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Peritrochanteric Space Disorders: Anatomy and Management

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MRI-Arthroscopy Correlations

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Abstract

The anatomic structures in the peritrochanteric space are important causes of pain generation. Its causes have been encompassed in the term greater trochanteric pain syndrome (GTPS) and include trochanteric bursitis, external coxa saltans (snapping hip), and abductor tendon pathology. To identify the causes of pain and surgical indications, an in-depth understanding of the anatomy and clinical assessment is necessary. Imaging, such as standard radiographs, ultrasound, and magnetic resonance, can be useful aids to identify and treat GTPS. Conservative treatment is the first line of treatment and includes rest and activity modification, physical therapy, anti-inflammatories, corticosteroid injections, and biologic injections. When other causes of pain have been discarded and pain is recalcitrant to conservative measures, surgical treatment may be indicated.

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References

  1. Karpinski M, Piggott H. Greater trochanteric pain syndrome. A report of 15 cases. J Bone Joint Surg. 1985;67-B:762–3.

    Article  Google Scholar 

  2. Anderson TP. Trochanteric bursitis: diagnostic criteria and clinical significance. Arch Phys Med Rehabil. 1958;39:617–22.

    CAS  PubMed  Google Scholar 

  3. Gordon EJ. Trochanteric bursitis and tendinitis. Clin Orthop Relat Res. 1961;20:193–202.

    CAS  Google Scholar 

  4. Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44:2138–45.

    Article  CAS  PubMed  Google Scholar 

  5. Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;23:1246.e1–5.

    Article  Google Scholar 

  6. Kagan A. Rotator cuff tears of the hip. Clin Orthop Relat Res. 1999;(368):135–40.

    Google Scholar 

  7. Kingzett-Taylor A, Tirman PF, Feller J, McGann W, Prieto V, Wischer T, Cameron JA, Cvitanic O, Genant HK. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. Am J Roentgenol. 1999;173:1123–6.

    Article  CAS  Google Scholar 

  8. Lall AC, Schwarzman GR, Battaglia MR, Chen SL, Maldonado DR, Domb BG. Greater trochanteric pain syndrome: an intraoperative endoscopic classification system with pearls to surgical techniques and rehabilitation protocols. Arthrosc Tech. 2019;8:e889–903.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009;108:1662–70.

    Article  PubMed  Google Scholar 

  10. Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC, Multicenter Osteoarthritis Study Group. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil. 2007;88:988–92.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lievense A, Bierma-Zeinstra S, Schouten B, Bohnen A, Verhaar J, Koes B. Prognosis of trochanteric pain in primary care. Br J Gen Pract. 2005;55:199–204.

    PubMed  PubMed Central  Google Scholar 

  12. Fearon AM, Scarvell JM, Neeman T, Cook JL, Cormick W, Smith PN. Greater trochanteric pain syndrome: defining the clinical syndrome. Br J Sports Med. 2013;47:649–53.

    Article  PubMed  Google Scholar 

  13. Tan LA, Benkli B, Tuchman A, Li XJ, Desai NN, Bottiglieri TS, Pavel J, Lenke LG, Lehman RA. High prevalence of greater trochanteric pain syndrome among patients presenting to spine clinic for evaluation of degenerative lumbar pathologies. J Clin Neurosci. 2018;53:89–91.

    Article  PubMed  Google Scholar 

  14. Collèe G, Dijkmans BAC, Vandenbroucke JP, Rozing PM, Cats A. A clinical epidemic-logical study in low back pain. Description of two clinical syndromes. Rheumatology. 1990;29:354–7.

    Article  Google Scholar 

  15. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. Am J Roentgenol. 2013;201:1083–6.

    Article  Google Scholar 

  16. Robertson WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DG, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy. 2008;24:130–6.

    Article  PubMed  Google Scholar 

  17. Pfirrmann CWA, Chung CB, Theumann NH, Trudell DJ, Resnick D. Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae—MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. Radiology. 2001;221:469–77.

