Gluteus Medius Tear
The gluteal muscles are a major group of muscles located at the back of the pelvis forming the buttocks that helps in the stability of the hip. The gluteal muscles comprise of three muscles: gluteus maximus, gluteus medius, and the gluteus minimus. These muscles facilitate in abduction, extension, internal and external rotational movements of the hip.
Gluteal tears occur either because of injury or strain of the muscle. The main symptom is pain or irritation of varied intensity in the hip region. Prolonged activities like sitting, standing, and walking might exacerbate the symptoms. These tears are associated with aging. It is commonly seen in people who participate in sports activities that involve constant forceful movements of the hip or any conditions that cause friction on the gluteal tendon.
A muscle strain may be graded according to its severity as follows:
- Grade 1: A gentle tear of the muscle accompanied with pain but there is no loss of range of motion or strength.
- Grade 2: A partial tear of muscle associated with incomplete loss of strength and flexibility.
- Grade 3: Complete tear or rupture of the gluteal muscles with total loss of strength and movements.
Any traumatic injury or a degenerative condition of the hip might lead to a gluteal muscle tear. Because of an acute traumatic injury, a partial or full thickness tear may occur; this might lead to localized bleeding, scar tissue formation, and tendon calcification. Degenerative conditions or chronic inflammation of the gluteal tendons (tendinopathy) from overuse may lead to complete rupture of the tendon.
Diagnosis of a gluteal muscle tear is based on the following:
- Medical history
- General physical examination: Palpation over the hip area may exhibit tenderness. Standard muscle testing such as hip abduction, flexion, internal and external rotation, and hip extension will be performed. Any gait abnormalities will be detected along with the underlying cause.
- Investigations: Hip or pelvic X-rays are indicated to rule out other possible causes of hip pain. Occasionally, a MRI or ultrasound may be recommended.
The symptoms of a gluteal muscle tear may be treated conservatively. Surgery is indicated only in severe cases. The non-surgical treatment options include:
- Apply ice bags over the affected area to reduce tenderness and swelling
- Start NSAIDs prescribed by your doctor to cut back pain and inflammation
- Physical therapy as recommended by your doctor
- Activity modification to avoid prolonged exercises and positions that overstrain the affected muscle
- Use of assistive devices like canes or crutches might aid in walking
- Placement of a pillow between the knees while sleeping is advised to reduce the painful stretching of the affected muscle.
Surgical treatment involves the use of minimally invasive techniques to repair a severe, full-thickness gluteal tear wherein small incisions are made through which an endoscope and other miniature surgical instruments are inserted to reapproximate the tendon onto the bone.
If the gluteal tears are left untreated it may result in gait abnormalities, muscle weakness, and hip joint stiffness. Progression of partial thickness to full-thickness tears can lead to chronic pain and gait disturbances.