Sonographic pathoanatomy of greater trochanteric pain syndrome

Aims To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. Materials and methods Using ultrasound we evaluated eighty-eight clinically diagnosed patients with...

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Bibliographic Details
Published in:Journal of ultrasound 2024-09, Vol.27 (3), p.501-510
Main Authors: Atilano, Leire, Martin, Nerea, Iglesias, Gotzon, Martin, Jose Ignacio, Mendiola, Josu, Aiyegbusi, Ayoola, Bully, Paola, Rodriguez-Palomo, Manuel, Andia, Isabel
Format: Article
Language:English
Subjects:
Atrophy
Biomarkers
Calcification
Calcium
Evaluation
Medical imaging
Medicine
Medicine & Public Health
Multivariate analysis
Original Paper
Pain
Regression models
Tendons
Ultrasonic imaging
Ultrasonic testing
Ultrasound
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Summary:Aims To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. Materials and methods Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models. Results Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness ( p  = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus ( p  = 0.014); calcifications were associated with tendon thickness ( p  = 0.042), hypoechogenicity ( p  = 0.005) and the presence of partial tears ( p  = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension ( p  = 0.008) and dysfunction in patients with gluteal muscle atrophy ( p  = 0.001) and loss of fibrillar pattern in the gluteus medius ( p  = 0.002). Conclusion GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.
ISSN:1876-7931
1971-3495
1876-7931
DOI:10.1007/s40477-023-00836-x