trochanter also has been described.6,7