1 / 38

YGC -Journal club ICS Team 29.4.2013

YGC -Journal club ICS Team 29.4.2013. 1 review article + 2 studies+1 new technique. Introduction Review article Paper 1 Paper 2 New technique Q&A. GTPS Greater trochanteric pain syndrome. Incidence 10-25 % Stegemann 1923 – ‘Trochanteric bursitis’ Syndrome – Leonard JAMA 1958

valmai
Download Presentation

YGC -Journal club ICS Team 29.4.2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. YGC -Journal clubICS Team29.4.2013

  2. 1 review article + 2 studies+1 new technique • Introduction • Review article • Paper 1 • Paper 2 • New technique • Q&A

  3. GTPS Greater trochanteric pain syndrome • Incidence 10-25 % • Stegemann 1923 – ‘Trochanteric bursitis’ • Syndrome – Leonard JAMA 1958 • Pain and reproducible tenderness - Gr. trochanter,buttock,lateral thigh

  4. Anatomy • Sub G Maximus and Sub G Medius • Variable occurrence of bursae • Unpredictable referral pain patterns • Buttock Groin Low back • Frequent misdiagnosis,inadequate response to injections

  5. E’logy&Associations • 10-20% over 60 • UK ??,US 1.8/1000 • Obese woman with back pain & hip OA&short leg • Vectors around the hip altered

  6. Mechanism • Trauma overuse Obesity • ~92% had OA hip, RA ,LS OA • c/c microtrauma,regional ms dysfunction • Inflammation of G medius,GMedius/F Lata • Ac trauma crstal deposition TB • Caution r/o stress # and AVN

  7. Evaluation • Pain – lateral hip or buttock - exacerbated by differing postures Physical exam – jump sign • Resistance to abduction and ext rotation • No pain on extension ~ intra art pathology

  8. Where is the pain ?

  9. Diffentials - ITB Syndrome – Ober’s test -Meralgia paresthetica

  10. Treatment • Conservative • NSIADS Ice Physio Wt loss Behaviour modification Flexibility,Ms strengthening • Injections • Arthroscopic bursectomy • ITB lengthening • Osteotomies

  11. Summary of paper • Authors • Aim of study • Methods used (including randomisation process if RCT, etc) • Statistics • Results • Conclusions

  12. Critique • Level of Evidence • Did the authors accomplish their aim? • Did the evidence support their conclusions? • Methods • Any bias? (Selection/Treatment/Evaluation/Spectrum/Observer etc) • Power of study acceptable? • Any flaws in methodology? • Loss to follow-up etc? • Any improvements to study design possible? • Appropriate statistics used for study? • Appropriate analysis of results?

  13. Conclusions • Conclusion about quality of study • Implications for current practice

  14. No 1

  15. Summary of paper • Authors • Aim of study • Methods used (including randomisation process if RCT, etc) • Statistics • Results • Conclusions

  16. Summary of paper • Karpinsky and Piggott – JBJS Br 1985 • 6 year study new patients ( 12-59 y Ave 43 y) • Retrospective review • 15 patients with Trochanteric pain • 11 F / 4 M • 12 had Full ROM hip/3had back pain • Radiographs 12 Normal /3 Calcification • 12 Steriod,2US,1 no mention • Important to diagnose – treatment helps outcome

  17. No 2

  18. Summary of paper • Peter Walker et al CORR 2006 • Does imaging predict response to injection • Prospective ,97 pts 3 year period • Inclusions lat hip pain ,presumed dx Trochanteric bursitis,rx with physio,NSAIDs

  19. Summary of paper • Excluded Traumatic cases,prev injection, spinal sx • Statistics • 74 F/23M Ave - 58 (23-74y) - 4 younger than 50 • MRI Hip 78 • CT LS spine 42 • 3 phase bone scan hip pelvis and l spine • SPEC T to evaluate spine disorders

  20. Summary... • History Phys exam + Investigations • Response to injection • Trochanteric bursitis –GT hyperemia and uptake at post aspect of GT • G medius tendinitis-Lateral and ant hyperemia + uptake lateral and anterior • Zygapophyseal disease - SPECT

  21. Stats • Binary logistic regression • Fischer exact test • Results -Scintigraphic criteria + P V 90% / -P V97% -Inter obs reproducibility kappa value .82

  22. 97 pts -12 Bilateral • Symptoms dur Ave 4.8months (3wks-9Mo) • 75/97 back pain ! ( 74/97 Scinti evidence) • Scintigraphic 84 ( none 13) • 4 Multi level discs /10 other probs

  23. Could any variable predict response to injection ? • 48 Injections. • 18 recurrent pain in 6 weeks

  24. Analysis • Spinal disease predicted recurrent symptoms

  25. A new technique for Trochanteric bursitis • Govaert A M C Amsterdam JBJS Br 2003 • 10 patients ( 12 hips ) • Salvage procedure for a pt who already had bursectomy and IT band surgery • 1994-2000 • 12 hips • 10 F/2 M • 28-73 Y (48.3Y)

  26. A new technique for trochantric bursitis • Pain on awakening got worse limiting ADLs • Full ROM,10 limp,1 used a stick ,1 crutches • Tender GT • Radiographs no abnormalities • One year NSAIDs Physio,Injection, heel raise – NO EFFECT • Mean dur Rx 4 years • Mean no of injectiosn 3

  27. A new technique for trochantric bursitis • 5 Bursectomy fenestration • One 2 surgeries • Pain recurred 6.3 months(1-23 Mo)

  28. Surgery • Osteotomy of trochanter • 5-10 mm slice of trochanter • Reattached distal and medial 2 4.5 screws

  29. Post op

  30. Results • F U 6-77 Mo (23.5Mo) • Mean score inproved 15.8-27.5

  31. Conclusions • Repetitive friction • Conservative 90 % Why effective ? -reduction of trochanter height -increase stregth of AbDuctors -post op hyperemia

More Related