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 tear of the tendon from the greater trochanter of the femur bone.  Conditions causing pain to the outside of the hip are grouped into a condition called "Greater Trochanteric Pain Syndrome" because the pain is typically localized near the greater trochanter of the femur bone.

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. 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

Tears of the gluteus medius tendon are commonly seen without a traumatic injury.  Patients that have been diagnosed with bursitis of the hip that may not be improving may also have gluteus medius tendon injury.  Damage to the tendon can range from tendinitis to partial or complete thickness tears.

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 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 tendon 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.  MRI may be helpful to view the pathological changes of the muscle.

Treatment

The aim of treatment is to reduce pain and restore the normal function of the gluteus medius muscle.  Initial treatment involves basic modalities such as rest, activity modification, ice, gentle massage of the hip area, as well as physical therapy.

Medications such as nonsteroidal anti-inflammatory drugs or NSAIDs and steroid injections may be given to reduce the pain and inflammation. You may 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 gluteus medius tears that do not respond to more conservative measures. The surgery can be performed endoscopically through small incisions to reattach the torn tendon back onto the greater trochanter. This helps to restore strength and function to the gluteus medius muscle.

  • American Orthopaedic Society for Sports Medicine
  • The Arthroscopy Association of North America
  •  American Academy of Orthopaedic Surgeons
  • International Society for Hip Arthroscopy