Surgical release of the internal obturator tendon for the treatment of retro-trochanteric pain syndrome: a prospective randomized study, with long-term follow-up

Abstract

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.

Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release

“…Dynamic compression of the sciatic nerve caused by a stretched or altered dynamic of the obturator internus muscle should be included as a possible diagnosis for DGS 25 . As the sciatic nerve passes under the belly of the piriformis and over the superior gemelli/obturator internus, a scissor-like effect between the two muscles can be the source of entrapment 26 .…”

Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study

“…Recently, it has been observed that the sciatic dysfunction in the pelvis was not only caused by different types of conflict with the pyramidal muscle, but there were also conflicts at other levels, giving rise to the concept of deep gluteal syndrome [1,2,6]. One of these causes is sometimes attributed to the gemelli-obturator internus complex [7][8][9].…”

Could tendinosis be involved in osteoarthritis?

“…They also confirmed increasing frequency in abductor mechanism tears with age. Meknas et al (2003Meknas et al ( , 2009 in two publications demonstrated a favorable short-and long-term outcome after the surgical release of the internal obturator tendon in patients with retro-trochanteric pain syndrome.…”