3/21/2024 0 Comments Gluteus medius stretch drawingA recent study of general medical practice in the Netherlands found gluteal tendinopathy to have the highest prevalence (4. The condition is more frequent in women aged 40–60 years, and various studies have described its prevalence as ranging from 10 to 25 % of the general population. For the purposes of this paper we will refer to the condition of gluteus medius tendinopathy, and/or gluteus minimus tendinopathy, with or without bursal distention, as gluteal tendinopathy. Magnetic Resonance Imaging (MRI) is very effective in recognizing partial and full thickness tears of the tendons of gluteus medius and minimus, tendon calcification and fatty muscle atrophy. Although traditionally considered to be trochanteric bursitis, more advanced imaging and surgical procedures in people with lateral hip pain have revealed a primary pathology of insertional gluteus medius or minimus tendinopathy, with bursal distention generally a concomitant finding. Gluteal tendinopathy or greater trochanteric pain syndrome is a debilitating condition, characterised by pain situated at or around the greater trochanter of the hip, and tenderness on palpation. Trial registrationĪustralia New Zealand Clinical Trials Registry ACTRN12612001126808. This study will provide clinicians with directly applicable evidence of the relative efficacy of three common approaches to the management of gluteal tendinopathy. The trial reporting will comply with CONSORT guidelines. Analyses will be conducted on an intention-to-treat basis using logistic and linear mixed regression models and the economic evaluation will report incremental cost-utility ratios. Economic evaluation will be performed to investigate the cost-effectiveness of the active interventions compared with the wait and see approach. Hip abductor muscle strength will be measured at baseline and 8 weeks. Outcomes will be evaluated at baseline, 4, 8, 12, 26 and 52 weeks using validated global rating of change, pain and physical function scales, psychological measures, quality of life and physical activity levels. The group allocated the wait and see approach will receive basic tendon care advice and reassurance in a single session by a trial physiotherapist. Education about load modification will be delivered in physiotherapy clinics and the exercise programme will be both home-based and supervised. The CSI therapy will consist of one ultrasound (US) guided CSI around the affected tendons and advice on tendon care. Two hundred one people with gluteal tendinopathy will be randomly allocated into one of three groups: (i) CSI (ii) physiotherapist-administered load modification and exercise intervention and (iii) wait and see approach. This randomised controlled trial aims to compare the efficacy on pain and function of a load modification and exercise-based programme with a CSI and a ‘wait and see’ approach for gluteal tendinopathy. Research on Achilles and patellar tendons has shown that load modification and exercise appears to be more effective than other treatments for managing tendinopathy, however, it is unclear whether a CSI, or a load modification and exercise-based physiotherapy approach is more effective in gluteal tendinopathy. Patients are usually offered three treatment options: (a) corticosteroid injection (CSI), (b) physiotherapy, or (c) reassurance and observation. The condition is often diagnosed as trochanteric bursitis, however radiological and surgical studies have revealed that the most common pathology is gluteus medius/minimus tendinopathy. The pain can affect sleep and daily activities, and is frequently recalcitrant. Lateral hip pain is common, particularly in females aged 40–60 years.
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