What is the initial management for a patient with right insertional gluteal tendinopathy and enteropathy?

From the Guidelines

The initial management for a patient with right insertional gluteal tendinopathy and enteropathy should prioritize relative rest, reduced activity, and pain control, as these measures prevent further damage and promote healing and pain relief 1. The goal of initial management is to reduce inflammation, alleviate pain, and promote tissue healing. Key components of this approach include:

• Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
• Pain management using NSAIDs, such as ibuprofen or naproxen, for short-term pain relief, although they have no effect on long-term outcomes 1
• Cryotherapy, including repeated applications of melting ice water through a wet towel for 10-minute periods, to provide acute relief of tendinopathy pain 1
• Eccentric strengthening exercises to effectively treat tendinopathy and potentially reverse degenerative changes 1 It is essential to note that while NSAIDs are recommended for short-term pain relief, they do not alter long-term outcomes, and their use should be limited to 1-2 weeks 1. Additionally, locally injected corticosteroids may be considered for acute-phase pain relief if conservative measures fail, but they do not alter long-term outcomes 1. Patients should temporarily avoid activities that aggravate symptoms, particularly those involving hip extension against resistance or prolonged sitting. Physical therapy, including specific exercises to strengthen the gluteal muscles while avoiding aggravating positions, is crucial for promoting tissue healing and maintaining function. Gentle stretching of the piriformis and external rotators may help, but should not reproduce pain. Ice application for 15-20 minutes several times daily can reduce local inflammation. Patients may benefit from using a cushion when sitting to reduce pressure on the affected area.

From the Research

Initial Management for Right Insertional Gluteal Tendinopathy and Enteropathy

The initial management for a patient with right insertional gluteal tendinopathy and enteropathy involves a multi-faceted approach.

• The condition is characterized by pain and inflammation in the gluteal tendons, which can be exacerbated by various factors such as mechanical loading, joint position, and muscle imbalances 2.
• The management of gluteal tendinopathy has evolved over time, with a shift from traditional beliefs focusing on anti-inflammatory treatments to a more active approach that empowers the individual to manage their condition through education, load management, and progressive exercise 3.
• Ultrasound-guided corticosteroid injections have been shown to be effective in reducing pain and improving function in patients with gluteus medius tendinopathy, with a significant reduction in pain levels and improvement in patient satisfaction 4.
• A comprehensive assessment of the patient's condition, including a thorough clinical examination and imaging studies, is essential to guide the management plan.
• The management plan may include a combination of:
  • Education on load management and exercise
  • Progressive exercise programs to strengthen the gluteal muscles and improve hip function
  • Ultrasound-guided corticosteroid injections to reduce inflammation and pain
  • Addressing any underlying enteropathy or gastrointestinal issues that may be contributing to the patient's symptoms

Key Considerations

• The management of gluteal tendinopathy requires a patient-centered approach, taking into account the individual's specific needs, goals, and circumstances.
• A multidisciplinary team, including physical therapists, orthopedic specialists, and gastroenterologists, may be involved in the management of the patient's condition.
• Regular follow-up and monitoring are essential to assess the patient's response to treatment and make any necessary adjustments to the management plan.
• The use of ultrasound-guided injections, such as those described in the study by 5, may be considered for patients who do not respond to conservative management.
• The management of insertional tendinopathy of the adductors and rectus abdominis, as described in the study by 6, may also be relevant to the management of gluteal tendinopathy, particularly in athletes or individuals with similar presentations.