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29/03/2017 0 Comments

La epidemia de la cadera: Síndrome del trocánter mayor

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Hay una auténtica epidemia mundial que afecta al trocánter mayor, y la población susceptible de tener este problema son las personas con mayor edad, especialmente a partir de los 50-60-70 años, aunque también puede aparecer en edades más tempranas tanto en corredores como en población sedentaria. Como están de moda las trilogías, vamos a dividir la información que queremos compartir en tres entradas. En la primera, ésta, nos vamos a centrar en presentar este síndrome, en una segunda expondremos el mecanismo lesivo y los factores que lo predisponen, y en la tercera hablaremos de la vacuna que va a prevenir su desarrollo.

El dolor localizado sobre el lateral de la cadera, en el trocánter mayor, ha sido diagnosticado durante muchos años de forma errónea como bursitis trocantérea5,67, siendo usado por primera vez este término en 1923 por Stegerman65. Y a pesar de que hay aproximadamente 20 bursas sinoviales en el área trocantérea73, sólo el 8% de las personas con este síndrome tienen bursitis8, y el 20% presenta engrosamiento de la bursa48.

trocmayor2

El SÍNDROME DEL TROCÁNTER MAYOR es una etiqueta que referencia una variedad de diagnósticos crónicos de cadera como la “Coxa Saltans”, o la bursitis trocantérea, aunque son las tendinopatías del glúteo medio y glúteo menor la causa primaria4,39,46,67.

trocmayor4

Han sido muchos los autores que han comparado al glúteo medio y menor con el manguito rotador del hombro12,40,41,54, de hecho también se ha comparado el síndrome del trocánter mayor con el síndrome subacromial. Ver: El síndrome subacromial, La Epidemia del hombro, en la que veíamos como aumentaba exponencialmente el número de casos en cada década a partir de los 50 años.

En el síndrome del trocánter mayor ocurre algo parecido tal y como muestran Chi et al15.

El 10-25% de la población general sufre este síndrome, caracterizado por un persistente dolor sobre el trocánter mayor67, pudiendo afectar tanto a gente sedentaria como a deportistas (principalmente a corredores por sobreuso)23.

SÍNTOMAS:

  • Dolor al tumbarse sobre el lado afectado44, especialmente de noche76.
  • Dolor al Sentarse con las piernas cruzadas44. La flexión de cader prolongada provoca un aumento de la tensión de la fascia glútea64,66; mientras que cruzar las piernas aumenta la compresión que ejerce la cintilla iliotibial sobre estas estructuras.
  • Dolor en apoyo monopodal prolongado con carga44.
  • Tolerancia reducida al ejercicio físico44.
  • Coxa Saltans: Son “crujidos” (a veces audibles y/o dolorosos) producidos por los movimientos de la cadera en el plano frontal, debido a que en los movimientos de flexo-extensión hay una migración anterior y posterior de las fibras anteriores del glúteo mayor y la cintilla iliotibial sobre el trocánter mayor.
  • Dolor en la aducción pasiva, al final del rango.
  • Dolor en la abducción de cadera resistida26,60,62.
  • Dolor durante la marcha7,76.
  • Pérdida de los rangos de movimiento de la cadera y de la fuerza de abducción cuando hay desgarros de los tendones glúteos25.

CARACTERÍSTICAS:

  • Las personas con este síndrome suelen presentar hipertrofia del TFL68 y atrofia del glúteo medio y glúteo menor55,71.
  • Déficit 32-42% de fuerza en abducción de cadera2,3.
  • Presentan mayor traslación lateral de la pelvis al prepararse para un apoyo monopodal1.
  • Suelen presentar alteración de la relación longitud-tensión en los abductores de cadera7,34.
  • Aproximadamente dos tercios de las persona que sufren este síndrome presentan dolor lumbar y/o artrosis de cadera19.
  • Y entre las personas con este síndrome cronificado el 13-40% presentan calcificaciones en el trocánter mayor45,60.

Evidentemente esta epidemia debemos tratarla con la importancia que se merece. Los médicos y los fisioterapeutas tienen mucho trabajo aquí. Pero desde nuestra parcela tenemos una vacuna súper potente para prevenir la aparición de este problema o retrasarlo, pero lo desarrollaremos en una entrada posterior.

Mucho cuidado, que hemos comprobado que la edad siempre va en aumento, no hay excepciones, y la edad es la mejor amiga de esta epidemia.

 

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