Hip - Gluteus Medius Tears
Description
The gluteus medius and gluteus minimus, the hip abductors, are muscles that attach to the outer aspect of the hip (the greater trochanter) by a thickened portion of non-elastic tissue called tendons. The abductors are responsible for abducting the leg, or moving it away from the body. Tears in the abductor tendons can either be partial or complete.
What are the causes?
Abductor tears are typically repetitive, overuse and degenerative in nature. Tears in the abductor tendons may also be secondary to multiple corticosteroid injections given in the area for trochanteric bursitis.
What are the symptoms?
Abductor tears can mimic trochanteric bursitis, causing pain in the outer aspect of the hip over the greater trochanter. Abductor tears, unlike trochanteric bursitis, cause a decrease in motion and loss of strength in the gluteus medius and/or gluteus minimus. Patients with abductor tears may also find it difficult to balance or keep the hips straight while standing on one leg.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam including X-rays. Exam findings will consist of loss of active range of motion (patient moves the hip), preserved passive range of motion (the surgeon moves your hip), weakness and pain with muscle testing. X-rays may or may not demonstrate calcification near the tendon insertion on the greater trochanter. MRI is helpful in diagnosing the tear.
Non-operative
Non-operative treatment for partial and small tears of the abductors may be beneficial. Your surgeon may prescribe anti-inflammatory medication, physical therapy, cryotherapy and activity modification. Your surgeon may offer an injection. Patients whose pain does not resolve with non-operative treatment should discuss surgical treatment options with their surgeon.
Platelet Rich Plasma (PRP) Injections is another non operative option. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. A one time leukocyte rich, concentrated PRP injection is recommended. One injection may be all you need, however, there are times where multiple injections may provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the tendon. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
Abductor tears that fail to improve with non-operative treatment can be treated with a minimally-invasive arthroscopic or open procedure. The tendon(s) are repaired back to the bone with sutures and anchors. Postoperative medication and physical therapy are at your surgeon’s discretion.
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