Hip Gluteus Medius Tendon Tear
Pain at the lateral, or outer side of the hip region may be attributable to problems of the gluteus medius tendon (or hip abductor). In many ways, the hip gluteus tendons are very similar to the shoulder rotator cuff tendons. Both are susceptible to injury, either through chronic over-use or from a sudden trauma such as a fall. The tendon may become inflamed, thickened or frayed, a condition otherwise known as tendonitis. In more severe cases, the tendon may actually be torn off of its greater trochanteric attachment site.
Patients generally present with pain at the lateral hip region, or outer bony portion of the hip, inability to lay on the hip at night-time, weakness with hip abduction, and weakness with single-leg stance.
Treatments usually start with anti-inflammatory medications and physical therapy. Your doctor may recommend an injection of pain medication such as cortisone and/or lidocaine which can be performed in the office and may be performed with ultrasound guidance. This can also be useful as a diagnostic test to rule out other causes of “hip pain” such as lower back nerve radiating pain. Most patients may be treated without surgery if treatment is thorough and started early in the course of the disease.
In recalcitrant cases, your surgeon may recommend surgical intervention. This may be performed through an arthroscopic approach or even a small open approach. The tendon is repaired back to its insertion site using suture anchors. After surgery, it is important that the repaired tendon heal to its bony insertion site. Therefore, you may be instructed to use a walker or crutches to off-load the hip and not place full weight on the lower extremity. Also, you may not perform active or resisted hip abduction maneuvers as this may strain the repair site. In some cases, patients may be placed into a brace which must be worn over the clothes. The brace will help restrict certain hip motions to allow complete healing of the tendons. Diligent physical therapy is paramount for a successful outcome.