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.
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Abbreviations
- GTPS:
-
Greater trochanteric pain syndrome
- H&E:
-
Haematoxylin and eosin
- ICC:
-
Intra-class correlation co-efficient
- SP:
-
Substance P
- SHG:
-
Second harmonic generation
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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.
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The authors declare that there are no competing interests.
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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
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DOI: https://doi.org/10.1007/s00296-014-2957-7