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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

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

Bristow

Concept

Non-anatomical bony block 

- transfer of coracoid process through subscapularis

- dynamic anteroinferior musculotendinous sling

- provides subscapularis tenodesis

- preventing lower portion from displacing proximally as arm abducted

- when shoulder in vulnerable position abduction and ER

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 ~ 5^o valgus 

Surgical Options

1.  Open antero-lateral approach 

Large / Massive Cuff Tear

2.  Deltopectoral approach

Large Subscapularis tear

3.  Arthroscopic Assisted Mini-open

Indication

- Small / Moderate Cuff Tear < 3cm

- no retraction

Technique

- arthroscopic SAD

Epidemiology

Extremely uncommon

Stability provided by joint capsule /costoclavicular & interclavicular ligaments 

Recurrent instability uncommon

Many apparent dislocations in adolescents may be growth plate injuries 

-will remodel without treatment

If OA from chronic dislocation may resect SCJ

Definition

Instability in at least 2 planes

- postero-inferior

- antero-inferior

- antero-postero-inferior

Epidemiology

Recognised as a common problem 

- often misdiagnosed

Most patients athletic

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