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Sonographic pathoanatomy of greater trochanteric pain syndrome

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Abstract

Aims

To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis.

Materials and methods

Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models.

Results

Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002).

Conclusion

GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.

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Data availability

The data that support the findings of this study are available from the corresponding author, AI, upon reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Interventional Unit, Radio-Diagnostic Service, Cruces University Hospital, 48903, Barakaldo, Spain

    Leire Atilano, Gotzon Iglesias, Jose Ignacio Martin & Josu Mendiola

  2. Regenerative Therapies, Cruces University Hospital, Biobizkaia Health Research Institute, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Spain

    Leire Atilano, Nerea Martin, Gotzon Iglesias, Jose Ignacio Martin, Josu Mendiola, Manuel Rodriguez-Palomo & Isabel Andia

  3. Department of Orthopedic Surgery, Cruces University Hospital, 48903, Barakaldo, Spain

    Nerea Martin & Manuel Rodriguez-Palomo

  4. Department of Physiotherapy, Faculty of Clinical Sciences College of Medicine, University of Lagos, Lagos, Nigeria

    Ayoola Aiyegbusi

  5. Methodological and Statistical Consulting, Sopuerta, Spain

    Paola Bully

Authors
  1. Leire Atilano
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Contributions

Conceptualization: LA, JIM, NM and IA. Patient recruitment, clinical diagnoses and demographic and clinical data acquisition: NM and MR-P. Methodology, scanning technique, radiologists’ consensus of US template to standardize data acquisition: LA, GI, JIM, and JM. Tridimensional MRI, segmentation and 3D printing model for gluteal tendons anatomy: GI. Scores and images assessment: AA. US diagnoses, image acquisition and intraobserver reliability: LA and GI. Electronic data collection logbook, data curing and statistical analyses: PB. Writing original draft: IA, AA, LA and NM. Writing, review and editing: LA, PB and IA.

Corresponding author

Correspondence to Isabel Andia.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local Ethics Committee of Euskadi (2019028).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the ultrasound images.

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Atilano, L., Martin, N., Iglesias, G. et al. Sonographic pathoanatomy of greater trochanteric pain syndrome. J Ultrasound (2023). https://doi.org/10.1007/s40477-023-00836-x

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