Editorial Commentary: Treatment of Concomitant Intra-Articular Pathology in Patients With Greater Trochanteric Pain Syndrome Is Indicated by Provocative Impingement or Instability Physical Examination and Ultrasound-Guided Analgesic Injection Testing

Editorial Commentary: Treatment of Concomitant Intra-Articular Pathology in Patients With Greater Trochanteric Pain Syndrome Is Indicated by Provocative Impingement or Instability Physical Examination and Ultrasound-Guided Analgesic Injection Testing

Authors: Domb BG, Curley AJ

Journal:Arthroscopy, March 2023

DOI:10.1016/j.arthro.2022.08.014

Objective:

To highlight diagnostic strategies for identifying intra-articular pathology in patients presenting with greater trochanteric pain syndrome (GTPS).

Key Findings:

• GTPS is often caused by peritrochanteric issues such as tendinopathy or bursitis but may coexist with intra-articular lesions like labral tears or chondral damage.
• Provocative physical exams combined with ultrasound-guided analgesic injections can differentiate pain sources.
• Patients who respond to both intra-articular and peritrochanteric injections may benefit from a combined endoscopic and arthroscopic surgical approach.

Conclusion:

Accurate diagnosis of coexisting intra-articular pathology in GTPS patients requires thorough clinical examination and diagnostic injection testing to guide comprehensive treatment planning.

What Does This Mean for Providers?

• Perform detailed physical exams focusing on signs of impingement or instability in GTPS patients.
• Utilize ultrasound-guided analgesic injections to delineate intra-articular versus peritrochanteric pain generators.
• Consider combined surgical interventions when both pain sources are present to optimize patient outcomes.
• This approach can prevent incomplete treatment and reduce persistent symptoms after isolated procedures.