Gluteus Medius Tendon Tear - Everything You Need To Know - Dr. Nabil Ebraheim
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- čas přidán 30. 07. 2019
- Dr. Ebraheim’s educational animated video describes gluteus medius tendon tear - abductor muscle tears.
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The gluteus medius tendon tear is recognized more as a cause of hip pain and if this tear causes disability to the patient, then the treatment is repair of the tear. However, if the repair is not possible because the patient has advanced muscle atrophy or there is a big gap between the tendon and its insertion, then we will do transfer of the gluteus maximus muscle to the greater trochanter. The pathology of the hip abductor is common. It is grouped under the greater trochanter pain or bursitis and there is a spectrum between bursitis and tendonitis, tendinosis, to a partial tear, to a complete tear, to a massive chronic neglected tear. These tears happen more with hip arthritis and it is clinically silent. It is part of the greater trochanter pain syndrome, where the patient will have chronic lateral hip pain and tenderness over the greater trochanter and the pain can mimic other serious causes of hip pain, including stress fracture, AVN, arthritis, and piriformis syndrome. The lateral hip pain may not be limited to the greater trochanter. It may extend into the buttock or even to the lower back, and this may complicate the clinical picture more. The role of hip abductor tendon tear as a cause of hip pain is underestimated. Usually the condition is dismissed as trochanteric bursitis. When an elderly patient complains about trochanteric bursitis, especially if it is chronic and not getting better with treatment, careful examination is necessary and imaging may be necessary. So the patient will come with symptoms of lateral or posterior hip pain with tenderness over the greater trochanter. The patient will have a limp and will have weakness of abduction and Trendelenburg Gait. The symptoms and exam may be nonspecific or may even be confusing. The strength may be 4/5 or even 5/5. The patient may present many months or years after the onset of the symptoms. The condition may be totally occult. MRI may be necessary to diagnose the tear. MRI may show partial tear to tendonitis or tendinosis or even retraction of the tear with atrophy of the muscle, which may need soft tissue release for repairing the tendon. The MRI may show significant muscle atrophy and the patient may need gluteus maximus transfer. If an elderly patient has a hip replacement and continues to complain of symptoms of greater trochanteric pain and walks with a limp, consider in the differencial diagnsosis a gluteus medius tendon tear. An MRI can really be helpful, even in the presence of prosthesis in the hip. Before we talk about the treatment of the tear, we need to talk about what is the role of the gluteus medius and gluteus minimus muscles. The gluteus medius and minimus muscles are important in stabilizing the ipsilateral hip in the stance phase of the gait cycle. The weakened gluteus medius allows the opposite side of the pelvis to tilt downwards during stance on the weakened side. The other side of the pelvis tips down. The trunk leans towards the weakened side, which is called abductor lurch during the stance phase. This occurs because the trunk is basically trying to help the weak side of the pelvis (giving the muscle assistance). This really helps the weak side by moving the center of gravity near the fulcrum on the weak side. This shortens the moment arm from the center of gravity to the hip joint and this will reduce the force and the effort. TREATMENT OF GLUTEUS MEDIUS & MINIMUS TEARS We need to understand the area of insertion of the tendons on the greater trochanter. The greater trochanter has four facets: Gluteus Minimus - Inserts into the anterior facet. Gluteus Medius - Inserts into the lateral and superoposterior facets. Gluteus Maximus - Inserts into the posterior facet. Another important area of interest: Early Repair is Better! The tendon goes into a progressive phase of deterioration from tendinosis to partial tear, degeneration to complete tear, retraction, fatty infiltration, and atrophy. You need to think about the condition and treat it before it reaches that chronic, advanced stage. Nonoperative treatment of the hip abductor like tendinosis,tendonitis, or bursitis is successful in the majority of patients. Surgical repair for partial or complete hip abductor tendon tears is also successful in relieving the pain and improving the function of the patient. Not all tears are repairable, even with soft tissue release. A complete tear plus muscle atrophy and fatty degeneration represents a bad prognosis and a difficult, complex situation for the patient. When the tear cannot be repaired or the cause of the muscle atrophy is superior gluteal nerve injury, then a muscle transfer is necessary.
Awesome video Dr. I really appreciate this information!
Thank you
I just had an MRI and quoting the MRI, I have a “low grade partial thickness tear is seen in the right gluteus medius tendon and mild insert tendon is present in the right gluteus minimum tendon” and if not for your excellent explanation, I would have no idea what the MRI described. This was an excellent presentation to understand. I have seen Orthopedics and no doctor for months has been able to diagnose . Because of my age they all say the pain is due to severe arthritis. How wrong they are. Maybe you should send your video to orthopedics or tell them to watch it on CZcams.Thank you so much. This was very very instructive and eye-opener.
Thank you! I have been suffering for months with torn tendons but none of my physicians seem to have watched this video! At least I understand my situation now. I am so grateful! I may need to come to Toledo!
Extremely helpful, clear and concise with wonderful visuals. Thank you.
Thank you Dr Ebraheim. You always give excellent articles that are very easy to understand!
