Gluteal Tendinopathy: Difference between revisions
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== Pathoanatomy/Pathomechanics == | == Pathoanatomy/Pathomechanics == | ||
Changing in loading (tensile or compressive) affects the homeostasis of tendons. Failure to adapt to loading, due to rapid increase in intensity and/or frequency with insufficient recovery time, results in a series of catabolic effects. | [[Stress Loading|Changing in loading]] (tensile or compressive) affects the homeostasis of tendons. Failure to adapt to loading, due to rapid increase in intensity and/or frequency with insufficient recovery time, results in a series of catabolic effects. | ||
Both gluteus medius and minimus are inserted in the greater trochanter. at their inertional point they could be compressed by the Iliotibial band (ITB) at high degrees of hip adduction and flexion e.g. Standing on one leg, crossed sitting, excessive lateral pelvic tilt or shift during dynamic single leg loading tasks. running with a midline or cross-midline foot-ground contact pattern<ref name=":0" />. | Both gluteus medius and minimus are inserted in the greater trochanter. at their inertional point they could be compressed by the Iliotibial band (ITB) at high degrees of hip adduction and flexion e.g. Standing on one leg, crossed sitting, excessive lateral pelvic tilt or shift during dynamic single leg loading tasks. running with a midline or cross-midline foot-ground contact pattern<ref name=":0" />. | ||
Frontal plane control in single leg standing requires synergy between: Trochanteric abductor muscles (gluteus medius and gluteus minimus) by 70% and ITB-tensioning abductors (upper abducting portion of gluteus maximus, tensor fascia lata and vastus lateralis) by 30%<ref name=":1">Kummer B. Is the Pauwels' theory of hip biomechanics still valid? A critical analysis, based on modern methods. Annals of anatomy= Anatomischer Anzeiger: official organ of the Anatomische Gesellschaft. 1993 Jun;175(3):203-10.</ref>. Studies observed imbalance between these two groups in patients with lateral hip pain but it is not clear whether this imbalance is preceding or results from GT<ref name=":1" /><ref>Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M. Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology. 2005 Jun;235(3):969-76.</ref>. Decreased femoral neck angle (coxa vara) is also associated with greater ITB compressive loads in patients with GT<ref>Birnbaum K, Prescher A, Niethard FU. Hip centralizing forces of the iliotibial tract within various femoral neck angles. Journal of Pediatric Orthopaedics B. 2010 Mar 1;19(2):140-9.</ref>. | Frontal plane control in single leg standing requires synergy between: Trochanteric abductor muscles (gluteus medius and gluteus minimus) by 70% and ITB-tensioning abductors (upper abducting portion of gluteus maximus, tensor fascia lata and vastus lateralis) by 30%<ref name=":1">Kummer B. Is the Pauwels' theory of hip biomechanics still valid? A critical analysis, based on modern methods. Annals of anatomy= Anatomischer Anzeiger: official organ of the Anatomische Gesellschaft. 1993 Jun;175(3):203-10.</ref>. Studies observed imbalance between these two groups in patients with lateral hip pain but it is not clear whether this imbalance is preceding or results from GT<ref name=":1" /><ref>Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M. Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology. 2005 Jun;235(3):969-76.</ref>. Decreased femoral neck angle (coxa vara) is also associated with greater width between the iliac wings and the greater trochanters (offset), leading to greater ITB compressive loads in patients with GT<ref>Birnbaum K, Prescher A, Niethard FU. Hip centralizing forces of the iliotibial tract within various femoral neck angles. Journal of Pediatric Orthopaedics B. 2010 Mar 1;19(2):140-9.</ref> <ref>Viradia NK, Berger AA, Dahners LE. Relationship between width of greater trochanters and width of iliac wings in tronchanteric bursitis. American journal of orthopedics (Belle Mead, NJ). 2011 Sep;40(9):E159-62.</ref>. | ||
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== Clinical Presentation == | == Clinical Presentation == | ||
Studies using various scales rate it as a cause of moderate to | Studies using various scales rate it as a cause of moderate to severe pain and disability [1-4], with one study demonstrating quality of life and levels of | ||
severe pain and disability [1-4], with one study demonstrating quality of life and levels of | |||
disability to be similar to end stage hip osteoarthritis (OA)[5].<br> | disability to be similar to end stage hip osteoarthritis (OA)[5].<br> | ||
Revision as of 16:56, 17 July 2018
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Introduction[edit | edit source]
Gluteal Tendinopathy (GT) is defined as moderate to sever disabling pain over the Greater Trochanter (lateral hip pain). It is often referred to as Greater Trochanter Pain Syndrome (GTPS) and was traditionally diagnosed as Trochanteric Bursitis, however, recent research defines non-inflammatory tendinopathy of the gluteus medius and/or gluteus minimus muscles to be the main source of lateral hip pain[1].
This condition affects both athletes (particularly runners) and less active people[1]. One of four females over 50 years is likely to be affected by GT[2].
Gluteal Tendinopathy (GT) has significant impacts on the quality of life, it interferes with sleep (side lying) and common weight bearing tasks[1].
Pathoanatomy/Pathomechanics[edit | edit source]
Changing in loading (tensile or compressive) affects the homeostasis of tendons. Failure to adapt to loading, due to rapid increase in intensity and/or frequency with insufficient recovery time, results in a series of catabolic effects.
Both gluteus medius and minimus are inserted in the greater trochanter. at their inertional point they could be compressed by the Iliotibial band (ITB) at high degrees of hip adduction and flexion e.g. Standing on one leg, crossed sitting, excessive lateral pelvic tilt or shift during dynamic single leg loading tasks. running with a midline or cross-midline foot-ground contact pattern[1].
Frontal plane control in single leg standing requires synergy between: Trochanteric abductor muscles (gluteus medius and gluteus minimus) by 70% and ITB-tensioning abductors (upper abducting portion of gluteus maximus, tensor fascia lata and vastus lateralis) by 30%[3]. Studies observed imbalance between these two groups in patients with lateral hip pain but it is not clear whether this imbalance is preceding or results from GT[3][4]. Decreased femoral neck angle (coxa vara) is also associated with greater width between the iliac wings and the greater trochanters (offset), leading to greater ITB compressive loads in patients with GT[5] [6].
Clinical Presentation[edit | edit source]
Studies using various scales rate it as a cause of moderate to severe pain and disability [1-4], with one study demonstrating quality of life and levels of
disability to be similar to end stage hip osteoarthritis (OA)[5].
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis
[edit | edit source]
add text here relating to the differential diagnosis of this condition
Resources
[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Medicine. 2015 Aug 1;45(8):1107-19.
- ↑ Mellor, R., Bennell, K., Grimaldi, A., Nicolson, P., Kasza, J., Hodges, P., Wajswelner, H. and Vicenzino, B., 2018. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. bmj, 361, p.k1662.
- ↑ 3.0 3.1 Kummer B. Is the Pauwels' theory of hip biomechanics still valid? A critical analysis, based on modern methods. Annals of anatomy= Anatomischer Anzeiger: official organ of the Anatomische Gesellschaft. 1993 Jun;175(3):203-10.
- ↑ Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M. Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology. 2005 Jun;235(3):969-76.
- ↑ Birnbaum K, Prescher A, Niethard FU. Hip centralizing forces of the iliotibial tract within various femoral neck angles. Journal of Pediatric Orthopaedics B. 2010 Mar 1;19(2):140-9.
- ↑ Viradia NK, Berger AA, Dahners LE. Relationship between width of greater trochanters and width of iliac wings in tronchanteric bursitis. American journal of orthopedics (Belle Mead, NJ). 2011 Sep;40(9):E159-62.
