Should the pain persist despite multiple cortisone injections and quality physical therapy exercise, an MRI may be appropriate. A high quality MRI can visualize the gluteal tendons, and discern whether there is tendinosis or a partial or complete tear of the tendons. Hip arthroscopy surgeons have transferred the expertise gained from shoulder arthroscopic rotator cuff repair to the hip and hip gluteus medius or minimus tears can now be treated and repaired arthroscopically. Thin cameras and instruments are used through poke holes in the skin, allowing visualization of the deep structures. Anchors and sutures are then used to tie the gluteus medius and minimus back down to the bone, in anatomic position. This procedure is rather new, but the preliminary results have been promising. The bottom line is our understanding and treatment of greater trochanteric pain syndrome is expanding rapidly. If you are having lateral sided hip pain, the treatment options for this are expanding, and our techniques are getting more people with chronic lateral hip pain better.
Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be superior to other nonoperative modalities. Multiple surgical options for persistent TB have been reported, including bursectomy (n = 2), longitudinal release of the iliotibial band (n = 2), proximal or distal Z-plasty (n = 4), osteotomy (n = 1), and repair of gluteus medius tears (n = 4).