This study aimed to identify ultrasound (US) imaging biomarkers that can characterize patient phenotypes in Greater Trochanteric Pain Syndrome (GTPS). In this analysis, 88 patients clinically diagnosed with GTPS were evaluated using ultrasound for tendon matrix alterations and calcium deposits in the gluteus medius and gluteus minimus tendons. Additional ultrasound assessments included examining the fascia lata, trochanteric bursa, cortical irregularities, and presence of enthesophytes in the peritrochanteric region. Researchers used multivariate regression models to explore associations between these pathological changes and patient-reported pain and function.
Results revealed that 97.7% of patients exhibited gluteus medius tendinopathy, while 61.4% also presented with gluteus minimus tendinopathy. Calcium deposits, primarily found in the gluteus medius, were present in 97.7% of patients and were significantly associated with pain (p = 0.009). The calcifications correlated with increased tendon thickness (p = 0.042), hypoechogenicity (p = 0.005), and partial tears (p = 0.030). Bursa swelling was observed in 40.9% of patients, and regression analysis suggested that bursa distension correlated with reduced pain (p = 0.008), while gluteal muscle atrophy and a loss of fibrillar structure in the gluteus medius were associated with functional impairment (p = 0.001 and p = 0.002, respectively).
In conclusion, GTPS often involves degenerative, calcifying changes in gluteal tendons and other alterations within the peritrochanteric space that are associated with patient pain levels and functional capabilities. Ultrasound imaging markers, such as tendon hypoechogenicity, calcifications, and muscle atrophy, provide valuable insight into the severity and clinical impact of GTPS, highlighting the utility of ultrasound as a diagnostic tool for guiding treatment strategies in affected individuals.