Clear concise explanation with great visuals. Thank you
Excellent! My Gluteus Medius Tendon tear was after the hip replacement and overlooked for many months and was repaired four days ago and I am 300% better! I am a retired instructor/teacher and can tell you that you are as good as one could hope to find. The very best of luck!!
what symptoms did you have if i may ask ? i know that is what i have . if feel like my whole leg is affected
How many months after did they repair?
@@deenastewart4204 hey there, I'm not the one you posed the Question too but I have been having terrible versitis versitis and tendon apathy I see in that area going on 3 or 4 months now I had an mri that showed 10 and a 1/2 a tenant opathy moderate tropicanter versitis and labor's hair I saw an orthopedas who said that this can be a life long issue but I'm going to try to find someone who's especially good at this to help strengthen. I have not had any injections yet I'm trying to avoid that Have you had any imaging done? I have gone from Playing tennis, golf,yoga To limping and and not being able to sleep on either side at night very hopeless feeling and disabling I hope you are Finding some answers. This doctor seems to know his stuff
Hi Joseph, it’s been 3 years since my hip replacement and I’m still in agonizing pain due to my butt pain, have done 2 MRI and technicians say that because of the prosthesis they can’t see that area…. Does that even make sense?? I really don’t know what to do or what to look for
I partialy tear gluteus medius after THR and now is 3,5 months past and still I am not recovered. I am geting Crazy.
Thank you Doctor~ These lectures are very helpful to me.
concise. informative as usual!👍
Sue Wolfe- Thank you for the video. It helps me to understand what is going on inside! I had a hip replacement, which was needed in March, but the surgeon didn't inform me he didn't repair the tendons and ligaments. I still walk with a trendelenburg gait and need additional surgery to repair the gluteus minimus, medius and other areas. This was so helpful to see where they're located and the different levels of damage. Thank you!
Great video! Now I am up to date again!
Extremely helpful! Thank you, Dr.
Thanks again professor!! Note: you could add “muito obrigado” at the end of presentations! We Learn a lot from you here in Brazil - Greetings!
🇧🇷
First good explanation I’ve seen! Thank you!
Thank you. I am 7.5 weeks post-op left side open, full thickness gluteus medius tendon tear with severe retraction, fatty infiltration, and atrophy with donor alograft. I am doing well; however, now I am having greater trochanter pain and IT band sensitivity on the opposite side. From late 2011 to 2016, I experienced horrible greater trochanter bursitis and received many injections bilaterally. In 2016, I was dx with FAI bilaterally - a bit worse on right. I had surgical repair for right in Nov 2016 and for left in Mar 2017. It was a miracle fix ...... 50 years of pain was gone.
Until spring 2023 when left side greater trochanter pain returned. My spinal docs thought it was from my spine at first. In Nov I had an MRI which showed full thickness tear and retraction. Surgery was 7.5 weeks ago. Right side JUST started hurting yesterday. I will inform my surgeon this week.
What do you think might be going on?
Female, age 60, 140 lbs, 5' 4.5". VERY ACTIVE and physically fit normally.
Thank you.
Thank you. That really helped to answer my questions.
Thank you. It is very helpful.
thanks doc very helpful lecture understanding gluteus medius
This fits from a childhood injury. The pulled up hip, walking and my leg would flop with my foot turned in. I thought my one leg was shorter then the other too.
I’ll see if I can find a doctor to perhaps fix it. I’m 58 now tho so the G Maximus attached to the hip bone is probably the surgery now.
Thank you for making your video ❤️🎉❤️
Thank you very much Dr. I am very grateful on my and my patient's behalf. Kind regards
Great video. Prolo and prp would be a great option to treat condition.
Thank you so much, the video is really helpful
I appreciate the video 👍🏼
Extremely helpful. Thank you
Excellent
You are the best thank you sir
Thanks Doctor great video
Спасибо большое! Детально изложено, как мне и надо🙏
Very helpful.
Well Done
Thanks!
Thank you, very helpful. This hurts!
Incredibly helpful! Does anyone know of this surgery for advanced situations is done?
Excellent video, thank you! This seems to be an under diagnosed injury, especially in patients who’ve dealt with chronic IT band syndrome, and have had many steroid injections for hip bursitis. That would be me 😔
Me too
I believe yu just diagnosed my issue!
I’ve had 2 MRI’S. One for my lower back that showed nothing and one on my pelvis which shows bursitis on my medius and Maximus on my left and right side. I’ve been in pain for over 6 months and the orthopedic Dr. wants me to go to a spine Dr. it’s been so frustrating.
Thankyou very helpful and interesting. I'm 58, healthy, slim, had a fracture of greater trochanter fixed with dynamic hip screw 8 weeks ago. All was going well, discharged from hospital after 72 hours, but within 48 hours my whole leg, knee, foot swelled up I returned to hospital, more x rays showed new avulsion fracture of greater trochanter. Was advised to minimize weight bearing on right foot, delay physiotherapy and return for more x rays in 5 weeks. Those showed first fracture doing well, but second unchanged. They advise me that it may heal itself in time, but also that there's the chance it may not. My knee and calf is still incredibly stiff, inflexible, they said I should normally be able to bend it more at this stage and my foot sometimes still throbs. Looking at the x ray it's in the region of these gluteus muscles. I have more x rays again in 5 weeks, in the meantime they've arranged to start physiotherapy in 10 days and say I can now weight bear on right foot as much as is comfortable. In your experience what is the likelihood of this fracture resolving itself or is surgical intervention probably going to be needed?
