Twelve patients with clinical signs of retro-trochanteric pain syndrome were randomized to either operative treatment or a control group. Six patients were operated on with sectioning of the tendon to the internal obturator near its insertion to the trochanter major. There was no significant pain decrease in either group at 6 months. However, at 8 years, the decrease in pain was significant in the surgical group (P < 0.03) but not in the control group. Three patients in the surgical group who needed pain medication with opioids preoperatively managed without such drugs at 8 years. Two patients in the surgical group were working half time at the 8 year follow-up. Before the start of the study the patients had been out of work for 3 and 10 years, respectively. At inclusion 4/12 patients had minor degenerative changes at the L3-L5 level as seen on computerized tomography or magnetic resonance imaging. At 8 years, the corresponding change was found in 7/9 patients (P = 0.025). In conclusion, at 8 years after surgical release of the internal obturator muscle, the patients had a significant decrease in pain compared with the finding at inclusion. The corresponding was not found in the control group.

Diffuse retro-trochanteric pain occasionally radiating to the lower extremity could be caused by the piriformis or internal obturator muscle syndromes. Thirteen patients, with retro-trochanteric pain were included in the study. All patients suffered from a diffuse, but intense and often radiating hip pain. The median duration of the symptoms was 8 (1-20) years. The patients were treated by a specific supervised stretching programme with special emphasis on the internal obturator muscle. The duration of the stretching programme was 4 weeks. At inclusion, the median pain on the visual analogue scale (VAS) was 6.0 (3-7). The VAS for pain decreased to 4.0 (0-7) (p = 0.01) at 12 weeks. Five years after treatment, the VAS for pain was still significantly lower than at inclusion, 4.0 (0-7) (p = 0.018). A significant reduction in the number of positive Freiberg's tests and in the number of patients limping was also observed, both at 3 months and at 5 years after treatment. It appears that a supervised stretching programme renders significant short and long term decrease in symptom for patients with retro-trochanteric pain.