Conservative management of tendinopathies around hip

Abstract

SummaryBackground: The anatomy of hip is widely complex and several anatomical structures interact and contribute to its functioning. For position and role, hip and the surrounding tendons, which have their insertion around, are overstressed and often overloaded, especially in athletes. This could lead to the developing of several tendinopathies, among which the differential diagnosis is often complicated. Many conservative treatments are used in clinical practice, while actually, no defined conservative protocol is recommended. Methods: This is a review article. The aim of this manuscript is to evaluate the current evidences about the effectiveness of conservative management in hip tendinopathies. Conclusion: Conservative treatment is effective in the management of hip tendinopathies and may be considered the first-line approach for patients affected. However, there is lack of evidences about which is the most effective treatment. Exercise therapy seems to provide long-term pain relief, but the literature is still lacking about the correct type, dose, posology, intensity of exercise prescribed. Further studies about different local approaches, as PRP or hyaluronic acid injections, may be encouraged. Level of evidence: I.

Diagnosis and Management of Snapping Hip Syndrome: A Comprehensive Review of Literature

“…Level I studies published in literature, showed that corticosteroids improve pain at short-term follow-up, but not at 1 year after injection [18]. These result may reinforce the idea that the pathogenesis of SHS is not inflammatory, but multifactorial.…”

“…ESWT have been reported to be superior to corticosteroid injections in treatment of ESHS, in particular when associated to a home exercise program, while there is no evidence for treatment of ISHS. Then, the effectiveness of and eccentric exercises (EE) program has been reported for Achilles, patellar and hamstring tendinopathies, but no level I studies investigate EE for the management of SHS [18,20]. Surgical treatment is indicated when patients do not respond to conservative treatments.…”

“…However, literature is poor on this topic and there is not evidence they are effective. A recent systematic review of literature showed that corticosteroid injections improve pain and symptoms at short term follow-up, and they are superior to oral NSAIDs, but there is not statistically significant difference at 12 months follow-up [18]. Cohen et al [19] in a RCT found no differences between the corticosteroids injection under fluoroscopy into the trochanteric bursa or not, while better long-term results in terms of pain and function have been reported with ECSWT and home exercises compared to corticosteroids injections [20].…”

Osteoarthritis: Current Clinical Concept and Some Promising Therapeutic Approaches

“…Первый опыт использования данного средства от-носится к спортивной медицине -при травмах, сопрово-ждающихся повреждением связочного аппарата. За пос-леднее десятилетие локальные инъекции ОТП уверенно вошли в число средств, активно используемых для лече-ния такой патологии, как тендинит ротаторов плеча (в том числе в рамках синдрома сдавления ротаторов), эпикон-дилит, тендинит сгибателей пальцев, трохантерит, энтезит коленного сустава, повреждение и тендинит ахиллова су-хожилия, а также плантарный фасциит [58][59][60][61]. Кроме этого, обсуждается возможность применения инъекций ОТП при лечении хронической неспецифической боли в спине [62].…”

Tendinopathies of the hip and pelvis in athletes: A narrative review

“…Tendon disorders are very common in sports and any anatomical district may be interested depending on the type of sport practiced (Loiacono et al, 2019). For position and role, hip and the surrounding tendons are overstressed and often overloaded, especially in athletes (Schilders et al, 2013): this could lead to the developing of several tendinopathies, among which the differential diagnosis is often complicated (Frizziero et al, 2016). The anatomy of hip is extremely complex, and several muscles interact and contribute to its functioning: flexors (iliopsoas, rectus femoris, pectineus and sartorius), extensors (gluteus maximus and hamstrings -semimembranosus, semitendinosus and biceps femorii), adductors (adductors longus, brevis and magnus, pectineus and gracilis), abductors (gluteus medius, gluteus minimus, piriformis and tensor fascia latae), external rotators (biceps femoris, gluteus maximus, piriformis, assisted by the obturators, gemilli and quadratus femoris) and internal rotators (anterior fibres of gluteus medius and minimus, tensor fascia latae) (Wilson & Furukawa, 2014).…”