GLUTEUS MEDIUS TENDON INJURIES

WHAT AND WHERE IS THE GLUTEUS MEDIUS?

The gluteus medius is a muscle on the outside of the hip, which is important for abduction (lateral movement away from the body). The gluteus medium is sometimes referred to as the rotator cuff of the hip.  This muscle maintains the pelvis level and helps one stand upright and walk without a limp.

TYPES OF INJURY

Tendonitis/tendinopathy:  this diagnosis is made when the overall architecture of the tendon is intact, but it is inflamed.  

Tendon tear:  this diagnosis is made with MRI evaluation of the hip.  When the tendon is torn, it typically occurs where it attaches to the femur.  The tear can be partial or complete.  Once detached, the tendon can start to retract and displace.

WHAT ARE THE SYMPTOMS?

The most common symptom of gluteus medius tendon injury is pain along the outer aspect of the hip.  The pain can be dull/achy, but also can be sharp.  It often will radiate upwards toward the buttock and down towards the knee on the outside of the thigh.  Patients commonly report that they cannot sleep on the affected side.  When symptoms become severe, the patients often notice limping. These symptoms are identical to trochanteric bursitis but often with more weakness and limping.

HOW IS A DIAGNOSIS MADE?

The diagnosis of gluteus medius tendon injury is made with the combination of physical examination with patient history and usually X-rays and MRI evaluation.

TREATMENT OPTIONS

Conservative treatment often helps and includes:

• Anti-inflammatories

• Physical therapy exercises emphasizing core and gluteus medium strengthening

• rest and activity modifcation

• Injections - cortisone or PRP or stem cell

Surgical treatment is indicated when patients fail conservative treatment.  

• If the diagnosis is tendonitis, then surgery is done to remove the overlying bursitis. See our discussion on trochanteric bursitis.

• If there is a tear of the gluteus medius tendon then the tendon is repaired back to its insertion on the femur. This can typically be accomplished arthroscopically (minimally invasive) but the tendon tear is large or significantly retracted, then it may be repaired in an open fashion.