Gluteus Medius Tear

A gluteus medius tear is a condition characterized by severe strain on the gluteus medius muscle that results in partial or complete rupture of the muscle.

The gluteus medius is one of the major muscles of the hip and is essential for movement of the lower body and keeping the pelvis level during ambulation. The gluteus medius muscle arises from the top of the pelvic bone and attaches to the outer side of the thigh bone or femur at the greater trochanter by the gluteus medius tendon. The muscle functions as a hip abductor, controlling side to side movement of the hip and providing stabilization to the joint. Gluteus medius tears often occur at the tendinous attachment to the greater trochanter of the femur bone.

Causes

The tear or rupture of the gluteus medius muscle is commonly seen in runners and athletes involved in high-impact sports such as soccer or basketball. It can occur from sudden bursts of activity and poor flexibility of the gluteus muscle. Any traumatic or overuse injury, or degenerative changes can also lead to partial or complete tear of the gluteus muscle.

Symptoms

The symptoms of a gluteus medius tear involve pain and tenderness over the lateral aspect of the hip which may be aggravated with activities such as running, climbing stairs, prolonged sitting or walking, and lying on the affected side of the hip. One of the main symptoms of a gluteus medius tear is the presence of trendelenburg sign, evidenced by dropping of the pelvis towards the unaffected side during ambulation from being unable to properly bear weight on the affected limb.

Diagnosis

The diagnosis of a torn gluteus medius muscle starts with a physical examination of the patient including palpation of the affected muscle, testing muscle strength and assessing the walking pattern or gait of the patient. Special tests such as single-leg squat test or positive trendelenburg sign confirms the diagnosis of a gluteus medius tear. MRI or ultrasound may be helpful to view the pathological changes of the muscle.

Treatment

The aim of treatment is to restore the normal function of the gluteus medius muscle. Immediately following the rupture, RICE therapy is initiated and involves:

• Rest
• Ice
• Compression
• and
• Elevation

Medications such as non-steroidal anti-inflammatory drugs or NSAIDs and steroid injections may be given to reduce the pain and inflammation. You should use a pillow between your legs when sleeping and avoid positions that overstretch the muscle. Assistive devices such as a cane or crutches may be used temporarily to facilitate pain free ambulation.

Surgical treatment may be recommended to repair a complete, full-thickness gluteus medius tear. The surgery can be performed endoscopically through tiny incisions to reattach the torn tendon back onto the greater trochanter with stitches. This helps to restore strength and function to the gluteus medius muscle.

Conclusion

The gluteus medius is one of the main muscles of the hip that works to stabilize and control various hip movements. The tear or rupture of the muscle can result in pain, improper gait, and disability. Treatment includes surgical and non-surgical methods and the selection depends on the extent of the injury and the lifestyle of the patient.

Many patients with a hip labral tear do not have symptoms. However, some patients may experience pain in the hip or groin area, a catching or locking sensation in the hip joint, or significant restriction in hip movement.

Diagnosis

Your doctor will order certain tests to determine the cause of your hip pain.

X-rays of the hip allow your physician to rule out other possible conditions such as fractures or structural abnormalities.

Magnetic resonance imaging (MRI) may also be used to evaluate the labrum. An injection of contrast material into the hip joint space at the time of the MRI can help show the labral tears much clearer.

Injection of local anesthetic into the joint space is sometimes performed to confirm the location of the pain. If the injection completely relieves your pain, it is likely that the cause of the problem is located inside the hip joint.

Treatment Options

Treatment for a hip labral tear will vary depending on the severity of the condition. People with a minor labral tear recover within a few weeks with the help of non-surgical treatments.

Conservative treatments include:

• Medications: Anti-inflammatory medications can be helpful in relieving pain and reducing inflammation associated with labral tears. Your doctor may also recommend cortisone injections to alleviate the pain associated with a hip labral tear.
• Physical therapy: Physical therapy that helps to improve hip range of motion, strength, and stability are also recommended.

However, severe cases may require arthroscopic surgery to remove or repair the torn portion of the labrum.

Surgery

Hip arthroscopy, also referred to as keyhole surgery or minimally invasive surgery, is a surgical procedure in which an arthroscope, a narrow tube with a tiny camera on the end, is used to assess and repair damage to the hip.

The surgery is performed with the patient under general, spinal or local anesthesia.

Your surgeon will make 2 or3 small incisions around the hip joint area. The arthroscope is inserted into the hip joint through one of the incisions to view the labral tear. The camera attached to the arthroscope displays the image of the joint on the monitor. A sterile solution will be pumped into the joint to have a clear view and room to work. Through the other incisions specially designed instruments are inserted. Your surgeon repairs the torn tissue by sewing it back together or removes the torn piece all together, depending upon the cause and extent of the tear. After the completion of the procedure, the arthroscope and instruments are removed and the incisions are closed.

Post- Operative Care

Following the surgery, you will be given instructions on caring for your incisions, activities to avoid and exercises to perform for a fast recovery and a successful outcome. Physical therapy will be recommended by your doctor to restore your strength and mobility. Your doctor will also prescribe pain medications to keep you comfortable.

Risks and Complications

Possible risks and complications specific to arthroscopic hip surgery include:

• Infection
• Deep vein thrombosis(DVT)
• Blood vessel or nerve damage
• Hemarthrosis (bleeding inside the joint)
• Failure to relieve pain