Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, NY.
Montefiore Medical Center, New York.
Pain Physician. 2023 Jul;26(4):393-401.
Upper lateral hip pain is a common complaint in adults and is referred to as greater trochanteric pain syndrome (GTPS) and is more prevalent among older women. This is a debilitating condition that could result in lower physical activity and quality of life, and higher unemployment rate. GTPS is a clinical diagnosis, and many cases improve with conservative medical management (CMM). However, there is still a gap between patients not responding to CMM and those who are not good surgical candidates. Thus, percutaneous ultrasound tenotomy (PUT) may be a valuable treatment option to limit this gap.
Demonstration of the one-year pain and functional outcomes, including sit to stand.
Academic tertiary care medical center.
Forty-eight consecutive patients with refractory trochanteric pain due to iliotibial band (ITB) tendinopathy. Fifty-six hips were treated; 8 patients underwent bilateral procedures. Electronic medical record review of consecutive patients who underwent ITB TENEX® was performed at Montefiore Medical Center from December 2019 to December 2021. Institutional guidelines recommended TENEX® for greater trochanteric pain refractory to conservative treatment and ultrasound (US) confirmed ITB tendinopathy (hypoechogenicity or thickened tendon > 6 mm). Pain level, as well as sit-to-stand, side-lying, and walking tolerance levels were evaluated at baseline preprocedure visit and one-year visit. Follow-up was performed by independent practitioners and corroborated by chart review.
Numeric Rating Scale (NRS-11) improved by 4 points across all patients. Seventy percent of patients endorsed pain relief at one-year visit. Median preprocedure NRS-11 was 9. The reported median NRS-11at one year was 5 (Wilcoxon signed rank NRS-11 demonstrated a Z score of -6.042 with P < 0.001). One-year analysis among all patients revealed 57%, 78%, and 66% improvement in side-lying, sit-to-stand, and walking tolerance levels, respectively.
We believe that our results must be confirmed with a randomized control trial with a control arm and more patients included.
PUT of the ITB using the TENEX® tissue remodeling device could be a safe and effective treatment for ITB tendinopathy-associated GTPS.
上外侧臀部疼痛是成年人常见的主诉，被称为大转子疼痛综合征（GTPS），在老年女性中更为常见。这是一种使人虚弱的疾病，可能导致较低的身体活动和生活质量，以及更高的失业率。GTPS 是一种临床诊断，许多病例通过保守医学管理（CMM）得到改善。然而，在对 CMM 反应不佳和不适合手术的患者之间仍然存在差距。因此，经皮超声肌腱切开术（PUT）可能是一种有价值的治疗选择，可以缩小这一差距。
展示一年的疼痛和功能结果，包括从坐到站。
学术三级护理医疗中心。
对 2019 年 12 月至 2021 年 12 月在蒙特菲奥雷医疗中心接受 ITB TENEX®治疗的因髂胫束（ITB）肌腱病导致难治性转子间疼痛的 48 例连续患者进行电子病历回顾。56 髋接受治疗；8 例患者接受双侧手术。机构指南建议 TENEX®用于对保守治疗和超声（US）确认的 ITB 肌腱病（低回声或增厚肌腱 > 6 毫米）难治的 GTPS。在术前就诊和一年就诊时评估疼痛程度以及从坐到站、侧卧位和步行耐受力水平。通过独立从业者进行随访，并通过图表审查进行证实。
所有患者的数字评定量表（NRS-11）均提高了 4 分。70%的患者在一年就诊时表示疼痛缓解。术前中位数 NRS-11 为 9。报告的一年中位数 NRS-11 为 5（Wilcoxon 符号秩 NRS-11 显示 Z 分数为-6.042，P < 0.001）。所有患者的一年分析显示，侧卧位、从坐到站和步行耐受力水平分别改善了 57%、78%和 66%。
我们认为，我们的结果必须通过随机对照试验得到证实，该试验包括对照组和更多的患者。
使用 TENEX®组织重塑装置对 ITB 进行 PUT 可能是 ITB 肌腱病相关 GTPS 的一种安全有效的治疗方法。
