Hip
Gluteus Medius / Gluteus Minimus Injuries
What is the gluteus medius tendon?
The gluteus medius is a major muscle, sometimes referred to as the rotator cuff of the hip, 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 hip abduction). The gluteus medius also plays an essential role in allowing you to stand up straight. This muscle is attached to the bony prominence of the hip called the greater trochanter by a very strong tendon known as the gluteus medius tendon.
What causes gluteus medius tendon injury?
The gluteus medius tendon can be torn or ripped from the trochanter as the result of a traumatic injury, from repetitive forces exerted during athletics and other physical activities, or as a result of degeneration of the tendon in older patient populations where the tendon becomes weaker and repetitive “microtrauma” can cause tearing.
Overuse
Repetitive activities or sports that involve excessive hip and leg movement, such as running, cycling, or dancing, can put strain on the gluteus medius tendon, leading to injury over time.
Aging
Tendons naturally degenerate and become less flexible with age, making them more susceptible to injury. This is especially common in older adults.
Trauma
A sudden, forceful impact or injury to the hip or buttock area can damage the gluteus medius tendon. This can occur in accidents, falls, or sports-related collisions.
Poor Biomechanics
Improper body mechanics, such as poor running or walking form, can place excessive stress on the gluteus medius tendon, increasing the risk of injury.
Muscle Imbalances
Weakness or imbalances in the muscles around the hip and buttock area can alter the mechanics of the gluteus medius tendon and increase the likelihood of injury.
Inflammation
Conditions like tendinitis or bursitis in the hip can irritate and weaken the gluteus medius tendon, making it more prone to injury.
Repetitive Stress
Engaging in activities that involve frequent pivoting or lateral movements, such as certain sports or jobs, can strain the gluteus medius tendon. Additionally, repetitively running on an incline or decline can also add excess strain to the gluteus medius tendon.
Inadequate warm-up and stretching
Failing to properly warm up or stretch before engaging in physical activities can make the tendon more vulnerable to injury. Additionally, runners who rapidly increase their routine instead of gradually increasing activity often wind up overstraining the gluteus medius muscle or tendon.
What are the symptoms of a gluteus medius tendon injury?
Most patients with a gluteus medius tendon injury have a combination of sharp pains and persistent dull aches in and around the hip (usually on the outside, or lateral aspect, 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. Gluteus medius tendon tears are classified by “grades,” with Grade 1 injuries including the mildest tears and Grade 4 comprising the most severe tears.
- Grade 1 Tear: patient experiences mild pain and little to no loss of mobility or strength.
- Grade 2 Tear: patient has a partial tear with mild pain and some loss of mobility and strength .
- Grade 3 Tear: patient has a complete tear of the gluteus medius tendon and complete loss of mobility and strength.
- Grade 4 Tear: patient has a complete tear of the gluteus medius tendon and retraction of the muscle, potentially leading to muscle atrophy. Complete loss of mobility and strength is also present.
Typically, symptoms become more significant as the grade of severity increases.
Pain
Pain in the outside, or lateral aspect, of the hip, is one of the hallmark symptoms. The pain may be sharp, aching, or throbbing and can range in intensity from mild to severe. It is often aggravated by activities that involve the affected muscle, such as walking, running, or climbing stairs.
Weakness
You may experience weakness or difficulty in using the hip and leg on the side of the injured gluteus medius tendon. This weakness can affect your balance, stability, and ability to perform activities that require hip strength. Weakness of the gluteus medius tendon may also lead to a limp when walking, known as a Trendelenburg gait.
Tenderness
The area over the gluteus medius tendon may be tender to the touch. This tenderness is often localized to the outer part of the hip and buttock.
Swelling
In some cases, there may be mild swelling or inflammation around the hip or buttock area.
Pain at Night
Some individuals with gluteus medius tendon injuries may experience pain or discomfort at night, especially when lying on the affected side.
How is a gluteus medius tendon injury diagnosed?
During your consultation with Dr. Bryan Penalosa, a Chicago sports medicine surgeon and hip specialist, your medical history, gluteus medius tendon symptoms, and past injuries will be reviewed.
