A 32-year-old woman presents to the Emergency Department with night hip pain a few days after running in a half marathon She says the pain has occurred previously associated with training runs, but has got much worse in the period after the half marathon. She has no past medtcal history of note and takes no regular medication. When you ask her to walk she has an obvious lim!> and complains of pain on the outside of her hip, and you can elicit tenderness on palpation over the greater trochanter. Active movement in particular is limited by pain. Which of the following is the most appropriate intervention?
A Oiclofenac gel
B.llioltbtal band lengthening surgery
C Local corticosteroid injection
D.Oral naproxen
E Oral prednisolone
This patient has greater trochanteric pain syndrome, precipitated 09. by her distance running. It is a repetitive overload tendinopathy of the gluteus medius and minimus muscles. These muscles play a primary role in hip abduction and pelvic stabilization whilst walking, running, and standing on one leg. In the ftrst 111stance a reduction in weight bearing exercise such as running, coupled with oral NSAID use, are the interventions of choice.
lliottbial band lengthening surgery, (Option B), is incorrect. Surgery to lengthen the band, bursectomy and gluteal muscle repair are all potential interventions, but they are usually reserved for pattents failing NSAIDs and local corucosterotd tnjectton.
Diclofenac gel, (Option A), is incorrect. Oiclofenac gel is less effective versus systemic naproxen, and is therefore not likely to adequately resolve this patient’s pain.
Local corticosteroid injection, (Option C), is incorrect. Local corticosteroids are reserved for patients who fail to gain control of symptoms on NSAIDs.
Oral prednisolone, (Option E), is incorrect. Oral prednisolone offers no added beneftt compared to local delivery of corticosteroids