Point-of-Care Ultrasound in Greater Trochanteric Pain Syndrome

• Pain with rest measured by a numeric rating scale [ Time Frame: Baseline and 2 weeks ] [ Designated as safety issue: No ]
• Pain with activity as measured by a numeric rating scale [ Time Frame: Baseline and 2 weeks ] [ Designated as safety issue: No ]
• Demographics [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  age, gender, race/ethnicity, education, occupation, comorbidities, overall health status.
• Pressure point threshold as measured by an algometer [ Time Frame: Baseline ] [ Designated as safety issue: No ]
• Clinical data: Predictors of treatment response [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  • Duration of pain
  • Body Mass Index
  • Physical exam findings
  • Treatments tried in the past
  • Presence of back pain

Greater trochanteric pain syndrome (GTPS) is a common cause of musculoskeletal pain.

The primary aim of this study is to describe the soft tissue and bony structural ultrasound (US) findings identified in the lateral hip and iliotibial band (ITB) in patients presenting with greater trochanteric pain syndrome (GTPS) in an outpatient rheumatology clinic.

GTPS, widely known as trochanteric bursitis, encompasses a spectrum of disorders (gluteal tendinopathy, tears, bursitis, and ITB syndrome) that are difficult to distinguish by clinical exam alone. Better understanding of US imaging characteristics in relation to clinical symptoms may be helpful in identifying those patients who would most benefit from corticosteroid injections and other non-operative treatment options.

Point-of-care musculoskeletal US use has been shown to reduce repeated hospital appointments, improve accuracy of diagnosis, and provide expedited treatment, thus improving quality of care in an outpatient musculoskeletal clinic. US assessment is not routinely included in the management of GTPS patients and ideal imaging modalities are not established.

Outpatient rheumatology clinic

Inclusion Criteria:

• Lateral hip pain thought to be due to GTPS as evidenced by tenderness to palpation of the lateral hip over the greater trochanter
• Have a pain score of at least 2 out of 10 on an 11-point numeric rating scale
• Lateral hip pain for at least 1 week
• For participants with bilateral GTPS, the most symptomatic hip will be considered the study hip
• Have a telephone

Exclusion Criteria:

• Inability to give informed consent
• BMI > 40
• Evidence of severe OA of the study hip by X-ray
• Avascular necrosis of the study hip
• Groin pain at rest or with log-rolling
• Hip internal rotation range of motion < 15 degrees
• Prior fracture involving the study hip or femur
• Prior hip surgery or prosthesis in the painful hip
• Paralysis or paresis of the lower extremity
• Wheelchair bound
• Open wound or skin lesions in the lateral hip