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Greater Trochanteric Pain Syndrome

  • Troch bursitis is one of the bane’s of orthopaedics
  • infrequently needs to be treated surgically
  • much recalcitrant bursitis isn’t bursitis at all
    • new term: “greater trochanteric pain syndrome”
  • Signs

    • trendelenberg stance on one leg
    • abductor lurch
      • shift body weight over symptomatic side, reducing forces that abductors need to keep pelvis level
    • MRI is reliable at showing abductor pathology
      • sometimes seen as normal consequence of aging
      • determine clinical relevance from exam
    • Ultrasound
      • guided corticosteroid or PRP injections
      • shows structural problems
      • therapeutic and diagnostic value
  • Access to peritroch space

    • Byrd Arthroscopy Techniques paper
    • It is more difficult to protect glut med repairs than cuff
  • Glut Tear vs FAI results

    • 100% female (glut)
    • baseline mHHS 20 points worse than FAI patients
    • Improvement mean of 43 points is twice as good as that seen in FAI patients
  • Older population, severely disabled because of this problem, but not too difficult to sort out
  • tell them at least 6 months for recovery, although it is usually about 4-5 months
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