"I feel I have been taken seriously" Women's experience of greater trochanteric pain syndrome treatment-A nested qualitative study.

BACKGROUND: Women experiencing greater trochanteric pain syndrome (GTPS) report high levels of pain and reduced quality of life. Exploring how they manage GTPS in a daily life context can provide important knowledge about individual coping strategies. Education, extracorporeal shockwave therapy (ESWT) and exercise have good group level evidence for efficacy in clinical trials and are increasingly used in routine care for patients with GTPS. Exploring women's experiences of such treatment may help understand the mechanisms underpinning these positive results and inform treatment strategies. We therefore aimed to explore how women with GTPS experience and manage their daily life, and their experience of the combined treatment of education, ESWT and exercises. METHODS: This qualitative study was nested within a cohort study based in a hospital outpatient clinic and a physiotherapy clinic in Denmark assessing the combined treatment of education, ESWT and exercises. Data was collected from eleven women using in-person, individual, semi-structured interviews which were audio recorded. Transcripts were coded and analysed using an inductive thematic analysis approach. FINDINGS: Five themes were identified: (1) Daily life was controlled and structured by pain; (2) The condition was acknowledged and taken seriously by treating professionals; (3) The participants´ experiences of the intervention-information is key; (4) Improved capability and autonomy in pain management and (5) The women´s perspectives on improving and expanding the intervention. Learning how to manage pain was experienced as the most important element of the program to the women to be able to minimize pain and manage daily life. CONCLUSION: Exploration of how women with greater trochanteric pain syndrome experienced and managed daily hip pain, and how they experienced and adapted to treatment are important novel findings that will inform clinical practice. This new knowledge may be used to inform an individualized patient education, treatment and evaluation strategy for women with the painful and debilitating condition of GTPS.

[Intraneural ganglioncyst from the "forgotten" knee joint].

Disorders in the proximal tibiofibular joint (PTFJ) is often missed or misinterpreted because healthcare professionals often do not consider it a source of pathology. This is a case report of the symptoms and treatment in a young man with intraneural ganglion cyst originating from the PTFJ. The diagnosis was verified by an MRI scan, since there were few objective findings. Treatment is decompression of the cyst, and to prevent recurrence it is important to disconnect the articular branch.

Satisfactory outcome following arthroscopic fixation of tibial intercondylar eminence fractures in children and adolescents using bioabsorbable nails.

INTRODUCTION: Tibial intercondylar eminence fracture is a rare fracture and is commonly treated with suture, screw or bio-absorbable nail. Current literature includes little information regarding outcome of surgically treatment with bio-absorbable nails. The purpose of this study was to report the clinical and functional outcomes in patients with tibial intercondylar eminence fractures arthroscopically treated with bio-absorbable nails. METHODS: The study design was retrospective follow-up. Sixteen patients, age 11-16 years, were surgically treated with bio-absorbable nail following an intercondylar eminence fracture. Thirteen patients participate in the present follow-up study. The median follow-up time was 6.5 years. The main outcome measurement was the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measurements consisted of: Eq5d-5L questionnaire, knee pain, knee laxity, range of motion (ROM), muscle strength, gait analyses, radiological outcomes, activity and level. RESULTS: The median KOOS scores for the five subscales were: pain 98.5 (19-100), symptoms 90.5 (54-100), ADL 100 (22-100), sport 87.5, (0-100) and QOL 88.0 (13-100), indication satisfactory outcome. Low level of gait asymmetry was observed. Almost balanced muscle strength between the injured and non-injured leg for knee extension and knee flexion strength was observed. Measurement of anterior knee laxity showed 12 patients with a knee laxity between - 1 and 2 mm. The examination of intercondylar eminence displacement at the time of follow-up showed that 12 patients had a displacement of 2 mm or less. CONCLUSION: This case series demonstrates satisfactory patient-reported and functional outcomes in the treatment of intercondylar eminence fractures in children and adolescents with bio-absorbable nails.

[Osteoid osteoma and labrum injury in a hip of a 29-year-old woman].

Osteoid osteoma is a benign bone tumour most commonly seen in long bones, and CT-scan is the modality of choice showing nidus with surrounding sclerosis. Osteoid osteoma with an intra-articular location in the hip may lack sclerosis, and it may also lack nocturnal pain and pain relieved by non-steroidal anti-inflammatory drugs, which is most commonly seen in osteoid osteoma. This is a case report of a combination of osteoid osteoma and labrum injury in a hip of a 29-year-old woman.

Translation, validation and test-retest reliability of the VISA-G patient-reported outcome tool into Danish (VISA-G.DK).

The Victorian Institute of Sport Assessment (VISA) questionnaire model is based on item response theory using a graded response (responses reflect increasing difficulty). The purpose of the VISA-G is to monitor patient outcomes and evaluate treatment strategies for people with greater trochanteric pain syndrome (GTPS). The primary aim of the current study was to translate and culturally adapt the VISA-G into a Danish context (DK) through forward and back translation and cognitive interviews. The second aim was to establish test-retest reliability and face validity of the VISA-G into a Danish context (DK). No major disagreements were observed between the original and translated versions of the questionnaire. A total of 58 heterogenous asymptomatic, and 49 symptomatic respondents (response rate: 92% and 78% respectively) completed the VISA-G.DK twice, 1 week apart. The VISA-G.DK had excellent internal consistency (Cronbach's alpha: asymptomatic = 0.86; symptomatic = 0.98). The test-retest reliability was excellent for the total score: ICC: 0.961 (95% CI [0.933-0.978]). Standard Error Measurement was calculated to be 0.6. Bland-Altman plots showed no significant or relevant differences from test to retest in the total score with mean differences below 1 (0.61). The minimal detectable change was 3.17 for both groups. The VISA-G.DK was found to be valid, reliable and acceptable for use in the Danish population.

Surgical fenestration and rehabilitation of a sports traumatic non-union ischial tuberosity fracture - Case report.

INTRODUCTION: Ischial tuberosity fractures and complications may be an under recognized diagnosis in adolescent athletes. Operative interventions differ and may include anchor re-fixations, resections and osteostimulating drilling and partial hamstring releases. This case report illustrates a novel and less invasive management of a non-union following a proximal ischial tuberosity avulsion. This approach has to our knowledge not previously been described. PRESENTATION OF CASE: The patient, a 14 years old female athlete, was complaining of sharp pain in the right side of the groin region, after an acute injury during a handball game. The pain was concentrated at the insertion of the adductor muscle group to the superior pubic ramus and the pubic symphysis. She was referred to our orthopaedic sports clinic after 6 months of unsuccessful conservative treatment. An MRI scan showed an ischial tuberosity non-union with a displacement less than 10 mm. Nine months after injury a surgical procedure was performed with the patient under general anaesthesia. An ultrasound guided fenestration of the non-union of the ischial tuberosity with a 1.6 mm Kirshner wire was performed. The enthesis was fenestrated 10 times, using a 1.2 mm syringe. Finally, a 5 ml local anaesthetic was injected in the area. 17 months after the trauma and 8 months postoperatively the patient had a full return to normal day activities including pain free squats and lunges. Radiologically the non-union was healed. CONCLUSION: This novel and less invasive surgical procedure may therefore be seen as a possible treatment option to non-union of the ischial tuberosity with minimal displacement.