Gluteus Medius (Abductor Tear)

Anatomy

The gluteus medius and minimus muscles start at the iliac crest of the pelvis and form tendons that attach to the greater trochanter of the femur (bony knob on the side of your hip).

                       

Gluteus medius                              Gluteus Minimus

images from www.orthobullets.com

Symptoms

While some may be acute, generally injuries of these muscles develop over time and predominantly affect females. Typical symptoms are pain over the trochanter (bursitis) and when tears are large enough, will present with a limp or (Trendelenburg gait). This is due to the inability of the muscle to balance or keep the pelvis level while walking, which makes the bursitis that much worse. Most patients that present with tears are middle aged females that have had multiple trochanteric hip injections without significant relief of their symptoms.

Treatment

In patients where initial conservative measure have failed including steroid injections, an MRI is typically the next step. MRI helps us evaluate the soft tissues around the hip and lets us see gluteus medius tears.  PRP recently has been shown to be effective at both 3 months and 2 years at relieving symptoms and improving function of the hip and may be an important adjunct in the treatment of small partial abductor tears. With MRI evidence of a tear and marked abduction weakness an endoscopic repair may be indicated. Endoscopic repair is also indicated for full thickness tears. In some rare instances the tear can be retracted and muscle atrophy has set in and a salvage procedure such as a gluteus maximus muscle transfer is required for pain relief. 

Author
Dr. Dustin Woyski Orthopedic Surgeon and Hip Specialist

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