Sarah Morton1, Otto Chan2, Jessica Price1, Melanie Pritchard2, Tom Crisp3, John D Perry3, Dylan Morrissey4. 1. Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK. 2. BMI London Independent Hospital, UK. 3. Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK ; BMI London Independent Hospital, UK. 4. Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, UK ; BMI London Independent Hospital, UK ; Physiotherapy Department, Bart's Health NHS Trust, London, UK.
Abstract
BACKGROUND: the aim of this study was to measure the effects of high volume image-guided injections and structured rehabilitation (HVIGI&SR) for greater trochanter pain syndrome (GTPS). METHODS: 31 consecutive subjects were recruited (23 retrospectively; 8 prospectively) over 5 months. GTPS was diagnosed based on history and examination findings, alongside radiological examination. The HVI-GI used a 22-gauge spinal needle to administer 10ml of 0.5% Marcaine and 50 mg hydrocortisone just deep to the periosteum underlying the gluteal tendon insertion under ultrasound guidance, followed by structured rehabilitation. A visual analogue scale (VAS) for pain was used as the main outcome measure. RESULTS: the mean VAS improved from 81.7 mm (±17.6) to 42.3 mm (±28.3), (p<0.05) in the prospective subjects at a mean of 6 weeks, considered clinically significant. In the retrospective subjects the mean VAS had improved from 74.6 (±10.9) mm to 38.2(±31.2) mm at two weeks (p<0.01) and 31.3 (±27.6) mm at the final time point, a mean of 60 weeks (p<0.01). The Hip and Groin Outcome Score in the prospective group showed a non-significant increase from 173.2 to 296.1 (p=0.12). CONCLUSION: HVIGI&SR should be considered when short- and medium-term pain-relieving treatment for GTPS is required. Controlled studies are warranted to fully establish effectiveness, and assess long term effects. LEVEL OF EVIDENCE: case series.
BACKGROUND: the aim of this study was to measure the effects of high volume image-guided injections and structured rehabilitation (HVIGI&SR) for greater trochanter pain syndrome (GTPS). METHODS: 31 consecutive subjects were recruited (23 retrospectively; 8 prospectively) over 5 months. GTPS was diagnosed based on history and examination findings, alongside radiological examination. The HVI-GI used a 22-gauge spinal needle to administer 10ml of 0.5% Marcaine and 50 mg hydrocortisone just deep to the periosteum underlying the gluteal tendon insertion under ultrasound guidance, followed by structured rehabilitation. A visual analogue scale (VAS) for pain was used as the main outcome measure. RESULTS: the mean VAS improved from 81.7 mm (±17.6) to 42.3 mm (±28.3), (p<0.05) in the prospective subjects at a mean of 6 weeks, considered clinically significant. In the retrospective subjects the mean VAS had improved from 74.6 (±10.9) mm to 38.2(±31.2) mm at two weeks (p<0.01) and 31.3 (±27.6) mm at the final time point, a mean of 60 weeks (p<0.01). The Hip and Groin Outcome Score in the prospective group showed a non-significant increase from 173.2 to 296.1 (p=0.12). CONCLUSION: HVIGI&SR should be considered when short- and medium-term pain-relieving treatment for GTPS is required. Controlled studies are warranted to fully establish effectiveness, and assess long term effects. LEVEL OF EVIDENCE: case series.
Entities:
Keywords:
VAS scale; greater trochanter pain syndrome; injection; ultrasound
Authors: Jennifer R McEvoy; Kenneth S Lee; Donna G Blankenbaker; Alejandro Munoz del Rio; James S Keene Journal: AJR Am J Roentgenol Date: 2013-08 Impact factor: 3.959
Authors: Sarah Morton; Otto Chan; John King; David Perry; Tom Crisp; Nicola Maffulli; Dylan Morrissey Journal: Muscles Ligaments Tendons J Date: 2014-07-14
Authors: William G Mitchell; Sharon C Kettwich; Wilmer L Sibbitt; Randy R Sibbitt; Maheswari Muruganandam; Noelle A Rolle; William A Hayward; Roderick A Fields; Luis P Roldan; N Suzanne Emil; Monthida Fangtham; Arthur D Bankhurst Journal: Rheumatol Int Date: 2018-01-20 Impact factor: 2.631