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Endoscopic Peritrochanteric Space: Evaluation and Treatment

  • Hal David Martin
Chapter

Abstract

A thorough understanding of the anatomy and biomechanics of the hip will help in the evaluation and treatment of lateral-based hip pain. The peritrochanteric space involves all the osseous, musculotendinous, neurovascular, and kinematic chain of the hip joint. Peritrochanteric space disorders include patients with trochanteric bursitis, external coxa saltans (or external snapping hip), and gluteus medius and minimus tears. As part of a comprehensive standardized physical examination, a lateral-based hip pain evaluation will guide the examiner toward a differential diagnosis. Conservative therapy is the first line of treatment; however endoscopic surgical intervention can provide pain relief and a return to normal function in cases of recalcitrant peritrochanteric problems. Key aspects of the clinical examination, peritrochanteric space pathology, peritrochanteric space anatomy, and endoscopic navigation and treatment are described in this chapter.

Keywords

Peritrochanteric space Lateral hip pain Greater trochanter Trochanteric bursitis External coxa saltans External snapping hip Iliotibial band Gluteus medius Gluteus minimus 

References

  1. 1.
    Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;23(11):1246.e1–5.CrossRefGoogle Scholar
  2. 2.
    Mosier BA, Quinlan NJ, Martin SD. Peritrochanteric Endoscopy. Clin Sports Med. 2016;35(3):449–67.CrossRefGoogle Scholar
  3. 3.
    Martin HD, Shears SA, Palmer IJ. Evaluation of the hip. Sports Med Arthrosc Rev. 2010;18(2):63–75.CrossRefGoogle Scholar
  4. 4.
    Martin H, Palmer I, Hatem M. Physical examination of the hip and pelvis. In: Nho SJ, Leunig M, Larson CM, Bedi A, Kelly BT, editors. Hip arthroscopy and hip joint preservation surgery. New York, NY: Springer; 2017. p. 139–59.Google Scholar
  5. 5.
    Gomez-Hoyos J, Martin RL, Schroder R, Palmer IJ, Martin HD. Accuracy of 2 clinical tests for ischiofemoral impingement in patients with posterior hip pain and endoscopically confirmed diagnosis. Arthroscopy. 2016;32(7):1279–84.CrossRefGoogle Scholar
  6. 6.
    Martin HD, Kivlan BR, Palmer IJ, Martin RL. Diagnostic accuracy of clinical tests for sciatic nerve entrapment in the gluteal region. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):882–8.CrossRefGoogle Scholar
  7. 7.
    Martin HD, Shears SA, Johnson JC, Smathers AM, Palmer IJ. The endoscopic treatment of sciatic nerve entrapment/deep gluteal syndrome. Arthroscopy. 2011;27(2):172–81.CrossRefGoogle Scholar
  8. 8.
    Martin RLSR, Gomez-Hoyos J, Khoury AN, Palmer IJ, McGovern RP, Martin HD. Accuracy of 3 clinical tests to diagnose proximal hamstrings tears with and without sciatic nerve involvement in patients with posterior hip pain. Arthroscopy. 2018;34(1):114–21.CrossRefGoogle Scholar
  9. 9.
    Perry J. Gait analysis: normal and pathological function. Thorofare: Slack Inc.; 1992.Google Scholar
  10. 10.
    Karpinski MR, Piggott H. Greater trochanteric pain syndrome. A report of 15 cases. J Bone Joint Surg Br. 1985;67(5):762–3.CrossRefGoogle Scholar
  11. 11.
    Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc Rev. 2010;18(2):113–9.CrossRefGoogle Scholar
  12. 12.
    Ilizaliturri VM Jr, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. 2006;22(5):505–10.CrossRefGoogle Scholar
  13. 13.
    Khoury A, Brooke K, Helal A, Bishop B, Erickson L, Palmer IJ, et al. Proximal iliotibial band thickness as a cause for recalcitrant greater trochanteric pain syndrome. J Hip Preserv Surg. 2018;5(3):296–300.CrossRefGoogle Scholar
  14. 14.
    Domb BG, Nasser RM, Botser IB. Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair. Arthroscopy. 2010;26(12):1697–705.CrossRefGoogle Scholar
