1502 - Expanding Interventional Options for Recalcitrant Greater Trochanteric Pain Syndrome with Novel Use of Superior Gluteal Nerve Stimulation

Case Diagnosis: Recalcitrant greater trochanteric pain syndrome

Case Description: A 59-year-old female with chronic bilateral greater trochanteric pain syndrome (GTPS) failing multiple standard treatments was referred to clinic. The patient underwent successful greater trochanteric sensory nerve (GTsn) radiofrequency ablation (RFA) with 6 months of relief but elected not to repeat the ablative procedure. She then trialed a left femoral temporary peripheral nerve stimulator (PNS) with good effect during the 60-day treatment period but had return of pain immediately upon device explant. She then underwent a novel right superior gluteal nerve (SGN) prognostic block and PNS trial with a positive response, leading to eventual permanent PNS implantation treatment to the SGN.

Discussions:

Multiple advanced interventional treatments served in concert for the patient’s pain management. The GTsn is a branch of the femoral nerve and provides dedicated sensory innervation to the GT structures. GTsn ablation improves pain through the destruction of the sensory pathway to the greater trochanter. As an alternative to ablative treatments, PNS works by neuromodulation of nerves innervating the painful structure. Permanent PNS (pPNS) is more invasive while temporary PNS (tPNS) may have poor predictability of treatment effect durability after device explant. 

Rational nerve target selection is foundational. Femoral nerve tPNS treatment was chosen to also affect the GTsn pathway, with a positive outcome, though unfortunately limited in durability. The SGN was chosen as it provides sensorimotor innervation of the gluteus minimus and medius. After a positive SGN diagnostic block and PNS trial, pPNS treatment was chosen in order to provide lasting pain relief.

Conclusions: The combination of advanced treatment options can provide optimized GTPS management, balancing the advantages and disadvantages of each. SGN PNS is a novel treatment for recalcitrant GTPS. By providing pain relief and enabling timely rehabilitation, this procedure addresses both symptoms and functional recovery.