Nonoperative Approach to Treatment of a Gluteus Medius Tear

Abstract

Case Diagnosis: We present two cases of atraumatic gluteus medius tear. Case Description: Patient 1 is a 58-year-old female with right gluteal and hip pain. On physical exam, there was focal tenderness in the right gluteal area with pain on external rotation of the right hip and an antalgic gait. Patient 2 is an 82-year-old male status-post left gluteus medius repair with subsequent revision. Since the surgery, the patient continued to have episodic left hip pain and suffered multiple falls. Physical exam demonstrated limited left hip abduction and tenderness of the iliopsoas muscle. Both patients exhibited a sedentary lifestyle and neither had fluoroquinolone or steroid exposure near the time of tear. Differential diagnoses included avascular necrosis of the femoral head, greater trochanteric bursitis, gluteal nerve injury, iliotibial band syndrome, paralabral cyst, and gluteus medius tear. For each patient, an MRI confirmed the diagnosis of gluteus medius tendon tear. Both were referred to physical therapy. Patient 1 experienced decreased pain and Patient 2 experienced decreased pain, increased strength and range of motion, and increased ambulation. Discussions: Chronic gluteus medius tears may be seen more frequently in those with decreased flexibility or strength. Neither patient had medication risk factors for muscle tear, but both endorsed a sedentary lifestyle. These tears can be treated successfully nonoperatively or with surgery. Nonoperative management includes pain control and physical therapy to target the hip rotators. Conservative treatment may provide up to 90% of patients with pain relief. However, few studies have evaluated the best exercises for the management of gluteus medius tears. Exercise can improve patient function without the risks associated with surgery. Conclusions: This case series suggests that atraumatic gluteus medius tendon tears may be effectively treated nonoperatively, especially for patients with a sedentary lifestyle. Further studies should be conducted to evaluate the role of nonoperative treatment.