    Article  CAS  PubMed  Google Scholar 

  18. Bogunovic L, Lee SX, Haro MS, Frank JM, Mather RC, Bush-Joseph CA, Nho SJ. Application of the Goutallier/Fuchs rotator cuff classification to the evaluation of hip abductor tendon tears and the clinical correlation with outcome after repair. Arthroscopy. 2015;31:2145–51.

    Article  PubMed  Google Scholar 

  19. Bunker TD, Esler CN, Leach WJ. Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997;79:618–20.

    Article  CAS  PubMed  Google Scholar 

  20. Redmond JM, Chen AW, Domb BG. Greater trochanteric pain syndrome. J Am Acad Orthop Surg. 2016;24:231–40.

    Article  PubMed  Google Scholar 

  21. Lachiewicz PF. Abductor tendon tears of the hip: evaluation and management. J Am Acad Orthop Surg. 2011;19:385–91.

    Article  PubMed  Google Scholar 

  22. Domb BG, Nasser RM, Botser IB. Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair. Arthroscopy. 2010;26:1697–705.

    Article  PubMed  Google Scholar 

  23. McConnell T, Tornetta PI, Benson E, Manuel J. Gluteus medius tendon injury during reaming for gamma nail insertion. Clin Orthop Relat Res. 2003;407:199–202.

    Article  Google Scholar 

  24. Haraldsson BT, Langberg H, Aagaard P, Zuurmond A-M, van El B, DeGroot J, Kjær M, Magnusson SP. Corticosteroids reduce the tensile strength of isolated collagen fascicles. Am J Sports Med. 2006;34:1992–7.

    Article  PubMed  Google Scholar 

  25. Domb BG, Brooks AG, Byrd JW. Clinical examination of the hip joint in athletes. J Sport Rehabil. 2009;18:3–23.

    Article  PubMed  Google Scholar 

  26. Walker-Santiago R, Ortiz-Declet V, Maldonado DR, Wojnowski NM, Domb BG. The modified resisted internal rotation test for detection of gluteal tendon tears. Arthrosc Tech. 2019;8:e331–4.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P. Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum. 2008;59:241–6.

    Article  CAS  PubMed  Google Scholar 

  28. Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy. 2008;24:1407–21.

    Article  PubMed  Google Scholar 

  29. Sutter R, Kalberer F, Binkert CA, Graf N, Pfirrmann CWA, Gutzeit A. Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle. Skelet Radiol. 2013;42:627–33.

    Article  Google Scholar 

  30. Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). Am J Roentgenol. 2004;182:137–43.

    Article  Google Scholar 

  31. White LM, Oar DA, Naraghi AM, Griffin A, Safir OA. Gluteus minimus tendon: MR imaging features and patterns of tendon tearing. Skelet Radiol. 2021;50(10):2013–21. https://doi.org/10.1007/s00256-021-03745-4.

    Article  Google Scholar 

  32. Belzunce MA, Henckel J, Fotiadou A, Di Laura A, Hart A. Automated measurement of fat infiltration in the hip abductors from Dixon magnetic resonance imaging. Magn Reson Imaging. 2020;72:61–70.

    Article  PubMed  Google Scholar 

  33. Steinert L, Zanetti M, Hodler J, Pfirrmann CWA, Dora C, Saupe N. Are radiographic trochanteric surface irregularities associated with abductor tendon abnormalities? Radiology. 2010;257:754–63.

    Article  PubMed  Google Scholar 

  34. Rosinsky PJ, Yelton MJ, Ankem HK, Meghpara MB, Maldonado DR, Shapira J, Yelton BR, Lall AC, Domb BG. Pertrochanteric calcifications in patients with greater trochanteric pain syndrome: description, prevalence, and correlation with intraoperatively diagnosed hip abductor tendon injuries. Am J Sports Med. 2021;49(7):1759–68.

    Article  PubMed  Google Scholar 

  35. Westacott DJ, Minns JI, Foguet P. The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears--a systematic review. Hip Int. 2011;21:637–45.