Physical Exam
He will conduct a physical examination checking range of motion, gluteus medius strength, and palpation of the painful hip region. Palpation may include Dr. Penalosa or a member of his team gently pressing on the affected area to check for tenderness, swelling, or warmth. This can help identify the specific location of pain and rule out other possible causes. A comprehensive physical exam is key to determine the cause of your hip pain.
Imaging
In some cases, imaging studies may be ordered to confirm the diagnosis of a gluteus medius tendon injury and rule out other conditions that could be causing the lateral hip pain. X-rays are often the first imaging test done to rule out issues such as fractures or degenerative joint diseases. While they may not directly show gluteus medius tendon injuries, they can help rule out other causes of hip pain. Ultrasound imaging can provide real-time images of soft tissues like the trochanteric bursa and gluteus medius tendon, and can help identify signs of hip inflammation or tearing of the gluteus medius tendon. An MRI may be recommended to gain detailed images of the hip area, including the bursa, gluteal tendons, hip labrum, and muscles.
Gluteus Medius / Gluteus Minimus Injuries Treatment Options
Can gluteus medius tendon injuries be treated without surgery?
The initial treatment for low grade gluteus medius tendon injuries begins with non-operative treatment. Many individuals find relief with lifestyle modifications, including:
- Avoiding activities that worsen symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib, help reduce hip pain and hip inflammation.
- Using a cane or crutches to help with walking.
- Physical therapy to increase hip strength and flexibility. This can include stretching the hip joint, rolling therapy, and/or learning to use ice or heat to relieve pain.
- Platelet rich plasma (PRP) Injection(s) to the gluteus medius tendon may help with pain relief temporarily (months) or permanently. These injections include taking the growth factors from your own blood and spinning them down before injecting them into the gluteus medius tendon under ultrasound guidance.
While some minor or partial tears may improve with conservative treatment options, more substantial damage to the gluteus medius tendon typically requires surgery in order to relieve pain and restore normal function in the hip.
What are the surgical options for gluteus medius tendon injuries?
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 using small non-metal anchors. In a hip arthroscopy, surgery is performed through small incisions, minimizing tissue damage so recovery is faster. During the procedure, the tendon is also reattached to the bone using small suture anchors.
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) to restore strength and function to the hip abductors. This is called a gluteus maximus transfer.
Recovering from Gluteus Medius / Gluteus Minimus Surgery
How long is the recovery after a gluteus medius tendon repair?
The recovery time after gluteus medius tendon repair surgery can vary depending on several factors, including the extent of the surgery, individual patient characteristics, and the level of activity that the patient is striving to return to. In general, most patients can recover full, unrestricted activity in 7-9 months following gluteus medius tendon repair surgery, provided they complete a good physical therapy program.
Here’s a general overview of what to expect after gluteus medius tendon repair:
Initial Recovery Phase (0-6 weeks):
The immediate post-operative period following gluteus medius tendon repair surgery involves rest and protection of the surgical site. Patients will be non-weight bearing for 6 weeks following hip surgery, typically using crutches for a total of 6-8 weeks. A hip brace will be worn for 6 weeks following surgery. Pain and discomfort are common during this phase, but medications are prescribed to help manage it.
Intermediate Recovery Phase (6-12 weeks):
During this time, physical therapy begins to improve strength, stability, and restore a proper gait. Return to light, low-impact activities may be allowed under the guidance of Dr. Bryan Penalosa and his team, as well as your physical therapist. Patients should still avoid high-impact activities or activities that involve excessive hip stress.
Advanced Recovery Phase (3-6 months):
As strength and range of motion improve, patients can start transitioning to more demanding activities. Physical therapy continues to focus on functional movement and exercises. Return to full activities typically occurs around 6-8 months following gluteus medius tendon repair after Dr. Bryan Penalosa has formally evaluated and cleared the patient to do so.
Long-Term Recovery (6 months to 1 year and beyond):
Complete recovery may take up to a year or more. Patients should continue with maintenance exercises to ensure long-term joint health.
Long-Term Effects of Untreated Gluteus Medius Injuries
What are the long-term effects of an untreated gluteus medius injury?
When gluteus medius tendon tears are left untreated, the gluteus medius tendon can retract and make future treatment more challenging. Addressing gluteus medius tendon injures early through conservative treatments or surgical intervention can help reduce the risk of this and improve hip joint function and overall quality of life.