Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome

Abstract

Objective This study examined patients with greater trochanteric pain syndrome (GTPS) to determine the prevalence of gluteus medius pathology by utilizing magnetic resonance imaging (MRI), and to evaluate the presence of Trendelenburg's sign, pain on resisted hip abduction, and pain on resisted hip internal rotation as predictors of a gluteus medius tear in this group of patients. Methods Twenty‐four subjects with clinical features consistent with GTPS were recruited. A standard physical assessment was performed at study entry, including assessment of the 3 specific physical signs. Following this initial assessment, MRI of the affected hip was performed. A 1.5T whole body MRI system was utilized, with T1 and T2 fast spin‐echo sequences performed in the coronal and axial planes. All MR images were reviewed in random order by a single radiologist. In 12 patients, the 3 physical signs were assessed at study entry and at 2 months by the same observer and the intraobserver reliability for each of the signs was calculated. Results All subjects were women (median age 58 years, range 36–75 years). The median duration of symptoms was 12 months (range 12–60 months). MRI findings were as follows: 11 patients (45.8%) had a gluteus medius tear, 15 patients (62.5%) had gluteus medius tendinitis (pure tendinitis in 9 patients and tendinitis with a tear in 6 patients), 2 patients had trochanteric bursal distension, and 1 patient had avascular necrosis of the femoral head. Trendelenburg's sign was the most accurate of the 3 physical signs in predicting a tendon tear, with a sensitivity of 72.7% and a specificity of 76.9%. Moreover, Trendelenburg's sign was the most reliable measure, with a calculated intraobserver kappa of 0.676 (95% confidence interval 0.270–1.08). Conclusion The results support the hypothesis that gluteus medius tendon pathology is important in defining GTPS. In this series, trochanteric bursal distension was uncommon and did not occur in the absence of gluteus medius pathology. The physical findings suggest that Trendelenburg's sign is the most sensitive and specific physical sign for the detection of gluteus medius tears, with an acceptable intraobserver reliability. Further delineation with MRI, especially in patients with a positive Trendelenburg's sign, is recommended prior to any consideration of surgery in this group of patients. Finally, with the pathology of this condition defined, the challenge will be to devise and assess, by randomized controlled trial, an appropriate treatment strategy for this group of patients.

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

“…They did not report on bursa findings at surgery or on histopathology [9]. In studies that have used MRI or ultrasound to differentiate between gluteus medius and minimus pathology, including ours, imaging gluteus minimus pathology has been underreported when compared with the surgical findings [4,8,9,23,26,30,34].…”

All-Endoscopic Single-Row Repair of Full-Thickness Gluteus Medius Tears

“…1,2 More frequent diagnosis can be attributed in part to the increased use of magnetic resonance imaging (MRI), as well as an increased awareness within the orthopaedic community. Tears of the gluteus medius and minimus were first described in the 1990s as "rotator cuff tears of the hip" 3,4 and follow the same patterns of retraction, fatty atrophy, and occasional calcification as seen in the shoulder.…”

A different approach to the management of greater trochanter pain syndrome

“…Trochanteric bursitis is a common regional pain syndrome (Bird et al 2001, Jones and Erhard 1997, Kingzett-Taylor et al 1999, Paluska 2005, Shbeeb et al 1996. Although it is referred to as an inflammatory condition, the clinical signs of redness, local heat and swelling are not usually demonstrated (Bird et al 2001, Paluska 2005, Shbeeb et al 1996.…”

“…Although it is referred to as an inflammatory condition, the clinical signs of redness, local heat and swelling are not usually demonstrated (Bird et al 2001, Paluska 2005, Shbeeb et al 1996. The appropriate term for this condition has been suggested as Greater Trochanter Pain Syndrome (GTPS) (Bird et al 2001, Kingzett-Taylor et al 1999, Paluska 2005, Shbeeb et al 1996.…”

“…Although it is referred to as an inflammatory condition, the clinical signs of redness, local heat and swelling are not usually demonstrated (Bird et al 2001, Paluska 2005, Shbeeb et al 1996. The appropriate term for this condition has been suggested as Greater Trochanter Pain Syndrome (GTPS) (Bird et al 2001, Kingzett-Taylor et al 1999, Paluska 2005, Shbeeb et al 1996. This syndrome has been reported to typically affect soft tissue structures, specifically the Gluteus Medius (GM) tendon and the greater trochanter bursa (Bird et al 2001, Paluska 2005, Shbeeb et al 1996.…”