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Hip

Gluteus Medius / Minimus Tears

What is the gluteus medius muscle?

The gluteus medius is a major muscle that surrounds and stabilizes your hip during movement and allows you to lift your leg to the side, away from the midline of your body (a movement called abduction), and to stand up straight. The gluteus medius muscle is attached to the bony prominence of the hip (called the greater trochanter) by a very strong tendon.

What causes a gluteus medicus muscle tear?

The muscle can be torn or ripped from the trochanter as the result of an injury or from repetitive forces exerted during athletics and other physical activities. This is also referred to as the rotator cuff of the hip. As such, this can be present in older patients where the tendon becomes weaker and can tear with repetitive “microtrauma.” Additionally, runners who rapidly increase their routine instead of gradually increasing activity often wind up overstraining the gluteus medius muscle or tendon. Running on inclines or declines or failing to warm up properly before participating in sports can also cause tears.

While some minor or partial tears may improve with conservative treatment options like rest, ice and physical therapy (especially in patients who are not very physically active), more substantial damage typically requires surgery in order to relieve pain and restore normal function in the hip.

What symptoms are associated with gluteus medius abductor and tendon tears?

Gluteus medius tendon tears are classified by “grades,” with Grade 1 injuries including the mildest tears and Grade 4 comprising the most severe tears. When these tears are left untreated, the tendon can retract and make future treatment more challenging. Most patients with a tear have a combination of sharp pains and persistent dull aches in and around the hip (usually on the outside of the hip). Pain is worse when lying on the injured side, and weakness and tenderness often lead to limping. Symptoms also tend to become worse after a long period of standing, sitting, or walking.

How is a gluteus medius tear diagnosed?

Dr. Jorge Chahla will conduct a comprehensive evaluation of your symptoms and function and perform a physical examination of your hip. He will look for areas of tenderness and swelling, and order imaging tests like X-rays and an MRI to confirm the diagnosis and evaluate the extent of the injury.

How are gluteus medius tears treated?

When there is a complete gluteus medius tear, they usually require surgery to correct. Inflammation of the tendon (tendonitis) or partial tears can be treated with conservative measures (anti inflammatories, physical therapy, and injections). Recent evidence suggest that partial tears have a good outcome with platelet rich plasma (taking the growth factors from your own blood and spinning them down). Surgery can be done open (through a 6cm incision) or arthroscopic. An open approach is usually preferred for chronic cases. The goal of surgery is to reattach the tendon to the greater trochanter. In a hip arthroscopy, surgery is performed through small incisions, minimizing tissue damage so recovery is faster. During the procedure, the tendon is reattached to the bone using small suture anchors. When damage is more extensive, a larger incision (or “open” surgery) may be required to provide greater access to the hip.

When the gluteus medius has been torn for a long period of time, the gluteus maximus (a bigger muscle that covers the gluteus medius) can be transferred (change the insertion of the tendon) restoring strength and function to the hip abductors.

Rehabilitation after a gluteus medius tear

After surgery, you’ll need to use crutches and wear a hip brace during the initial stages of healing, and your activity will be restricted for 6 weeks so that the tendon can heal appropriately (like a rotator cuff). Physical therapy will play an important role in recovery, strengthening your hip as well as preventing a buildup of scar tissue that can interfere with normal joint function.

Don’t ignore hip pain.

Gluteus medius abductor and tendon tears typically cause significant pain, but they aren’t the only cause of hip pain. Hip pain – even relatively minor discomfort – can be a sign of a serious underlying problem. Having pain evaluated and treated as soon as possible is important for relieving your symptoms, and it’s also important for ensuring you’ll enjoy a speedy return to the activities you love. To find out what’s causing your hip pain – and how it can be treated – call Dr. Jorge Chahla in Chicago, Illinois to schedule a consultation where you will receive the correct diagnosis and all your treatment options.


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