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Greater trochanter pain syndrome

Greater trochanteric pain syndrome

 

Definition

 

Chronic lateral trochanteric pain

- abductor tendon tendonitis

- trochanteric bursitis

 

Epidemiology

 

Women 40 - 60 years old

 

Mechanism

 

? repetitive friction of iliotibial tract over GT

 

Symptoms

 

Pain over upper lateral thigh with activity

- often related to hip flexion

 

PVNS

Definition

 

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

 

Epidemiology

 

Age: 20 - 50

Sex: M > F

 

Types

 

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

 

Open Acromioplasty

Described by Neer / modified by Rockwood

 

Two Step Acromioplasty

 

1.  Anterior acromioplasty

- resect anterior acromion back to ACJ

- prevent impingement in flexion

 

2.  Resect anteroinferior acromion 

 

Technique

 

Position

- beach chair 

- mark anatomy

- limb draped free

 

Open Bankart Repair

Aim

 

Repair of the anterior capsule & avulsed labrum to anterior glenoid 

- anatomic repair

 

Usually combined with a capsular shift

 

Contraindications

 

Bony bankart > 25% glenoid

 

Technique

 

Position

- beach chair position

- arm free

- Mayfield head ring / Spyder and Tmax

 

Subtalar and Triple Arthodesis

Biomechanics

 

Able to achieve relatively high level of function after STJ fusion

- previously believed that isolated STJ fusion should not be performed

- believed that triple arthrodesis was operation of choice for hindfoot

- STJ fusion has superior result with less stress on AJ

 

Average loss of DF 30% / PF 10%

 

Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints

- imperative that fusion be positioned in ~ 5o valgus 

Arthrodesis

Indications

 

Indications have narrowed

- due to success of shoulder arthroplasty

 

1. Chronic infections of GHJ

2. Stabilization in paralytic disorders

3. Post-traumatic brachial plexus palsy

4. Salvage of failed GHJ Arthroplasty

- may need bone graft procedures

5. Arthritic diseases unsuitable for arthroplasty / young patient

Lateral Epicondylitis / Tennis Elbow

Incidence

 

Lateral : Medial 9:1

 

Epidemiology

 

4th & 5th decades

- M = F

- 75% dominant arm 

 

50% of regular tennis players

- especially > 2 hrs / week

 

Aetiology

 

Insertion pathology / Enthesopathy

 

Over-extension of the elbow with supination / pronation

 

Anatomy

 

Lateral epicondyle

- anconeus from posterior face

- ECRB and EDC from anterior face (CEO)

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