Analysis of the Sensory Innervations of the Greater Trochanter for Improving the Treatment of Greater Trochanteric Pain Syndrome
ABSTRACT In medical practice, greater trochanteric pain syndrome has an incidence of 5.6 per 1,000 adults per year, and affects up to 25% of patients with knee osteoarthritis and low back pain in industrialized nations. It also occurs as a complication after total hip arthroplasty. Different etiologies of the pain syndrome have been discussed, but an exact cause remains unknown. The purpose of this study was to obtain a better understanding of the sensory innervations of the greater trochanter in attempt to improve the treatment of this syndrome. Therefore, we dissected the gluteal region of seven adult and one fetal formalin fixed cadavers, and both macroscopic and microscopic examination was performed. We found a small sensory nerve supply to the periosteum and bursae of the greater trochanter. This nerve is a branch of the n. femoralis and accompanies the arteria and vena circumflexa femoris medialis and their trochanteric branches to the greater trochanter. This nerve enters the periosteum of the greater trochanter directly caudal to the tendon of the inferior gemellus muscle. This new anatomical information may be helpful in improving therapy, such as interventional denervation of the greater trochanter or anatomically guided injections with corticosteroids and local anesthetics. Clin. Anat., 2012. © 2012 Wiley Periodicals, Inc.
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ABSTRACT: The contents of this review may appear odd. After a brief description of the coxofemoral joint, the entities discussed include ilioinguinal neuropathy within the context of the nerves that may be damaged during lower abdominal surgery, meralgia paresthetica, piriformis syndrome with the appropriate caveats, trochanteric syndrome, "ischial bursitis" and trochanteric syndrome caused by ischemia. These cases were chosen to stress our belief that rheumatologists are first and foremost internists. We further believe that being current in other pathologies such as peripheral neuropathies and certain vascular syndromes sooner or later benefits our patients.12/2012; 8. DOI:10.1016/j.reuma.2012.10.006
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ABSTRACT: Greater trochanteric pain syndrome (GTPS) is a common cause of extra-articular lateral hip pain. The underlying etiology of GTPS ranges from gluteus medius and minimus tendinopathy or tears, to external coxa saltans or iliotibial band syndrome. Historically, this source of lateral hip pain was typically diagnosed as trochanteric bursitis as it was believed to be due to inflammation of the subgluteus maximus bursa. However, recent imaging and histopathological studies have shown that most cases are instead due to underlying gluteus medius or minimus tendon disorders. Identifying the specific pain generator in GTPS is important as the treatment differs depending on the cause. Strengthening should be prescribed in cases of gluteal tendinopathy; corticosteroid injections and NSAIDs may be helpful in cases of primary bursitis; and surgery may be indicated in functionally limiting gluteal tendon tears unresponsive to conservative treatment.03/2014; 3(1):60-66. DOI:10.1007/s40141-014-0071-0
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ABSTRACT: The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p < 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p < 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score > 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p < 0.05).Aging - Clinical and Experimental Research 09/2014; 27(3). DOI:10.1007/s40520-014-0272-5 · 1.01 Impact Factor