    Article  PubMed  Google Scholar 

  36. McMahon S, Fleury J. External validity of physical activity interventions for community-dwelling older adults with fall risk: a quantitative systematic literature review. J Adv Nurs. 2012;68:2140–54.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;(304):78–83.

    Google Scholar 

  38. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg. 1999;8:599–605.

    Article  CAS  Google Scholar 

  39. Krishnamoorthy VP, Kunze KN, Beck EC, Cancienne JM, O’Keefe LS, Ayeni OR, Nho SJ. Radiographic prevalence of symphysis pubis abnormalities and clinical outcomes in patients with femoroacetabular impingement syndrome. Am J Sports Med. 2019;47:1467–72.

    Article  PubMed  Google Scholar 

  40. Khoury AN, Brooke K, Helal A, Bishop B, Erickson L, Palmer IJ, Martin HD. Proximal iliotibial band thickness as a cause for recalcitrant greater trochanteric pain syndrome. J Hip Preserv Surg. 2018;5:296–300.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011;21:447–53.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Furia JP, Rompe JD, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med. 2009;37:1806–13.

    Article  PubMed  Google Scholar 

  43. Mallow M, Nazarian LN. Greater trochanteric pain syndrome diagnosis and treatment. Phys Med Rehabil Clin N Am. 2014;25:279–89.

    Article  PubMed  Google Scholar 

  44. Cohen SP, Strassels SA, Foster L, Marvel J, Williams K, Crooks M, Gross A, Kurihara C, Nguyen C, Williams N. Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomised controlled trial. BMJ. 2009;338:b1088.

    Article  PubMed  PubMed Central  Google Scholar 

  45. McEvoy JR, Lee KS, Blankenbaker DG, del Rio AM, Keene JS. Ultrasound-guided corticosteroid injections for treatment of greater trochanteric pain syndrome: greater trochanter bursa versus subgluteus medius bursa. AJR Am J Roentgenol. 2013;201:W313–7.

    Article  PubMed  Google Scholar 

  46. Labrosse JM, Cardinal E, Leduc BE, Duranceau J, Rémillard J, Bureau NJ, Belblidia A, Brassard P. Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR Am J Roentgenol. 2010;194:202–6.

    Article  PubMed  Google Scholar 

  47. Walker-Santiago R, Wojnowski NM, Lall AC, Maldonado DR, Rabe SM, Domb BG. Platelet-rich plasma versus surgery for the management of recalcitrant greater trochanteric pain syndrome: a systematic review. Arthroscopy. 2020;36:875–88.

    Article  PubMed  Google Scholar 

  48. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015;43:752–61.

    Article  PubMed  Google Scholar 

  49. Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N. Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med. 2009;37:1981–90.

    Article  PubMed  Google Scholar 

  50. Alpaugh K, Chilelli BJ, Xu S, Martin SD. Outcomes after primary open or endoscopic abductor tendon repair in the hip: a systematic review of the literature. Arthroscopy. 2015;31:530–40.

    Article  PubMed  Google Scholar 

  51. Burman MS. Arthroscopy or the direct visualization of joints. J Bone Joint Surg Am. 1931;13:669–95.

    Google Scholar 

  52. Byrd JW. Hip arthroscopy utilizing the supine position. Arthroscopy. 1994;10:275–80.

    Article  CAS  PubMed  Google Scholar 

  53. Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E. Hip arthroscopy by the lateral approach. Arthroscopy. 1987;3:4–12.

    Article  CAS  PubMed  Google Scholar 

  54. Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc Rev. 2010;18:113–9.

    Article  PubMed  Google Scholar 

  55. Maldonado DR, Chen JW, Walker-Santiago R, Rosinsky PJ, Shapira J, Lall AC, Domb BG. Forget the greater trochanter! Hip joint access with the 12 o’clock portal in hip arthroscopy. Arthrosc Tech. 2019;8:e575–84.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Baker CL, Massie RV, Hurt WG, Savory CG. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. 2007;23:827–32.

