The Role of Referred Pain From the Retro Trochanteric Region in Patients With Knee Pain

The Role of Referred Pain From the Retro Trochanteric Region in Patients With Knee Pain. Prevalence, Interpretation and Management: A Randomized Controlled Study

The role of referred pain from the retro trochanteric region, in patients with knee pain. Defining and quantifying this sub group of knee patients in the investigators list of refered knee patients. Evaluating the effect of treatment. A randomized trial.

Study Overview

• Status: Unknown
• Conditions: Referred Pain
• Intervention / Treatment: Other: Physiotherapy; Other: Conservative treatment

Detailed Description

Knee pain is a great problem in the society. Besides obvious and known causes, for which there are increasing understanding and ways to treat, there is still a rather large group of patients in which the symptoms are not easily understood and harder to treat.

This group is often characterized by having symptoms ranging from months to years, having seen several physicians, gone through several x-rays/mri´s, and various treatment with no help.

The investigators find ever more suspicion towards specific mechanisms in the hip region as a source of knee pain. It is well known in pediatric medicine that children with serious disease in the hip often debut with knee pain. This relationship is not so well established in adults.

Pain in the lower extremity can arise from inflammation or strain of the retro trochanteric muscles, and/or more indirectly if these processes impact the sciatic nerve. The later explanation is commonly known as the piriformis syndrome.

Professor Oddmund Johansen has studied this type of pain extensively. In the later years he has found interest in patients with knee pain.

These patients will often have pain with deep palpation to the posterior hip region, when tightening the hip rotators with flexion and adduction, and they will often respond with pain relief, within minutes, when local anesthesia is placed on the distal attachment of the hip rotators on the posterior margin of the greater trochanter. Afterwards, lasting pain relief can be seen with a specified stretching regiment for these muscles.

The investigators will recruit suiting patients from a knee referral list. Inclusion will be based on clinical examination and whether they respond to the injection. After inclusion they will be scored with pain and quality of life forms, randomised in two groups, one with a stretching regime and one with conservative and symptomatic treatment.

There is interest in defining and quantifying this sub group of knee patients. They will be followed up after 3 months, with a new examination and scoring to evaluate the effect of the intervention.

The study will examine how the patients react and comply with the proposed diagnosis and treatment. A cost analysis will also be considered.

• Study Type: Interventional
• Enrollment (Anticipated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Anders Hennig, Physician; Phone Number: +4797650807; Email: anders.hennig@unn.no
• Study Contact Backup: Name: Oddmund Johansen, Professor; Phone Number: +4707766; Email: oddmund.johansen@unn.no

Study Locations

• Norway
  • Tromsø, Norway
    • University Hospital of Northern Norway
    • Contact: Anders Hennig, Physician; Phone Number: +4797650807; Email: anders.hennig@unn.no
    • Contact: Oddmund Johansen, Professor; Phone Number: +4707766; Email: oddmund.johansen@unn.no
    • Principal Investigator: Anders Hennig, Physician
    • Sub-Investigator: Oddmund Johansen, Professor

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Knee pain
• Failure to understand the pain with more conventional diagnosis
• Symptoms and retrotrochanteric pain with examination
• Pain relief with retro trochanteric local anaesthetic injection

Exclusion Criteria:

• Mental illness
• Failure to cooperate
• Not adequate Norwegian language skills
• Other well known disease explaining symptoms

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Physiotherapy Group; Physiotherapy	Other: Physiotherapy; Physiotherapy
Placebo Comparator: Conservative group; Conservative treatment	Other: Conservative treatment; Conservative treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain on VAS score	0 no pain, 10 worst possible pain	At 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
KOOS score subscales Pain	Standard scoring on the KOOS subscale of pain	At 3 months
KOOS score subscale Symptoms	Standard scoring on the KOOS subscale of symptoms	At 3 months
KOOS score subscale Function in daily living	Standard scoring on the KOOS subscale of Function of daily living	At 3 months
KOOS score subscale Knee-Related Quality of Life	Standard scoring on the KOOS subscale of Knee-Related Quality of Life	At 3 months
KOOS score subscale Function in Sports and Recreation	Standard scoring on the KOOS subscale of Function in Sports and Recreation	At 3 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Working full time the last week	Response yes or no to question if the participant worked full time last week	At 3months

Collaborators and Investigators

• Sponsor: University Hospital of North Norway
• Investigators: Principal Investigator: Oddmund Johansen, Professor, University Hospital og North Nprway, ortopedic department

Publications and helpful links

General Publications

• Meknas K, Kartus J, Letto JI, Flaten M, Johansen O. A 5-year prospective study of non-surgical treatment of retro-trochanteric pain. Knee Surg Sports Traumatol Arthrosc. 2009 Aug;17(8):996-1002. doi: 10.1007/s00167-009-0750-z. Epub 2009 Mar 5.
• Meknas K, Johansen O, Kartus J. Retro-trochanteric sciatica-like pain: current concept. Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1971-85. doi: 10.1007/s00167-011-1573-2. Epub 2011 Jun 16.
• Meknas K, Kartus J, Letto JI, Christensen A, Johansen O. Surgical release of the internal obturator tendon for the treatment of retro-trochanteric pain syndrome: a prospective randomized study, with long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2009 Oct;17(10):1249-56. doi: 10.1007/s00167-009-0787-z. Epub 2009 Apr 18.
• Meknas K, Christensen A, Johansen O. The internal obturator muscle may cause sciatic pain. Pain. 2003 Jul;104(1-2):375-80. doi: 10.1016/s0304-3959(03)00045-9.

Study record dates

Study Major Dates

• Study Start: October 1, 2015
• Primary Completion (Anticipated): August 1, 2016
• Study Completion (Anticipated): August 1, 2017

Study Registration Dates

• First Submitted: May 11, 2015
• First Submitted That Met QC Criteria: September 24, 2015
• First Posted (Estimate): September 25, 2015

Study Record Updates

• Last Update Posted (Estimate): September 25, 2015
• Last Update Submitted That Met QC Criteria: September 24, 2015
• Last Verified: September 1, 2015

More Information

Terms related to this study

• Keywords: knee pain
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pain, Referred
• Other Study ID Numbers: 2015/157(REK)