33 Trochanteric Bursistis – A Misnomer, Gluteal Tendinopathy – Not The Whole Story?
Bibliographic record
Abstract
Introduction Greater trochanteric pain syndrome (GTPS) is common and can cause significant pain and dysfunction.3 While both trochanteric bursae and gluteal tendons have been implicated in the pathology,2,6 the underlying pathology remains controversial. Studies reporting on pathology are limited by sample size or methods, including lack of comparison specimens. Thus the aim of this study was to clarify the role of tendon and bursa pathology in GTPS. Methods Tendon and bursa specimens were obtained from 64 participants: 35 with GTPS and 29 control participants. Specimens were evaluated by a minimum of two investigators via light microscopy for histopathological and morphological differences. Immunohistochemistry methods were used to evaluate macrophages (CD68), inflammatory cells (CD45) and substance P. Tendon was evaluated used the Bonar score3. Bursa specimens were evaluated via a semi-quantitative scoring system. Second harmonic generation microscopy, via multiphoton excitation fluorescence (MPEF) was used to illustrate morphological findings (Figure 1). Results Higher levels of pathology were found in specimens from participants with GTPS vs controls. The stroma of the bursa score, mean (SD): GTPS 4.18 (1.65) vs. control 2.53 (1.61), p = 0.051. Bonar (tendon) score, mean (SD): GTPS 12.65 (2.0) vs. control 10.43 (4.83), p = 0.04. There was a higher frequency of SubP in bursa (9/12 vs 6/16, p = 0.047), but not the tendon (8/12 vs. 8/15, p = 0.484) of specimens from participants with GTPS vs controls. There was no evidence of increased frequency of macrophages or other inflammatory cells in the bursa or the tendon specimens from either group. Intra adipose septa were identified and found to be present more frequently in the stroma of bursa specimens of participants with GTPS than controls (27/31 vs 15.27, Fisher exact: p = 0.008), (Figure 1). Discussion Tendon pathology present in both groups, with higher degree of pathology in GTPS. More extensive bursa pathology was seen in the GTPS group, along with a higher frequency of SubP in the bursae from the GTPS than the OA group. This may explain why bursectomy appears to be a successful treatment for some people with GTPS.1 The IAS has previously reported in rats,5 but not to our knowledge, in humans. This well organised structure may play a role in bursa stabilisation and shear mitigation. Pathologically it may reduce the ability of the bursa stroma to mitigate compression forces over the tendon. References Baker, et al. Arthroscopy. 2007;23:827–832 Connell, et al. Eur Radiol. 2003;13:1339–1347 Fearon, et al. J Arthroplasty. 2014;29:383–386 Fearon, et al. J Sci Med Sport. 2013;doi: 10.1016/j.jsams.2013.07.008 Shaw, et al. J Anat. 2007;211:436–443 Spear, et al. Surg Clin N Amer. 1952;32:1217–1224
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.001 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".