  15. 15.
    Robertson WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DG, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy. 2008;24(2):130–6.CrossRefGoogle Scholar
  16. 16.
    Gardner MJ, Robertson WJ, Boraiah S, Barker JU, Lorich DG. Anatomy of the greater trochanteric ‘bald spot’: a potential portal for abductor sparing femoral nailing? Clin Orthop Relat Res. 2008;466(9):2196–200.CrossRefGoogle Scholar
  17. 17.
    Byrd JW. Hip arthroscopy utilizing the supine position. Arthroscopy. 1994;10(3):275–80.CrossRefGoogle Scholar
  18. 18.
    Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E. Hip arthroscopy by the lateral approach. Arthroscopy. 1987;3(1):4–12.CrossRefGoogle Scholar
  19. 19.
    Pfirrmann CW, Chung CB, Theumann NH, Trudell DJ, Resnick D. Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae--MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. Radiology. 2001;221(2):469–77.CrossRefGoogle Scholar
  20. 20.
    Mitchell JJ, Chahla J, Vap AR, Menge TJ, Soares E, Frank JM, et al. Endoscopic trochanteric bursectomy and iliotibial band release for persistent trochanteric bursitis. Arthrosc Tech. 2016;5(5):e1185–e9.CrossRefGoogle Scholar
  21. 21.
    Brignall CG, Stainsby GD. The snapping hip. Treatment by Z-plasty. J Bone Joint Surg Br. 1991;73(2):253–4.CrossRefGoogle Scholar
  22. 22.
    Faraj AA, Moulton A, Sirivastava VM. Snapping iliotibial band. Report of ten cases and review of the literature. Acta Orthop Belg. 2001;67(1):19–23.PubMedGoogle Scholar
  23. 23.
    Provencher MT, Hofmeister EP, Muldoon MP. The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band. Am J Sports Med. 2004;32(2):470–6.CrossRefGoogle Scholar
  24. 24.
    Farr D, Selesnick H, Janecki C, Cordas D. Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis. Arthroscopy. 2007;23(8):905.e1–5.CrossRefGoogle Scholar
  25. 25.
    Govaert LH, van Dijk CN, Zeegers AV, Albers GH. Endoscopic bursectomy and iliotibial tract release as a treatment for refractory greater trochanteric pain syndrome: a new endoscopic approach with early results. Arthrosc Tech. 2012;1(2):e161–4.CrossRefGoogle Scholar
  26. 26.
    Zini R, Munegato D, De Benedetto M, Carraro A, Bigoni M. Endoscopic iliotibial band release in snapping hip. Hip Int. 2013;23(2):225–32.CrossRefGoogle Scholar
  27. 27.
    Jost P, Walsh C, Bedi A, Kelly BT. Abductor tendinopathies and repair. In: Byrd JT, editor. Operative hip arthroscopy. New York: Springer; 2013. p. 299–308.CrossRefGoogle Scholar
  28. 28.
    Chandrasekaran S, Gui C, Hutchinson MR, Lodhia P, Suarez-Ahedo C, Domb BG. Outcomes of endoscopic gluteus medius repair: study of thirty-four patients with minimum two-year follow-up. J Bone Joint Surg Am. 2015;97(16):1340–7.CrossRefGoogle Scholar
  29. 29.
    Domb BG, Botser I, Giordano BD. Outcomes of endoscopic gluteus medius repair with minimum 2-year follow-up. Am J Sports Med. 2013;41(5):988–97.CrossRefGoogle Scholar
  30. 30.
    McCormick F, Alpaugh K, Nwachukwu BU, Yanke AB, Martin SD. Endoscopic repair of full-thickness abductor tendon tears: surgical technique and outcome at minimum of 1-year follow-up. Arthroscopy. 2013;29(12):1941–7.CrossRefGoogle Scholar
  31. 31.
    Thaunat M, Chatellard R, Noel E, Sonnery-Cottet B, Nove-Josserand L. Endoscopic repair of partial-thickness undersurface tears of the gluteus medius tendon. Orthop Traumatol Surg Res. 2013;99(7):853–7.CrossRefGoogle Scholar
  32. 32.
    Voos JE, Shindle MK, Pruett A, Asnis PD, Kelly BT. Endoscopic repair of gluteus medius tendon tears of the hip. Am J Sports Med. 2009;37(4):743–7.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • Hal David Martin
    • 1
  1. 1.Hip Preservation CenterBaylor University Medical Center at DallasDallasUSA

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