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

  • Basic Research
  • Hip
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Greater trochanteric pain syndrome can be severely debilitating. Ideal imaging modalities are not established, treatments are not reliably evaluated, and the underlying pathology is not well understood.

Questions/purposes

Using surgical and histopathology findings as a gold standard, we therefore determined the positive predictive value of preoperative ultrasound assessment for greater trochanteric pain syndrome recalcitrant to nonoperative management. In addition, we report the outcomes of gluteal tendon reconstructive surgery using validated clinical and functional outcome tools and evaluate the contribution of the tendon and bursa to greater trochanteric pain syndrome.

Patients and Methods

We reviewed 24 patients who had combined gluteal tendon reconstruction and bursectomy. Preoperative ultrasound imaging was compared with surgical findings. In the absence of a greater trochanteric pain syndrome specific outcome tool, surgical outcomes for pain and function were assessed via a 100-mm visual analog scale, the modified Harris hip score, and the Oswestry Disability Index. Strength also was measured. The tendon and bursa tissue collected at surgery was histopathologically reviewed.

Results

In our small study, ultrasound had a high positive predictive value for gluteal tendon tears (positive predictive value = 1.0). Patients reported high levels of pain relief and function after surgery; tendon and bursa showed pathologic changes.

Conclusions

Ultrasound appears to be clinically useful in greater trochanteric pain syndrome; reconstructive surgery seems to relieve pain and the histopathologic findings show tendinopathy and bursa pathology coexist in greater trochanteric pain syndrome.

Level of Evidence

Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Sarah Tobin, Wes Cormick, Teresa Neeman, Keith Dear, Jane Twin, Simon Gallant, Barry Flynn, Ian Duncan, and the patients.

Author information

Authors and Affiliations

  1. Australian National University, Canberra, Australia

    A. M. Fearon MPhysio, J. M. Scarvell PhD & P. N. Smith FRACS

  2. Trauma and Orthopaedic Research Unit at Canberra Hospital, Level 1, Building 6, 77 Yamba Drive, Garran, ACT, 2605, Australia

    A. M. Fearon MPhysio, J. M. Scarvell PhD & P. N. Smith FRACS

  3. Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia

    J. L. Cook PhD

Authors
  1. A. M. Fearon MPhysio
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  2. J. M. Scarvell PhD
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  3. J. L. Cook PhD
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  4. P. N. Smith FRACS
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Corresponding author

Correspondence to A. M. Fearon MPhysio.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

The surgery was performed at the Calvary John James Memorial Hospital, Deakin, ACT. The clinical assessments were performed at Canberra Hospital, Woden, ACT. The pathology was performed at Capital Pathology, Deakin, ACT. The imaging was performed by Canberra Imaging Group, ACT.

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Fearon, A.M., Scarvell, J.M., Cook, J.L. et al. Does Ultrasound Correlate with Surgical or Histologic Findings in Greater Trochanteric Pain Syndrome? A Pilot Study. Clin Orthop Relat Res 468, 1838–1844 (2010). https://doi.org/10.1007/s11999-009-1174-2

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  • DOI: https://doi.org/10.1007/s11999-009-1174-2

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