hip/buttock pain due to gluteal tendon tears

[ctts]

For patients who have pain in the posterior to posterolateral hip/buttock area, sometimes I find that it is due to gluteal tendon tears and/or tendinopathy seen on hip MRI. Typically after other causes have been evaluated for and ruled out (trochanteric bursitis, SI joint, hip DJD, piriformis, etc). Often middle aged to older patients. Generally not acute injury, but gradual onset, likely due to overuse. Worse with weight bearing, difficult to do single leg standing, pain/weakness with hip abduction. When I refer to ortho they never seems to be able to do anything for these patients. Peri-tendon steroid injections probably not great for the long-run. I do sometimes refer to PT...but then if it is an overuse problem to begin with, not sure that trying to strengthen the gluteal muscles makes sense. If overweight, then I suppose weight loss can be recommended. Regenerative options could be considered I suppose, but can they heal if they are still weight bearing, walking? I find that I am not really able to offer a satisfactory treatment plan for these patients. Do you see this? What do you do?

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[NJPAIN]

I’m no regen med expert but I would say PRP and have had success with this. Second thing I would say is that there is much to be learned from our PM&R brethren on this. Specifically, that this is a “downstream” problem and the upstream cause needs to be addressed. I suggest listening to podcast by Gerry Malanga (“Malanga Talks”) on this and similar topics. Good basic logical info. You just need to get past a bit of condescending tone.

 

[Dr. Ice]

Have done a bunch of PRP for gluteal tendinosis with excellent benefit

 

[MD87]

Can consider tenotomy/TENEX also. The surgeons I know only operate on younger patients. None of the older patients get surgery.

 

[lobelsteve]

Have done a bunch of PRP for gluteal tendinosis with excellent benefit

Publish.

 

[pmrmd]

I do PRP and Tenex for these years.

 

[bedrock]

I also do PRP for these after they fail PT

 

[Dr. Ice]

Publish.

Also works really well for labral tears

Publish.

 

[RoloTomassi]

What's everyone's PRP technique for this?

 

[Dr. Ice]

What's everyone's PRP technique for this?

Pure, ultrasound guidance, visualize tendon and greater trochanter, inject tendon sheath. I use 3 cc. I have done concomitant intra-articular for labral pathology as well with 2-3 cc

 

[plasma.]

Pure, ultrasound guidance, visualize tendon and greater trochanter, inject tendon sheath. I use 3 cc. I have done concomitant intra-articular for labral pathology as well with 2-3 cc

Dr. Ice do patients pay privately for this? Do you offer hip / SI joint steroid injection (if appropriate) first before moving to this? If they pay privately, do they seem to have higher expectations?

 

[Dr. Ice]

Dr. Ice do patients pay privately for this? Do you offer hip / SI joint steroid injection (if appropriate) first before moving to this? If they pay privately, do they seem to have higher expectations?

I’ll PM you. This conversation on this forum can only lead to holier than thou pontification

 

[lobelsteve]

I’ll PM you. This conversation on this forum can only lead to holier than thou pontification

Well if you do it pure and all.

 

[plasma.]

I’ll PM you. This conversation on this forum can only lead to holier than thou pontification

Sounds good thanks!

 

[Ducttape]

I’ll PM you. This conversation on this forum can only lead to holier than thou pontification

its not about being holier than thou.

it is about showing evidence based medicine to confirm that what we are doing is the most appropriate and safest treatment for the patient. and unlike conspiracy theories, the one postulating the treatment needs to be the one presenting evidence.

however, even in that light:

Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up - PubMed

ACTRN12613000677707 (Australian New Zealand Clinical Trials identifier).

pubmed.ncbi.nlm.nih.gov

there were actually 2 studies, an initial one and this one that is a follow up 2 years after.

Conclusion: Among patients with chronic gluteal tendinopathy and a length of symptoms >15 months, a single intratendinous LR-PRP injection performed under ultrasound guidance results in greater improvement in pain and function than a single CSI. The improvement after LR-PRP injection is sustained at 2 years, whereas the improvement from a CSI is maximal at 6 weeks and not maintained beyond 24 weeks.

now, before drusso goes and congratulates himself for seemingly making me a convert, i incidentally found this study while looking for that one:

Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis - PubMed

Our study shows that both ultrasound-guided tendon fenestration and PRP injection are effective for treatment of gluteal tendinosis, showing symptom improvement in both treatment groups.

pubmed.ncbi.nlm.nih.gov

Conclusions: Our study shows that both ultrasound-guided tendon fenestration and PRP injection are effective for treatment of gluteal tendinosis, showing symptom improvement in both treatment groups