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This case study sheds light on a situation where peripheral arterial disease was mistaken for Greater Trochanteric Pain Syndrome (GTPS). The patient, a woman aged between 55 and 60, had a complex medical history, including a battle with breast cancer, cardiovascular problems, and gastrointestinal complications stemming from previous treatments. Her presenting complaint was 14 months of persistent right hip pain. Despite conservative treatments aimed at GTPS, her symptoms failed to improve. Upon closer examination, it became evident that her symptoms were not typical of GTPS. She displayed signs such as pain that worsened rapidly with any activity (including cycling) and was completely alleviated by short rest periods (<120 seconds). The symptoms did not typically originate in the calves but in the lateral hip, and did not radiate distally. The rapid alleviation of symptoms with rest prompted further investigation. This led to the discovery of vascular issues, specifically iliac internal stenosis, which had been previously masked by the predominant musculoskeletal symptoms. The patient underwent surgery to address the underlying vascular pathology, receiving bilateral iliac stents. Postoperatively, her symptoms dramatically improved, and she experienced significant relief from her hip pain. Notably, clinical tests that were initially positive for musculoskeletal dysfunction, such as single-leg standing and specific isometric tests, no longer reproduced her previous pain. This case underscores the importance of considering vascular etiologies in patients presenting with atypical musculoskeletal symptoms, especially those with underlying cardiovascular risk factors. It highlights the potential pitfalls of relying solely on clinical presentations and the importance of a comprehensive assessment approach. Early recognition of vascular involvement and prompt intervention could have potentially prevented prolonged suffering and unnecessary treatments. In summary, this case emphasizes the critical role of thorough assessment and clinical reasoning in guiding appropriate management strategies, ultimately leading to improved patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: Optimal management for adhesive shoulder capsulitis (frozen shoulder) is currently unclear. We intended to explore whether treatment by intra-articular injections with corticosteroid and distension is more effective than treating with corticosteroids alone or treatment-as-usual in a primary care setting in Norway.Methods: In this prospective randomised intention to treat parallel study, 106 patients were block randomised to three groups; 36 (analysed 35) receiving steroid injection and Lidocaine (IS), 34 receiving steroid and additional saline as distension (ISD) and 36 had treatment-as-usual (TAU). Intervention groups received four injections within 8 weeks, assessed on 1st visit, at the 4th and 8th week. Outcomes were Shoulder Pain and Disability Index (SPADI), Numerical pain rating scale (NPRS) and passive range of motion (PROM). Postal assessment was repeated after 1 year for SPADI. Patients in the IS and ISD groups were "blinded" for intervention received and the assessor was "blinded" to group allocation.Results: At baseline there were no differences between groups in outcome measures. There were no statistical significant differences between the intervention groups in SPADI, NPRS and PROM at baseline, at short-term (4-and 8 weeks) or long-term (12 months). There were statistically significant differences (p < 0.01) in change scores at short-term for SPADI when comparing the IS and TAU groups (-20.8; CI-28.9 to -12.7), and the ISD and TAU groups (-21.7; CI-29.4 to -14.0), respectively for NPRS (-2.0; CI-2.8 to -1.1 and -2.2; CI-3.0 to -1.4), and for PROM, but not at long-term for SPADI (p > 0.05). Effect size (ES) at 8 weeks was large between both injection groups and TAU (ES 1.2). At 12 months ES was reduced to 0.3 and 0.4 respectively. Transitory side effects as flushing and after-pain were reported by 14 % in intervention groups.Conclusion: This intention to treat RCT in primary care indicates that four injections with corticosteroid with or without distension, given with increasing intervals during 8 weeks, were better than treatment-as-usual in treatment of adhesive shoulder capsulitis. However, in the long run no difference was found between any of the groups, indicating that natural healing takes place independent of treatment or not.Trial Registration: ClinicalTrials.gov, https://clinicaltrials.gov/ identifier: NCT01570985. [ABSTRACT FROM AUTHOR]