Gluteal Tendinopathy

Abstract

Gluteal tendinopathy as well as partial and full-thickness tears of gluteal tendons (gluteus minimus and/or medius tendon) were underestimated as a cause of chronic pain in the past, and treatment was most commonly based on the diagnosis of trochanteric bursitis. Tendinous pathologies can either stay asymptomatic or cause pain and muscular dysfunction, not necessarily being associated with osteoarthritis of the hip 1. As the terminus rotator cuff tear of the hip was published in 1997 2, its aetiopathogenesis was reconsidered, resulting in improvements in diagnosis and treatment. Nevertheless the adoption of those findings into clinical daily routine took time 3. Ultrasound and magnetic resonance imaging (MRI) as well as histopathologic examination questioned the relevance of acute bursitis being the only cause of greater trochanteric pain 4-6, while emphasizing degenerative tendinopathy causing those symptoms 6-8. The terminus greater trochanteric pain syndrome (GTPS) should hereby also include further pathologies, e.g. calcific tendinitis 1,5. GTPS affects about 10-25 [%] of the adult population 5. Ultrasound and MRI are reliable, non-invasive methods for detecting tendinous and bursal pathologies 7-9; in 88 [%] of all patients with trochanteric pain, MRI gives pathological findings 10. Nevertheless, in 50[%] of suspicious pertrochanteric pathologies, patients are free of symptoms 1,10. In patients undergoing total hip arthroplasty, the incidence of intraoperative macroscopically identified gluteal tendon tears reaches up to 22[%] 2,11-13. Tendinous tears cause pain and constrained muscular function. Sole traumatic tears are rare, most commonly they are based on pre-existing defects. Tendinosis and partial tears are primarily treated conservatively. Hereby, therapeutic options are similar to those for rotator cuff pathologies of the shoulder. Topical infiltration of corticosteroids and physical therapy offer good results especially in early stages. The effectiveness of extracorporeal shock wave therapy has also been proven 14. Surgical intervention is necessary in case of non-responsiveness to treatment or loss of gluteal muscular function. Hereby, the open gluteal repair always represented the method of choice, whereas recently, users of endoscopic systems reported similar or even better outcomes 15-21. © Georg Thieme Verlag KG Stuttgart, New York.