Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain

Abstract

Keeping in mind that the sample size was small (ie, possibly underpowered for indices of diagnostic utility with low precision), the results of this study indicate that a patient who reports lateral hip pain within 30 s of single-leg-standing is very likely to have GT. Patients with lateral hip pain who are not palpably tender over the greater trochanter are unlikely to have MRI-detected GT.

Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial

“…Pragmatically, it is common for clinicians to encounter patients with multiple conditions, which would usually be dealt with in their management as well. MRI confirmation is not always available or affordable, but evidence indicates that some clinical diagnostic tests used in this study’s selection process have high diagnostic utility when compared with MRI 10. Thus, use of these tests could improve confidence in selecting appropriate patients for the treatments used in this clinical trial.…”

Greater trochanteric pain syndrome: a review of diagnosis and management in general practice

“…7 Single clinical tests for GTPS lack validity, but a combination of tests can be used to increase the diagnostic accuracy; during a GP consultation two that can be used are direct palpation and the single leg stance test. Direct palpation of the greater trochanter (the 'jump sign' as the person can be so tender they jump off the bed) carries a positive predictive value (PPV) of 83% (for positive magnetic resonance imaging [MRI] findings); 5 if there is no pain on palpation the patient is unlikely to have GTPS. The single leg stance test (pain within 30 seconds of standing on one leg) has a very high sensitivity and PPV (100%) for positive MRI findings; if positive the patient is likely to have GTPS.…”

“…The single leg stance test (pain within 30 seconds of standing on one leg) has a very high sensitivity and PPV (100%) for positive MRI findings; if positive the patient is likely to have GTPS. 5 Combining these two clinical tests with others can further increase diagnostic accuracy; the FABER test (flexion, abduction, and external rotation), FADER test (flexion, adduction, and external rotation), and ADD test (passive hip adduction in side lying) aim to increase tensile load on the gluteus medius and minimus tendons, causing a replication of the patient's pain. Other associated clinical findings may include positive Ober's test, positive step up and down test, and Trendelenburg gait positive.…”

“…[1][2][3] Traditionally thought to be due to trochanteric bursitis, surgical, histological, and imaging studies have shown that GTPS is attributable to tendinopathy of the gluteus medius and/or minimus with or without coexisting bursal pathology. 1,4,5 Abnormal hip biomechanics are hypothesised to predispose to the development of these gluteal tendinopathies. Compressive forces cause impingement of the gluteal tendons and bursa onto the greater trochanter by the iliotibial band (ITB) as the hip moves into adduction.…”

Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy

“…If tendinopathy or tearing of the gluteal tendons is suspected, a magnetic resonance imaging (MRI) scan or ultrasound study can confirm the diagnosis and further detail the pathologic features. 13,19 Initially, the treatment regimen for gluteal tendinopathy consists of rest, activity modification, weight reduction, stretching, physical therapy, and nonsteroidal antiinflammatory medication. 26 More invasive techniques include corticosteroid injections, platelet-rich plasma (PRP) injections, 10,11 and extracorporeal shock wave therapy.…”