Chronic GTB - How do you treat it? What are all the options?

[wscott]

Chronic GTB. What are all the options?

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[MD87]

Chronic GTB. What are all the options?

PT.
Steroid.
Supposedly PRP.
Tenotomy/TENEX/TENJET.

 

[hyperalgesia]

Activity modification.

Don't use recumbent bike.

 

[deleted131481]

I'd like to hear thoughts on Tenex?

I've started doing some of these under ultrasound and I think fluoro and landmarks may be missing the bursa frequently. May not make a difference in pain relief though .

 

[PinchandBurn]

Chronic GTB. What are all the options?

How are you diagnosing it?


Ttp peri Great Troch?

 

[Tboned]

I'd like to hear thoughts on Tenex?

I've started doing some of these under ultrasound and I think fluoro and landmarks may be missing the bursa frequently. May not make a difference in pain relief though .

Ultrasound for the win

 

[pmrmd]

I'd like to hear thoughts on Tenex?

I've started doing some of these under ultrasound and I think fluoro and landmarks may be missing the bursa frequently. May not make a difference in pain relief though .

Works well for gluteal tendonopathy.

 

[SC Tian]

Some surgeons here do bursectomy, it is quite invasive to me, it is just my observation, the surgery does not work that well.

 

[Taus]

Some surgeons here do bursectomy, it is quite invasive to me, it is just my observation, the surgery does not work that well.

Likely because the problem is rarely “bursitis”. It’s gluteal tendinopathy.

 

[SSdoc33]

Its hard to treat.

The best treatment is to get a 65 year old overweight woman to all of sudden completely change her lifestyle and do her glut exercises daily. good luck with that.

Ive had several patients come back to see me after i have referred out for tenex or PRP. They prefer the steroid shots.

Never refer for bursectomy. And extremely rare to refer out for glut med tear unless it is acute and trauma-related and in a younger and thinner patient. Neither surgery is a good idea

 

[Doctodd]

Get the mri which will show glute or hip pathology. I don’t do prp for bursitis. Not sure why anyone would refer this out for prp specifically.

 

[RoloTomassi]

It's GTPS greater trochanteric pain syndrome now, GTB is an old term since it's usually a misnomer

 

[MitchLevi]

I've done PRP for partial thickness glute tears and tendonopathy (iffy results). Usually just well-rounded lifestyle management with PT and CSI.

It comes and goes.

You won't fix it.

 

[Orin]

Lifestyle modifications and exercise are ideal

I do offer RFA of the GTB innervation for some

Cooled Radiofrequency Ablation of the Trochanteric Branch of the Nervus Femoralis to Treat Greater Trochanteric Pain Syndrome - PubMed

Cooled radiofrequency ablation of the trochanteric branch of the nervus femoralis is a potential treatment for greater trochanteric pain syndrome. This procedure provides a potential steroid-sparing interventional treatment based on reproducible fluoroscopic landmarks.

pubmed.ncbi.nlm.nih.gov

Works well enough

 

[bedrock]

Lifestyle modifications and exercise are ideal

I do offer RFA of the GTB innervation for some

Cooled Radiofrequency Ablation of the Trochanteric Branch of the Nervus Femoralis to Treat Greater Trochanteric Pain Syndrome - PubMed

Cooled radiofrequency ablation of the trochanteric branch of the nervus femoralis is a potential treatment for greater trochanteric pain syndrome. This procedure provides a potential steroid-sparing interventional treatment based on reproducible fluoroscopic landmarks.

pubmed.ncbi.nlm.nih.gov

Works well enough

Interesting. That is news to me.

 

[runfastnow]

Impossible to fix without a lot of PT/strengthening. If you know how to isolate glute med/min you usually can show the patient how weak they are and if shoving that in their face doesn't get them on board then don't waste the time/energy preaching PT/HEP.

US guidance is gold standard IMO.
If fail USG CSI get an MRI.
If true tear in glute med or min on MRI would consider PRP but have seen 60-70% success rate (do a little tenotomy with it) and more so in thinner + more active people.
Surgery is 50/50 at best for bursectomy or glute tear. One of my partners does an IT band window surgery which seems to have better success.

I've had a few that have had atypical hip OA pain or labral tear that present as GTPS/GTB/lateral hip pain. If USG GTB injection fails and no real glute tear or ITB pathology on MRI I would try a fluoro guided intra-articular hip injection.

 

[lobelsteve]

Impossible to fix without a lot of PT/strengthening. If you know how to isolate glute med/min you usually can show the patient how weak they are and if shoving that in their face doesn't get them on board then don't waste the time/energy preaching PT/HEP.

US guidance is gold standard IMO.
If fail USG CSI get an MRI.
If true tear in glute med or min on MRI would consider PRP but have seen 60-70% success rate (do a little tenotomy with it) and more so in thinner + more active people.
Surgery is 50/50 at best for bursectomy or glute tear. One of my partners does an IT band window surgery which seems to have better success.

I've had a few that have had atypical hip OA pain or labral tear that present as GTPS/GTB/lateral hip pain. If USG GTB injection fails and no real glute tear or ITB pathology on MRI I would try a fluoro guided intra-articular hip injection.

Surgery is way less successful than 50/50 for this.

In training they say every Ortho does one GTbursectomy. Then no more.

 

[wscott]

The only other thing I can add is ASTYM along the length of ITB and TFL; 6-10X coupled with PT stretching, strengthening.
It seems to help for some, when coupled with CSI.