Skip to main content

Advertisement

SpringerLink
Log in

Increased substance P expression in the trochanteric bursa of patients with greater trochanteric pain syndrome

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Greater trochanteric pain syndrome (GTPS) is a pathology that can involve the trochanteric bursa or the tendons which attach to the greater trochanter. To clarify the potential importance of bursa versus tendon pathology and of substance P (SP) in contributing to pain in this condition tendon and bursa tissue biopsies were obtained from 34 patients with GTPS and 29 control subjects. Specimens were evaluated via light microscopy for histopathological and morphological differences, as well as using immunohistochemistry for macrophages (CD68), inflammatory cells (CD45) and SP. Bursa [stroma score, mean (SD): 4.18 (1.65) vs. 2.53 (1.61), p = 0.051] and tendon [Bonar score, mean (SD): GTPS mean (SD) 12.65 (2.0), control (10.43 (4.84), p = 0.04] from subjects with GTPS demonstrated more extensive signs of pathology than specimens from control subjects. There was a significantly greater presence of SP in the bursa (frequency: 9/12 vs. 6/16, p = 0.047), but not in the tendon (8/12 vs. 8/15, p = 0.484) of subjects with GTPS compared to controls. An increased presence of SP in the trochanteric bursa may be related to the pain associated with GTPS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

GTPS:

Greater trochanteric pain syndrome

H&E:

Haematoxylin and eosin

ICC:

Intra-class correlation co-efficient

SP:

Substance P

SHG:

Second harmonic generation

References

  1. Williams BS, Cohen SP (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 108:1662–1670

    Article  PubMed  Google Scholar 

  2. Rompe JD, Segal NA, Cacchio A et al (2009) Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med 37:1981–1990

    Article  PubMed  Google Scholar 

  3. Swezey RL (1976) Pseudo-radiculopathy in subacute trochanteric bursitis of the subgluteus maximus bursa. Arch Phys Med Rehabil 57:387–390

    PubMed  CAS  Google Scholar 

  4. Furia JP, Rompe JD, Maffulli N (2009) Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med 37:1806–1813

    Article  PubMed  Google Scholar 

  5. Fearon AM, Cook JL, Scarvell JM, et al (2014) Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. J Arthroplast 29(2):383–386

    Article  Google Scholar 

  6. Connell DA, Bass C, Sykes CA et al (2003) Sonographic evaluation of gluteus medius and minimus tendinopathy. Eur Radiol 13:1339–1347

    PubMed  Google Scholar 

  7. Fearon AM, Scarvell JM, Cook JL et al (2010) Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clin Orthop Relat Res 468:1838–1844

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Silva F, Adams T, Feinstein J et al (2008) Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol 14:82–86

    Article  PubMed  Google Scholar 

  9. Walsh MJ, Walton JR, Walsh NA (2011) Surgical repair of the gluteal tendons: a report of 72 cases. J Arthroplast 26:1514–1519

    Article  Google Scholar 

  10. Gotoh M, Hamada K, Yamakawa H et al (1988) Increased substance P in subacromial bursa and shoulder pain in rotator cuff diseases. J Orthop Res 16:618–621

    Article  Google Scholar 

  11. Schubert TE, Weidler C, Lerch K et al (2005) Achilles tendinosis is associated with sprouting of substance P positive nerve fibres. Ann Rheum Dis 64:1083–1086

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Lui PP, Chan LS, Fu SC et al (2010) Expression of sensory neuropeptides in tendon is associated with failed healing and activity-related tendon pain in collagenase-induced tendon injury. Am J Sports Med 38:757–764

    Article  PubMed  Google Scholar 

  13. Key JA (1928) The synovial membrane of joints and bursae. In: Cowdry EV (ed) Special cytology: the form and functions of the cell in health and disease. Paul B Hoeber, New York, pp 737–756

    Google Scholar 

  14. Woodley SJ, Mercer SR, Nicholson HD (2008) Morphology of the bursae associated with the greater trochanter of the femur. J Bone Joint Surg Am 90:284–294

    Article  PubMed  Google Scholar 

  15. Castor CW (1960) The microscopic structure of normal human synovial tissue. Arthr Rheum 3:140–151

    Article  CAS  Google Scholar 

  16. Benjamin M, Toumi H, Ralphs JR et al (2006) Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat 208:471–490

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Bohnsack M, Meier F, Walter GF et al (2005) Distribution of substance-P nerves inside the infrapatellar fat pad and the adjacent synovial tissue: a neurohistological approach to anterior knee pain syndrome. Arch Orthop Trauma Surg 125:592–597

    Article  PubMed  Google Scholar 

  18. Baker CL Jr, Massie RV, Hurt WG et al (2007) Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy 23:827–832

    Article  Google Scholar 

  19. Altman R, Alarcon G, Appelrouth D et al (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthr Rheum 34:505–514

    Article  CAS  Google Scholar 

  20. Krenn V, Morawietz L, Haupl T et al (2002) Grading of chronic synovitis—a histopathological grading system for molecular and diagnostic pathology. Pathol Res Pract 198:317–325