    Article  PubMed  Google Scholar 

  57. Farr D, Selesnick H, Janecki C, Cordas D. Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis. Arthroscopy. 2007;23:905.e1–5.

    Article  Google Scholar 

  58. Fox JL. The role of arthroscopic bursectomy in the treatment of trochanteric bursitis. Arthroscopy. 2002;18:1–4.

    Article  Google Scholar 

  59. Allen W, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3:303–8.

    Article  CAS  PubMed  Google Scholar 

  60. Polesello GC, Queiroz MC, Domb BG, Ono NK, Honda EK. Surgical technique: endoscopic gluteus maximus tendon release for external snapping hip syndrome. Clin Orthop Relat Res. 2013;471:2471–6.

    Article  PubMed  Google Scholar 

  61. Ilizaliturri VM, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. 2006;22:505–10.

    Article  PubMed  Google Scholar 

  62. Pierce TP, Kurowicki J, Issa K, Festa A, Scillia AJ, McInerney VK. External snapping hip: a systematic review of outcomes following surgical intervention: external snapping hip systematic review. Hip Int. 2018;28:468–72.

    Article  PubMed  Google Scholar 

  63. Zhang S, Dong C, Li Z, Wang Z, Wei M, Tong P, Li C. Endoscopic iliotibial band release during hip arthroscopy for femoroacetabular impingement syndrome and external snapping hip had better patient-reported outcomes: a retrospective comparative study. Arthroscopy. 2021;37(6):1845–52. https://doi.org/10.1016/j.arthro.2021.01.040.

    Article  PubMed  Google Scholar 

  64. Dwek J, Pfirrmann C, Stanley A, Pathria M, Chung CB. MR imaging of the hip abductors: normal anatomy and commonly encountered pathology at the greater trochanter. Magn Reson Imaging Clin N Am. 2005;13:691–704.

    Article  PubMed  Google Scholar 

  65. Perets I, Mansor Y, Yuen LC, Chen AW, Chaharbakhshi EO, Domb BG. Endoscopic gluteus medius repair with concomitant arthroscopy for labral tears: a case series with minimum 5-year outcomes. Arthroscopy. 2017;33:2159–67.

    Article  PubMed  Google Scholar 

  66. Chandrasekaran S, Gui C, Hutchinson MR, Lodhia P, Suarez-Ahedo C, Domb BG. Outcomes of endoscopic gluteus medius repair: study of thirty-four patients with minimum two-year follow-up. J Bone Joint Surg Am. 2015;97:1340–7.

    Article  PubMed  Google Scholar 

  67. Chandrasekaran S, Lodhia P, Gui C, Vemula SP, Martin TJ, Domb BG. Outcomes of open versus endoscopic repair of abductor muscle tears of the hip: a systematic review. Arthroscopy. 2015;31:2057–2067.e2.

    Article  PubMed  Google Scholar 

  68. Meghpara MB, Yelton MJ, Annin S, Rosinsky PJ, Shapira J, Maldonado DR, Lall AC, Domb BG. Return to activity after gluteus medius repair in active patients older than 50 years. Orthop J Sports Med. 2021;9:2325967120967968.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Meghpara MB, Bheem R, Haden M, Rosinsky PJ, Shapira J, Maldonado DR, Lall AC, Domb BG. Differences in clinical presentations and surgical outcomes of gluteus medius tears between men and women. Am J Sports Med. 2020; https://doi.org/10.1177/0363546520966335.

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  1. American Hip Institute Research Foundation, Chicago, IL, USA

    Benjamin G. Domb, Payam W. Sabetian & Kara Miecznikowski

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  1. Benjamin G. Domb
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Correspondence to Benjamin G. Domb .

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  1. Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA

    Brian C. Werner

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Domb, B.G., Sabetian, P.W., Miecznikowski, K. (2022). Peritrochanteric Space Disorders: Anatomy and Management. In: Werner, B.C. (eds) MRI-Arthroscopy Correlations. Springer, Cham. https://doi.org/10.1007/978-3-030-94789-7_33

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