title: Greater trochanteric pain syndrome: does imaging-identified pathology influence the outcome of interventions?
abstract: OBJECTIVE
  To assess the outcomes for patients seen in a rheumatology service presenting with features of the greater trochanteric pain syndrome (GTPS) and the impact of imaging results on the outcomes of treatment.
  
  
  METHODS
  Retrospective audit, using a phone interview was performed to establish links between results of imaging undertaken in the diagnostic work-up of patients with lateral hip pain and clinical outcomes for these patients. Patient perceptions of the effectiveness of interventions were also assessed.
  
  
  RESULTS
  Forty-five patients were included (82% female, mean age 69.6 years). Sixty-nine percent underwent radiological work-up, including plain X-rays (55%), computed tomography scans (64%), magnetic resonance imaging (48%) and ultrasound (90%). Coexistent trochanteric bursitis (TB) and gluteal tendinopathy were the most commonly elucidated pathologies accounting for the symptomatic presentation of 40% of patients. Forty-one patients underwent some form of intervention, most commonly injection of local anesthetic and corticosteroid (LACS) into the region of the TB (87%), two-thirds of which were undertaken under radiological guidance. Pain reduction was maximal following the third injection, with a significantly better response to unguided interventions and levels of symptomatic relief following the first injection being a good indicator of the probability of complete remission. Radiological demonstration of isolated TB correlated with a greater reduction in lateral hip symptoms following LACS TB injections both in the immediate post-injection phase and in the long-term.
  
  
  CONCLUSIONS
  The results of this audit suggest that the management of GTPS has reasonable patient outcomes; however, a prospective study with greater patient numbers is needed to confirm these results.
authors: Department of Medicine, The Queen Elizabeth Hospital Adelaide, Adelaide, South Australia, Australia.
authors: Shayne A
authors: SA
authors: Wilson
authors: Ernst M
authors: EM
authors: Shanahan
authors: Malcolm D
authors: MD
authors: Smith
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D018771:Arthralgia / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D002062:Bursitis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D059350:Chronic Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000294:innervation / Q000473:pathology; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D058748:Pain Perception; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013021:South Australia; D013577:Syndrome; D052256:Tendinopathy / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local
keywords: lateral hip pain; radiological investigations; steroid injections