pathology: trochanter major syndrom GTPS

yogabook / pathologie / trochanter-major-syndrom GTPS

Trochanter Major Syndrome / Greater Trochanteric Pain Syndrome (GTPS) / Trochanteric Tendinosis / Gluteal Tendinopathy

Definition of

Major trochanter syndrome is a group of symptoms of various disorders in the area of the greater trochanter. These include: Bursitis trochanterica, which can affect the three bursae bursa subgluteus maximus, bursa subgluteus medius and bursa subgluteus minimus, insertion tendinopathies or tears of the gluteus medius or gluteus minimus. The classification according to Thomas differentiates between three degrees:

  1. 1: no rupture of the gluteal tendons, intact function, pressure pain
  2. 2: partial rupture of the gluteal tendons, limited function, severe pressure pain
  3. 3: Tearing of the gluteal tendons, no function, permanent pain

The course is often progressive: tendinitis, tendinosis, rupture. The gluteus medius is more frequently affected than the gluteus minimus. Epidemilogy: 10-25% of the population are affected, W:M 4:1.

Cause

  1. Overuse, mostly on the ground of non-optimal structures

Prädisponierend

– posteroperativ

  1. Conditions after hip surgery(TEP: up to 50% develop disorders, arthroscopy, femoral neck fracture)

– Musculoskeletal system

  1. Muscular imbalances, especially weaknesses in the small gluteal muscles; muscular shortening
  2. Leg length differences, malpositions
  3. Weakness of the trunk muscles
  4. Pelvic instability, e.g. due to lack of abductor strength (small glutes)
  5. Sometimes an ITBS and hypertonus of the tensor fasciae latae is favorable

– Dispositional diseases

  1. RA and rheumatoid arthritis

– other factors

  1. female gender
  2. Obesity

Diagnosis

  1. Sono: clarifies degeneration of the tendons
  2. MRI for clarification of DD if necessary
  3. Running and gait analysis, also for non-athletes

Symptoms

  1. Exercise-induced pain
  2. Painful restriction of movement
  3. Pain radiating into the buttocks
  4. Rotational pain of the hip joint
  5. Reduced strength for abduction, limping
  6. Shortened, painful stretching of the glutes
  7. sometimes marked tenderness, especially with bursitis
  8. in an advanced stage: Trendelenburg sign
  9. Snapping hip (coxa saltans, Amon’s snapping hip)
  10. signs of inflammation, if applicable
  11. Painful lying on the affected side

Therapy

  1. PT
  2. Shock wave therapy
  3. ACP injections
  4. Inlays if necessary
  5. NSAIDs if necessary
  6. Relief, load reduction as far as necessary
  7. Stretching training, especially of the hip flexors and gluteal muscles
  8. Elimination of muscular imbalances, in particular one-sided abduction weakness
  9. Flexibility training of the gluteal muscles
  10. Training of the trunk (especially abdominal muscles and autochthonous back muscles) and proprioception
  11. Surgical refixation with debridement (removal of degenerated material from the tendons) in stage 3, prior to this only if indicated, resection of the bursa
  12. Caution with cortisone infiltrations: damages tendons

DD

  1. rheumatoid diseases
  2. DGS / Piriformis syndrome