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Peritrochantäre Schmerzsyndrome

Greater trochanteric pain syndrome

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Zusammenfassung

Peritrochantäre Schmerzen sind eine häufige Beschwerde in der orthopädischen Praxis. Die häufigsten Diagnosen sind myofasziale Schmerzsyndrome, Bursitis trochanterica, Tendinosen und Rupturen der Mm. glutaeus medius et minimus sowie die Coxa saltans externa. Ferner spielen Nervenkompressionssyndrome wie das Piriformissyndrom eine wichtige Rolle. Im vorliegenden Beitrag werden die wesentlichen diagnostischen und therapeutischen Verfahren bei peritrochantären Schmerzsyndromen zusammengefasst. Mit einer subtilen klinischen Untersuchung, welche durch gezielte bildgebende Verfahren und diagnostische Infiltrationen ergänzt wird, kann in den meisten Fällen eine Differenzierung der zugrunde liegenden Entitäten erreicht werden. Nach Diagnosestellung kann eine gezielte und meist zunächst konservative Therapie folgen, mit Erfolgsraten von mehr als 90 %. Bei Beschwerdepersistenz oder Sehnenruptur lassen sich Schmerz und Funktion mittels endoskopischer und offener Operationsverfahren in den meisten Fällen deutlich verbessern.

Abstract

Greater trochanteric pain is one of the common complaints in orthopedics. Frequent diagnoses include myofascial pain, trochanteric bursitis, tendinosis and rupture of the gluteus medius and minimus tendon, and external snapping hip. Furthermore, nerve entrapment like the piriformis syndrome must be considered in the differential diagnosis. This article summarizes essential diagnostic and therapeutic steps in greater trochanteric pain syndrome. Careful clinical evaluation, complemented with specific imaging studies and diagnostic infiltrations allows determination of the underlying pathology in most cases. Thereafter, specific nonsurgical treatment is indicated, with success rates of more than 90 %. Resistant cases and tendon ruptures may require surgical intervention, which can provide significant pain relief and functional improvement in most cases.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Gollwitzer, G. Opitz, L. Gerdesmeyer und M. Hauschild geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland

    H. Gollwitzer & M. Hauschild

  2. ATOS Klinik München, München, Deutschland

    H. Gollwitzer

  3. Facharztpraxis für Orthopädie, Spezielle Schmerztherapie, München, Deutschland

    G. Opitz

  4. Sektion onkologische und rheumatologische Orthopädie, Universitätsklinikum Schleswig Holstein, Campus Kiel, Kiel, Deutschland

    L. Gerdesmeyer

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  1. H. Gollwitzer
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  2. G. Opitz
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  3. L. Gerdesmeyer
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  4. M. Hauschild
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Correspondence to H. Gollwitzer.

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Gollwitzer, H., Opitz, G., Gerdesmeyer, L. et al. Peritrochantäre Schmerzsyndrome. Orthopäde 43, 105–118 (2014). https://doi.org/10.1007/s00132-013-2208-8

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  • DOI: https://doi.org/10.1007/s00132-013-2208-8

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