ENDOSCOPIC TREATMENT OF GREATER TROCHANTERIC PAIN SYNDROME OF THE HIP

The diagnosis of greater trochanteric pain syndrome encompasses a broad category of disorders, including trochanteric bursitis, gluteus medius or minimus tears, and external coxa saltans, all of which are associated with a common complaint of lateral-sided hip pain. Magnetic resonance imaging (MRI) and ultrasonography are the primary imaging modalities used to diagnose gluteus tendon abnormalities, with sensitivities of 73% and 79%, respectively. Nonoperative treatment, including rest, activity modification (including avoidance of exacerbating activities), nonsteroidal antiinflammatory drugs (NSAIDs), weight loss (if indicated), and physical therapy are effective for the majority of patients; often, an injection of cortisone and local anesthetic is performed as both a diagnostic and therapeutic modality. Operative options include iliotibial band z-lengthening, longitudinal iliotibial band release with subgluteal bursal excision, gluteus medius tendon repair, trochanteric reduction osteotomy, and partial excision of the iliotibial band with removal of the trochanteric bursa. Although these options are generally effective, they subject the patient to substantial surgical site morbidity and a long recovery process.