Tendinopathy of the glute muscle tendons (including tears) is recognised as the primary cause of symptoms in individuals with lateral hip pain (greater trochanteric pain syndrome). Gluteal tendinopathy often affects women in their 40-60s and manifests as chronic lateral hip pain with associated functional impairment. Chronic tendinopathy is often associated with tendon degeneration, weakening and tears.
Among the common treatment options available are physical therapy, injection therapy (corticosteroids, PRP) with or without needle tenotomy, shockwave therapy, therapeutic ultrasound, or surgical procedures such tendon repair.
Based on a recent review with The Orthopaedic Journal of Sports Medicine of current evidence on the results of 27 studies that evaluated treatment options and outcome effects for gluteal tendinopathy on 1103 patients - the evidence has been synthesised into a staged treatment recommendation to provide best patient outcomes.
Low- to Moderate-Grade Gluteal Tendon Disease (Grades 1-2 Tendinopathy)
Only 1 study investigated the effectiveness of physical therapy. The therapeutic effect of an 8-week exercise program was better than that of a wait-and-see approach over a 12-month period and showed better improvements over a steroid injection. Steroid injection can provide improvement in pain in the first 4 to 8 weeks but is often short lived. Of note, the therapeutic response was less successful after structural abnormalities within the gluteal tendons had developed. Outcome scores for a single steroid injection were found to be significantly less compared with a single PRP injection. In addition, the potential deleterious effects of steroid need to be taken into consideration. The available evidence therefore supports the use of a steroid injection for low- to moderate-grade tendinopathy only for short-term pain relief, while an LR-PRP injection achieves a good out come up to 2 years. Grade 4 gluteal tendinopathy is or obviously more difficult to treat.
Table 4 provides the evidence and recommendations for the different stages of tendinopathy.
The Preferred Treatment Method
In line with the recommendations in Table 4, the preferred treatment approach consists of a single LR-PRP injection for grades 1 and 2 tendinopathy, while endoscopic tendon repair (with or without augmentation) is the treatment method of choice for grade 4 tendinopathy. As for partial-thickness tears the choice is more towards a single PRP injection before opting for endoscopic tendon repair. Most importantly, we recommend that available treatment options be discussed in detail with patients and that decisions be made in conjunction with informed patients.
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