227 - Saving the butt: resolution of chronic gluteal pain after Plasma Rich Protein injections in patient with denervation atrophy after years of buttock botox and steroid injections

The patient is a 75-year-old female with chronic, constant, aching left hip pain exacerbated by positional changes which worsened over time and extended to the buttocks. Over two years, the patient received botulin toxin injections every 3 months interspersed by triamcinolone injections.

On presentation, the patient’s ADLs were limited by pain and her exam exhibited tenderness over the left medial gluteus medius and maximus. MRI demonstrated bilateral gluteus medius and minimus tendinopathy and edema and fatty atrophy of the left gluteus maximum muscle suggestive of a chronic denervation process.

The patient received combined PRP (Platelet-rich plasma) and PLP (platelet lysate plasma) injected around all gluteal aponeurosis and tendons under ultrasound.

At 8-week follow up, the patient reported significant improvement in baseline function and muscular strength; she could walk a mile pain-free, sleep through the night, and participate in PT.

 

Discussions:

Tendinopathies present a therapeutic challenge when traditional treatments like rest, physical therapy, NSAIDs and steroids are ineffective. PRP therapy has gained traction as a treatment modality due to its potential to accelerate healing by delivering high concentrations of growth factors directly to an injured area.  However, lack of standardized protocols has led to inconsistent results in the literature; although current trends in data may suggest PRP therapy may outperform corticosteroid injections in long-term functional outcomes.

Conclusions:

This case demonstrates how the use of chronic botulin toxin and steroid injections in refractory tendinopathy over a several year span can lead to neurogenic and fatty atrophy of muscle. Whereas the introduction of regenerative approaches such as PRP lead to both improved lasting pain relief and long-term functional outcomes.