Athletes often strain the gluteus medius muscle, making gluteus medius tears a frequently seen injury at NY Bone and Joint Specialists. Dr. Rupesh Tarwala has trained in various countries to learn the most advanced methods in Sports Medicine to treat hip injuries like gluteus medius tears. He is a top hip arthroscopist, treating professional grade athletes not only from across the United States, but other countries, with minimally invasive hip procedures.
Dr. Tarwala and all the NY Bone and Joint specialists are dedicated to providing the best orthopedic care. Our top class surgeons take the time to discuss your injury with you and exhaust all conservative options before considering surgery. Our doctors will accept in and out of network benefits and we will take care of all insurance processes on your behalf. We will always schedule follow up appointments or after care physical therapy appointments at your convenience and send you reminders. We would be happy to see you for emergency or same day appointments at any of our offices in Upper East Side and Midtown Manhattan as well as Englewood and Hoboken New Jersey.
At the side of our hip there is a bony protrusion called the greater trochanter (can be easily felt at area of side pocket of pants). The end of the gluteus medius muscle attaches to this bony area. The rest of the muscle lies on the upper side of each hip. The gluteus medius allows us to move our legs laterally away from the body, which orthopedists call abduction. We use this muscle when we walk to stand straight and keep us from not limping while we walk. Gluteus medius tears occur when the muscle is torn from the greater trochanter.
Gluteus medius tears are overuse injuries that usually result from a series of small tears that accumulate over time from repetitive motions. The resulting injury can be a partial tear from the greater trochanter or more extensive damage to the surrounding tissues.
Gluteus medius tendon tears are classified based on % of tear or clock position or area of trochanter exposed or severity of tear.
Grade 1 gluteus medius tear 1 – Mild tear: Based on percentage of tendon torn, in grade 1, 0-25% of the tendon is torn which will cause pain and inflammation.
Grade 2 gluteus medius tear – Moderate: The gluteus medius tedon is torn 26-50%. Causes pain, inflammation and weakness of abduction.
Grade 3 gluteus medius tear – Severe: About 51-99% of tendon is torn causing pain, inflammation and weakness of abduction.
Grade 4 gluteus medius tear – Severe: These are full thickness tears. Complete detachment of tendon from greater trochanter causing profound pain, inflammation and severe weakness of leg abduction and limping.
Overuse injuries are most common in athletes who repetitively put stress on certain joints and soft tissues. The gluteus medius is pulled during running, so a gluteus medius tear is a frequent injury for runners who suddenly intensify their routine rather than gradually increasing their workout to better stretch and prepare the muscle. This injury can also be the result of running on curvy or sloped surfaces because it will make your hip tilt abnormally and pull the gluteus medius beyond its normal range of motion.
Having unequal leg length or misaligned pelvis can have the same effect, since your hips are not aligned, pulling at one gluteus medius more than the other.
In less frequent cases, a gluteus medius tear can occur simply from aging. As we age our muscles lose flexibility and are more easily worn from everyday activities. Small tears can develop while sitting, walking, climbing stairs and any other task that involves the hip region, which can become problematic for elderly patients whose bodies are less able to repair themselves.
Your orthopedist will be able to diagnose a gluteus medius tear with a physical examination. By abducting the leg, your hip specialist will target the area of tenderness and weakness.
An MRI may be useful in determining the extent of tissue damage. It will reveal if your tendon is stretched or torn, which will require more intense healing and possibly surgery if your pain and weakness are severe enough.
Your hip doctor will advise you to rest only for a few days so in order to relieve inflammation and irritation, then physical therapy is crucial to healing properly. Other treatments can be used along with physical therapy for the most effective treatment.
Physical Therapy – Gluteus Medius tears require physical rehabilitation to first relieve symptoms and then begin healing and preventing future injury. Your physical therapist will begin your session by treating your hip with modalities like ice or ultrasound to calm inflammation. Your first therapy visits will involve manual and isometric stretching. It is important to stretch the irritated tissues to relieve stiffness and irritation and increase blood flow to the area to help heal tears. Your physical therapist will gradually introduce you to exercises to strengthen the muscle so it can better withstand activity.
Corticosteroid Injection – A corticosteroid injection will involve injecting an anti-inflammatory agent directly into your hip trochanteric bursa (which is on side of upper part of thigh bone) . This will provide you with pain relief over the course of a few months, which can make physical therapy easier and more effective.
Oral medication – Oral anti-inflammatories may be helpful in reducing pain for the first few weeks during your injury.
Surgical – If after about 3-6 months of conservative treatment your gluteus medius does not function well and causes pain, it may need to be surgically repaired. This usually only occurs for grade 2 to 4 gluteus medius tears when the tendon has been permanently lengthened or torn and cannot provide stability for your hip.
A gluteus medius tear can usually be corrected arthroscopically. Arthroscopic surgery involves two to three tiny incisions at the problem area. Your orthopedic surgeon can then insert a probe and small instrument into the incision to sew the tendon back in place, remove permanently damaged tissue, or make other repairs. The small incisions cause less trauma to your body, making recovery time much quicker with less risk of complication and scarring. This is an outpatient procedure.
For more severe ruptures to the tissue, an open surgery may be necessary. Your orthopedic surgeon will use anchors to stabilize the repaired tendon. This type of surgery requires more recovery time and more intense physical therapy to regain range of motion.
After your surgery you will need to use crutches or a stabilizing device that is strapped onto your hip to avoid stretching the healing tissues as you move. During the 6 months of restricted moving you will begin physical therapy to stretch the gluteus medius and help it heal properly.
Physical therapy is essential following surgery. Your physical therapist will manually stretch your leg to prevent scarred tissue buildup. This will keep the hip from becoming stiff and increase your range of motion. Strengthening will be necessary to support the healing hip and prevent injury to the weakened tendon in the future.