Greater Trochanteric Pain Syndrome and Injectables
Our first Research review from our Newcastle Podiatrist Blake.
This is something I have always wanted to do. I know the struggle that clinicians go through. Generally, its one of three:
- You don’t have the time to read the research
- You don’t have access to full articles
- You can struggle to interpret the data and findings.
So… I plan to solve all three of those struggles with one simple email and YouTube video. Now, Sports Medicine is a big topic so there are plenty of papers and literature to review. If you are itching to find out about about one, message us on instagram and we will throw it in the mix.
We will also be starting a YouTube serious where along with this email I will do a video format explanation of my interpretation, clinical application and understand of the paper.
To get in touch, I work at Achieve Podiatry which is in Newcastle, Australia. Both myself and Justin are the local Newcastle Podiatrist who see a wide range of pain and sports Medicine conditions. We both work at the University as clinical educators and Lectures.
SO LETS GET CRACKING
This study aimed to explore whether certain clinical tests (Faber’s test, Single leg stance for 30 seconds or Resisted derotation external hip rotation) or a rapid improvement in lateral hip pain following periarticular local glucorticoid injection are predictive of whether the injection is successful at the 1 month mark. Essentially, they do those aformentioned 3 clinical tests on everyone (a positive test is pain) and record who gets a positive result on all three tests. Then, out of a group of people they give half Local anaesthetic/Cortisone and the other half saline. They hypothesis that if you get a positive results on all three tests, you are more likely to have a positive outcome with injections and the same goes if you respond really well to the injection in the first 30 minutes. The definition they use for a good response post 30 minutes is patients reporting a decrease of at least 50% in LHP 30 min after the injection compared to the self-reported pain in the preceding 24 h.
Study type: Secondary analysis of an RCT (Randomisation, double-blinding and the use of a placebo group allowed for a unique comparison between subgroups and the primary outcome). 46 people. Inclusion criteria were: patients aged ≥ 18 years with LHP (Lateral hip pain) for greater than 1 month, an LHP score of ≥ 4 on a numeric rating scale (NRS) (out of 10) in the preceding week, failure of another standard treatment (physiotherapy and/or analgesics), and typical LHP reproduced by palpation of the greater trochanter.
GTPS - Greater trochanteric pain syndrome. The aetiology seems to implicate the repetitive friction between tendinous structures of the hip and the greater trochanter, probably favoured by altered biomechanics of the pelvis. Moreover, GTPS is frequently associated with low back pain and hip osteoarthritis
So… what does mean?
Clinicians struggle to know when to refer for injections and when it’s time to have the discussion with patients. This study offers some confidence for clinicians to base their clinical reasoning. If you can have the discussions with the patient and say ‘Listen, based of these three tests which you are positive for and your long standing history, I think its best you discuss injectables with your GP or Sports Doctor. Again, this isn’t much, but its more than what we had before and I am sure if you referenced with study with your referral network, they’d probably think you’re a weapon. It is very hard to predict who will respond to injections. I only hope more studies can come out like this. Now, there are limitations. Follow up was only a month, small amount of people and they fact that that 50% of their prediction modal is based on after the injection so we can predict that.