53 yo male who is active in playing pickle ball and practicing yoga with no significant past medical history presents with R upper leg pain that is a 5/10 and e year. The pain is exacerbated with movement. He recently had back pain that was successfully treated with PT. He states that the current leg pain has limited his pickle ball and yoga. He is a healthy male with no other concerns or issues. The differential diagnosis includes Greater trochanter pain syndrome vs. IT band tendinitis vs. IT band bursitis. The major risk factors are high intensity sports or long term overuse or over-training of muscles, and advanced age. Diagnostic tests include x-ray and MRI.
Greater Trochanteric Pain Syndrome is very common among athletes and older adults who are active in sports as well as those who are engaged in high physical activity. PRP injections serves as a non surgical option to treat these syndromes. Quite often the pathology may be in the gluteus medius and minimus tendon and not exclusively the bursa, therefore the site of injection needs to be considered. In most of the studies improvements were observed during the first 3 months after injection. Significant improvements were reported when patients were followed up to 12 months post treatment. There are, however, conflicting results between the randomized studies as to whether PRP is superior to corticosteroid. Furthermore, the use of different PRP systems, concentrations and volumes provides heterogeneity when trying to provide comparisons. Varying outcome measures were used to assess pain and functional outcomes with short follow-up and small sample sizes. Considering these factors, PRP seems a viable alternative treatment with the current evidence in patients with GTPS refractory to conservative measures.
Mohammed Ali, Eshan Oderuth, Ismael Atchia, Ajay Malviya, The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review, Journal of Hip Preservation Surgery, Volume 5, Issue 3, August 2018, Pages 209–219, https://doi.org/10.1093/jhps/hny027