Differentiation of greater trochanteric pain syndrome and hip osteoarthritis
Creators: name: Fearon, Angela Margaret
Publisher: name: The Australian National University
Year: 2011
Subjects: subject: RC932.F43 2011
subject: Hip joint Diseases
subject: Osteoarthritis
subject: Musculoskeletal system Diseases Diagnosis.
subject: Musculoskeletal System Anatomy

description: Greater trochanteric pain syndrome (GTPS) is a common, sometimes disabling, hip condition that affects older women in higher proportions than any other demographic. Reports that the diagnosis is straightforward are misleading with misdiagnosis and under-diagnosis frequently reported. A definitive set of diagnostic criteria has not been established. Despite the high prevalence of GTPS, the impact on quality of life and function has only been measured in people representing a narrow spectrum of the condition, and there is no Australian data. Other than being a woman over the age of 50, no risk factors have been established for the development of GTPS. Greater trochanteric pain syndrome is thought to be due to local tendon and bursa pathology, although this has not been established. Ultrasound imaging is commonly used for assessing these tendons and bursae about the greater trochanter, and surgical reconstruction of these tendons is undertaken, but neither have been extensively evaluated. The aims of this thesis were to: 1 Determine the diagnostic criteria for GTPS. 2 Establish clinical tests that differentiate GTPS from hip osteoarthritis. 3 Establish the level of pain and disability that people with GTPS suffer. 4 Determine if pelvic, hip or body morphology are intrinsic risk factors for GTPS. 5 Evaluate the effectiveness of combined tendon reconstruction and bursectomy for people with refractory GTPS. 6 Evaluate if the gluteus medius tendon and the trochanteric bursa of gluteus maximus demonstrate higher levels of pathology in those who undergo gluteal tendon reconstruction compared to those who undergo total hip arthroplasty for hip osteoarthritis. 7 Evaluate the diagnostic value of US imaging in diagnosing GMed and minimus tendon tears, and pathology in the trochanteric bursa of gluteus maximus. These aims were addressed through five studies involving four groups of participants recruited from the ACT and rural NSW. Outcome measures included a standardised clinical assessment of the hip; the Harris Hip Score; the Oswestry Disability Index; the Functional Co-morbidity Index; and the Australian Quality of Life Index. This thesis contends that the diagnostic criteria for GTPS should be: a) a history of lateral hip pain; b) having no difficulty manipulating shoes and socks on and off; c) pain on palpation ofthe greater trochanter; and d) Faber test that reproduces lateral hip pain. People with GTPS were found to have levels of pain and disability, almost indistinguishable from those experienced by participants with severe hip osteoarthritis. The risk factors for GTPS were confirmed to be multifactorial, with elevated peripheral adiposity and increase hip width implicated. A reduced femoral neck-shaft angle increased the odds of developing refractory GTPS. The evaluation of combined gluteal tendon reconstruction and bursectomy found that this surgery provided good pain relief and a reasonable level of post-operative function. Histopathologically, the tendon and bursa were both implicated in GTPS, with interadipose septae within the bursa stroma possibly explaining US reports of bursae thickening. US imaging on people with refractory GTPS was found to have a high positive predicative value for a tendon tear, when compared to surgery.