– Hip abduction
– Pelvic stabilization during single-leg stance
– Internal rotation of the hip (anterior fibers)
– External rotation of the hip (posterior fibers)
The gluteus medius plays a critical role in gait mechanics and athletic performance, particularly in activities involving lateral movement and single-leg stability.
Pathophysiology: Gluteus medius tears can be classified into two main categories:
1. Traumatic tears:
– Often result from acute injuries or falls
– More common in contact sports or high-impact activities
2. Degenerative tears:
– Develop over time due to repetitive microtrauma
– Associated with age-related changes and chronic overuse
Tears can be further categorized based on their location and severity:
– Partial-thickness tears
– Full-thickness tears
– Avulsion injuries from the greater trochanter
Risk Factors: Several factors can increase the likelihood of gluteus medius tears:
– Age (more common in individuals over 40)
– Female gender – Repetitive hip abduction activities
– Participation in sports with frequent cutting and pivoting movements
– Biomechanical abnormalities (e.g., leg length discrepancy, pelvic obliquity)
– Previous hip or lower extremity injuries
– Weakness in hip abductor muscles
Clinical Presentation: Patients with gluteus medius tears typically present with:
– Lateral hip pain, often described as deep and aching
– Pain exacerbated by weight-bearing activities, especially single-leg stance
– Difficulty with stairs, particularly descending
– Trendelenburg gait pattern
– Weakness in hip abduction
– Tenderness over the greater trochanter
– Pain with resisted hip abduction
In chronic cases, patients may report a gradual onset of symptoms and a history of progressive functional decline.
Diagnosis: Accurate diagnosis of gluteus medius tears involves a comprehensive approach:
1. Clinical examination:
– Gait analysis
– Trendelenburg test
– Single-leg squat assessment
– Strength testing of hip abductors
– Palpation of the greater trochanter and surrounding area
2. Imaging studies:
– X-rays: To rule out bony abnormalities or calcific tendinopathy
– MRI: Gold standard for diagnosis, providing detailed soft tissue visualization
– Ultrasound: Useful for dynamic assessment and guided injections
3. Diagnostic injections:
– Local anesthetic injections can help differentiate gluteus medius pathology from intra-articular hip disorders
Differential Diagnosis: It’s important to consider other conditions that may mimic gluteus medius tears:
– Greater trochanteric pain syndrome
– Iliopsoas tendinopathy
– Lumbar radiculopathy
– Osteoarthritis of the hip
– Stress fractures of the proximal femur or pelvis
– Snapping hip syndrome
Conservative Management:
1. Rest and activity modification
2. Physical therapy:
– Strengthening exercises for hip abductors and core muscles
– Gait training and balance exercises
– Manual therapy techniques
3. Non-steroidal anti-inflammatory drugs (NSAIDs)
4. Corticosteroid injections (used judiciously due to potential tendon weakening)
5. Platelet-rich plasma (PRP) injections (emerging treatment option)
Surgical Management: Indicated for full-thickness tears or when conservative management fails:
1. Open repair:
– Traditional approach with direct visualization of the tear
– Typically used for large or complex tears
2. Endoscopic repair:
– Minimally invasive technique
– Faster recovery and less postoperative pain
– Suitable for partial-thickness and some full-thickness tears
3. Tendon transfers:
– Used in cases of severe degeneration or chronic retraction
Postoperative Rehabilitation: Rehabilitation following gluteus medius repair is crucial for optimal outcomes:
Phase 1 (0-6 weeks):
– Protection of the repair
– Partial weight-bearing with crutches or walker
– Passive range of motion exercises
– Isometric exercises for surrounding musculature
Phase 2 (6-12 weeks):
– Progressive weight-bearing
– Active range of motion exercises
– Initiation of strengthening exercises
– Gait training
Phase 3 (12+ weeks):
– Advanced strengthening exercises
– Functional training
– Sport-specific drills
– Return to sport protocols
Return to Sport: The timeline for return to sport varies depending on the severity of the injury and the specific demands of the athlete’s sport. General guidelines include:
– Full pain-free range of motion
– Restoration of at least 90% strength compared to the unaffected side
– Successful completion of sport-specific functional tests
– Typically, 4-6 months for most athletes, but may be longer for high-level or overhead athletes
Prevention Strategies: Implementing preventive measures can help reduce the risk of gluteus medius tears:
1. Proper warm-up and cool-down routines
2. Regular strengthening exercises for hip abductors and core muscles
3. Addressing biomechanical abnormalities through gait analysis and orthotic interventions
4. Gradual progression of training intensity and volume
5. Adequate rest and recovery between training sessions
6. Proper technique in sport-specific movements