    Article  PubMed  CAS  Google Scholar 

  21. Blaine TA, Kim YS, Voloshin I et al (2005) The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Should Elb Surg 14:84S–89S

    Article  Google Scholar 

  22. Cook JL, Feller JA, Bonar SF et al (2004) Abnormal tenocyte morphology is more prevalent than collagen disruption in asymptomatic athletes’ patellar tendons. J Orthop Res 22:334–338

    Article  PubMed  CAS  Google Scholar 

  23. Firestein GS, Budd RC, Harris ED et al (2008) Kelley’s textbook of rheumatology, 8th edn. Elsevier, Philadelphia

    Google Scholar 

  24. Abraham T, Wadsworth S, Carthy JM et al (2011) Minimally invasive imaging method based on second harmonic generation and multiphoton excitation fluorescence in translational respiratory research. Respirology 16:22–33

    Article  PubMed  Google Scholar 

  25. Fearon A, Dahlstrom JE, Twin J, et al (2013) The Bonar score revisited: Region of evaluation significantly influences the standardized assessment of tendon degeneration. J Sci Med Sport. doi:10.1016/j.jsams.2013.07.008

  26. Ko JY, Wang FS, Huang HY et al (2008) Increased IL-1beta expression and myofibroblast recruitment in subacromial bursa is associated with rotator cuff lesions with shoulder stiffness. J Orthop Res 26:1090–1097

    Article  PubMed  CAS  Google Scholar 

  27. Soifer TB, Levy HJ, Soifer FM et al (1996) Neurohistology of the subacromial space. Arthroscopy 12:182–186

    Article  PubMed  CAS  Google Scholar 

  28. Shaw HM, Santer RM, Watson AH et al (2007) Adipose tissue at entheses: the innervation and cell composition of the retromalleolar fat pad associated with the rat Achilles tendon. J Anat 211:436–443

    PubMed  CAS  PubMed Central  Google Scholar 

  29. Jahss MH, Michelson JD, Desai P et al (1992) Investigations into the fat pads of the sole of the foot: anatomy and histology. Foot Ankle 13:233–242

    Article  PubMed  CAS  Google Scholar 

  30. Cichowitz A, Pan WR, Ashton M (2009) The heel: anatomy, blood supply, and the pathophysiology of pressure ulcers. Ann Plast Surg 62:423–429

    Article  PubMed  CAS  Google Scholar 

  31. George LK, Ruiz D Jr, Sloan FA (2008) The effects of total hip arthroplasty on physical functioning in the older population. J Am Geriatr Soc 56:1057–1062

    Article  PubMed  Google Scholar 

  32. Bachmeier CJ, March LM, Cross MJ et al (2001) A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthr Cartil 9:137–146

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was funded through the Australian National University as well as through a WorksafeBC Research at Work grant. AF was a recipient of an ANU PhD scholarship. AS is a recipient of a career investigator award from the Michael Smith Foundation for Health Research. JC was supported by the Australian Centre for Research into Sports Injury and its Prevention, which is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We gratefully acknowledge the expert assistance of Dr T Abraham with second harmonic generation and multiphoton excitation fluorescence microscopy, Jennie Scarvell for assistance with supervising the study, and Al Burns and Damian Smith for tissue collection.

Conflict of interest

The authors declare that there are no competing interests.

Author information

Authors and Affiliations

  1. Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia

    Angela Margaret Fearon & Paul N. Smith

  2. College of Medical, Biology and the Environment, Australian National University, Canberra, Australia

    Angela Margaret Fearon, Jane E. Dahlstrom & Paul N. Smith

  3. Capital Pathology, Canberra, Australia

    Jane Twin

  4. Anatomical Pathology, Canberra Hospital, Canberra, Australia

    Jane E. Dahlstrom

  5. Monash University, Melbourne, Australia

    Jill L. Cook

  6. Canberra Specialist Ultrasound, Canberra, Australia

    Wes Cormick

  7. Department of Physical Therapy, Centre for Hip Health and Mobility, Vancouver Coastal Health and Research Institute, University of British Colombia, Vancouver, Canada

    Angela Margaret Fearon & Alexander Scott

Authors
  1. Angela Margaret Fearon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jane Twin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jane E. Dahlstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jill L. Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wes Cormick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul N. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexander Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Scott.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 50 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fearon, A.M., Twin, J., Dahlstrom, J.E. et al. Increased substance P expression in the trochanteric bursa of patients with greater trochanteric pain syndrome. Rheumatol Int 34, 1441–1448 (2014). https://doi.org/10.1007/s00296-014-2957-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-014-2957-7

Keywords

Search

Navigation