Arthritis & Rheumatism, Volume 65,
October 2013 Abstract Supplement

Abstracts of the 2013 American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Meeting
San Diego, CA October 25-30, 2013.


Variable Imaging Characteristics Identified By Point-Of-Care Ultrasound For Greater Trochanteric Pain Syndrome.

Kohler1,  Minna J., Rastalsky1,  Naina, Fraenkel2,  Liana

Massachusetts General Hospital/Harvard Medical School, Boston, MA,
Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, New Haven, CT

Background/Purpose:

Greater trochanteric pain syndrome (GTPS) is a common cause of musculoskeletal pain that has been typically attributed to trochanteric bursitis. It encompasses a spectrum of disorders [gluteal tendinopathy, tears, bursitis, and iliotibial band (ITB) syndrome] that are difficult to distinguish by clinical exam alone. Few modalities for the treatment of GTPS exist and are recommended without consideration of the structural etiology of pain. Better understanding of ultrasound (US) imaging characteristics in relation to clinical symptoms may be helpful in identifying those patients who would most benefit from the various treatment options available.

Methods:

A prospective, observational, descriptive study was performed to describe the soft tissue and bony structural US findings identified in the lateral hip in patients presenting with GTPS to a dedicated outpatient rheumatology musculoskeletal US clinic. US imaging was obtained using a standardized protocol by 2 US-trained rheumatologists (NR, MK). Eligible subjects included ages 18 and above with lateral hip pain thought to be due to GTPS with pain for at least 1 week and a pain score of at least 2 out of 10 on an 11-point numeric rating scale at rest or with activity. For subjects with bilateral GTPS, the most symptomatic hip was considered the study hip. Most important ineligibility criteria included Body Mass Index (BMI) >40, groin pain, and symptomatic osteoarthritis of the hip. All US images were reviewed by both doctors for consensus of image interpretation.

Results:

74 eligible subjects were identified ranging in age from 25–85, with a mean BMI of 28 (±4.77); 62 (84.0%) were female. Forty-five (60.8%) had concomitant low back pain and 11 (14.9%) had chronic widespread pain. The mean duration of symptoms was 18 (±23.0) weeks. The mean level of pain at rest and activity were 4.8 (±2.87) and 6.7 (±2.36) respectively. Twenty-five (35.0%) had a prior episode of lateral hip pain. The most common location of bursal fluid was the subgluteus maximus bursa. Frequency and percentage of various imaging characteristics are summarized in the Table.

US Imaging Characteristics  N (%) 
Bony changes (Grade 0) 42 (56.8)
Bony changes (Grade 1) 18 (24.3)
Bony changes (Grade 2) 13 (17.6)
Bony changes (Grade 3) 1 (1.4)
Bursal fluid collections 34 (46.0)
Calcifications of gluteus medius 29 (39.2)
Calcifications of gluteus minimus 7 (9.5)
Calcifications in other locations 4 (5.4)
Enthesophytes in gluteus medius 7 (9.5)
Enthesophytes in gluteus minimus 1 (1.4)
Gluteus medius tendinopathy 57 (77.0)
Gluteus medius partial thickness tear 11 (14.9)
Gluteus medius full thickness tear 1 (1.4)
Gluteus minimus tendinopathy 10 (13.5)
Gluteus minimus partial thickness tear 3 (4.1)
Gluteus minimus full thickness tear 0 (0.0)
Tensor fascia latae abnormality (tendinopathy, tear, fluid) 14 (18.9)
Distal ITB tendinopathy 6 (8.1)
Distal ITB peritendinous fluid 3 (4.1)

Conclusion:

GTPS is commonly attributed to trochanteric bursitis, but only 46% of the subjects had US evidence of true bursitis. The addition of US evaluation to the clinical assessment of GTPS increase may diagnostic accuracy and improve medical decision making.

Disclosure: M. J. Kohler, None; N. Rastalsky, None; L. Fraenkel, None.

To cite this abstract, please use the following information:
Kohler, Minna J., Rastalsky, Naina, Fraenkel, Liana; Variable Imaging Characteristics Identified By Point-Of-Care Ultrasound For Greater Trochanteric Pain Syndrome. [abstract]. Arthritis Rheum 2013;65 Suppl 10 :231
DOI: 10.1002/art.2013.65.issue-s10

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