Valerie Vuillemin-Bodaghi, Presenter: Nothing to Disclose

Celine Mutschler, Abstract Co-Author: Nothing to Disclose

Herve Bard, Abstract Co-Author: Nothing to Disclose

Clement Pradel, Abstract Co-Author: Nothing to Disclose

Alexandre Sobotka, Abstract Co-Author: Nothing to Disclose

Guy Frija MD, Abstract Co-Author: Nothing to Disclose

To study involvement of gluteus medius tendon, gluteus minimus tendon and trochanteric bursae in patients explored for greater trochanteric pain syndrome resisting to medical treatment.

MR imaging was prospectively performed in patients presenting with greater trochanteric pain syndrome resisting to medical treatment. Clinical evaluation including muscular testing was previously performed. T1-weighted and fat saturated fast T2-weighted MR images were acquired with small field of view.The two parts of gluteus medius tendon (main tendon (MT) and lateral part (LT)), the gluteus minimus tendon (GMi) and the three principal trochanteric bursae (trochanteric, subgluteus medius and subgluteus minimus bursae) were analyzed by two examinators. Search for tendinosis, partial or complete tear and bursitis was performed for each patient. Clinical findings were revisited based on imaging results in the group of patients referred by the same physician.

Thirty eight patients (mean age 64, 35F/3M) were included.Bilateral examination was performed in 5 cases and finally 43 hips were analyzed. No case of normal MR examination was found. Major correlation between physical testing and imaging findings was noted in 17/26 (65.4%) patients examined by the same physician. Hypersignals and thickening were detected in MT in 16 patients (37.2%), in LT in 32 patients (74.4%) and in GMi in 25 cases (58.1%). Partial or complete tears were present respectively in 5 (12%), 12 (28%) and 1(2.3%) cases. All tendons (MT,LT and GMi) were involved in 9 cases (22.5%). GMi and LT were both involved in 11 cases (27.5%) whereas MT and LT were involved in 7 cases (17.5%). Isolated involvement of GMi and LT was noted in 4 (10%) and 7 cases (17.5%), but isolated involvement of MT has never been reported. Isolated bursitis was noted in 5 cases (12.5%).

Although clinical criteria are highly sensitive to detect greater trochanteric disease, MRI remains the best tool to localize specific tendinous lesions. LT tendinosis and association between LT and GMi lesions are the most frequent abnormalities. GMi is largely involved in the pathogenesis of the disease and should be more precisely evaluated by MRI.

Vuillemin-Bodaghi, V, Mutschler, C, Bard, H, Pradel, C, Sobotka, A, Frija, G, Greater Trochanteric Pain Syndrome: MRI Prospective Study of 38 Patients.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4416059.html