Thank you so much for explaining this. I just need to know which specialist I should go see. Some minutes I can walk pain free 5 minutes later I can not walk without chronic pain. Thank you for sharing.
John Haywood that is so true. Makes you think your condition is getting better and then an hour later you can hardly walk
I started with a sports med doc who took ultrasound, then moved from there to a sports medicine surgeon Everett Bone and Joint in WA state, who took an MRI then performed the surgery. I'm 6wks post-op
@@sharpjennifer1 did your ultrasound indicate or show any tears / inflammation ? I'm thinking I may have this but my ultrasound showed up completely normal and stumped my physiotherapist
@@GhettoMountainsJr did it improve?
@@sharpjennifer1 did you have a tear?
Which doctor should I go?
Thanks for the video, very informative..
I'm scheduled for this repair 1/17/20, just wondering what to expect on recovery..
how did it go?
How did your surgery & recovery go?
Where your attendance detached and fatty atrophy?
Mine is sore at the top of the gluteus medius along the edge of the hip bone
I was told I have bursitis, tendinitis and a tare of the abductor. Pain is awful shots do not help. Can I get surgery
Can sewing machine cause this tear ?? I have sciatica symptoms after getting tetanus injection and I was also using manual sewing machine which requires leg movements. My outer thigh from hip joint is very hard and inflamed I can walk but I have been taking medicines the stiffness and pain did not improve from the outer thigh and hip joint. I have pain in my whole leg there’s a nerve compression as I had numbness too. The mri of lumbar spine showed disc bulge But I really feel something is wrong in my hip and thigh. It’s been almost three months now. The doctors are only focusing on spine.
what muscle transfer here mean? surgery??
Thank you
👍 Great
Obrigada (from Brasil..) = thank you very much!
What about the treatment how to?
My left side gluteus hurt so much from lifting and squatting
When I sit or I stand you could feel stingy must be sciatica?
I have the same thing with my left side gluteus when I squat or deadlift, did you fix the problem? And if you did can you inform me with the treatment you did, thank you
@@fasooolkf8724 same thing bro but right glute you ever find out?
@@Discipleofthelordandjesus I found some stretches that made it a little bit better, text me on instagram Fasoolkf
Don’t forget about Ankylosing Spondylitis being able cause this type of injury. Its the only thing I can think of that could have caused it in my case. I had no indication it happened and very minimal extra pain from the injury. It was a full thickness tear of the Gluteus Medius. It felt no worse than the chronic Trochanter Bursitis or other itises I live with.
Hi doc.. what is best thing to cure the mild tendinopathy of the gluteus minimus tendon?! Or is there a vitamin to prevent??
Pertanyaan serupa dengan saya
Apakah dengan therapy bisa memperbaiki sakit saya ini ?
What type of MRI do you ask for?
You seem to only address elderly, I’m 50 & due 2 shoveling I squatted& deadlifted repeatedly. I think that caused the strain. I use wet heat but 3 weeks later it is very painful.
I alter between ice & wet heat. Any recommendations?
Could you explain the difference between the size and thickness of tears and when surgical repair is needed? In most of the articles I have read about glute tears they say if conservative measures help then you may not require surgery? Thanks for your response!
I had a follow up MRI after an injection for what we thought was bursitis, that showed a high grade partial to complete tear of the gluteus minimus as well as a high grade partial thickness tearing of the anteror fibers of the gluteus medius tendon. Partial tear ot the conjoint tendon . I am sure this happened as I was going overboard with my PIYO workouts but with conservative measures: no weight bearing exercises for months but isometrics, clam shells, basically starting over to regain my strength and I am so much better than I was in March when I could hardly walk and was having to lift my right leg into the car on the drivers side due to pain and weakness so I assume I should just continue with this plan? Thanks for your help with this.
oh thank you doc! wish you were near me... i have major spine decompression. cut from bra to s1... was going great.. then downhill and no one figured it out. went from orthopedic to spine and brain and she says, maybe spine again, but nope i don't think so she said. and all of my pelvis area layer after layer of all those MRI's show inflammation going off the charts.. she thinks the pelvis area or around there is the real issue. no nerve pain just pain of very hard pressure when trying to stand. now i see where she is going with this all. yep. finally after a hard YEAR of struggling, unable to stand hardly. and all the bursitis shots i have had from them going crazy too! (those do help lol) not one said, one, let's check your butt and pelvis hip areas. wow... hopefully now with this new surgeon, she can figure this all out. i am in a wheelchair half the time got so bad, and yet trying not to use it. hard when you can not stand for more than 2-4 minutes. Or might be other gluteus muscles or other within these areas. At least now on right track.
Hi. So sorry to hear your story. Was it your gluteus Tendons? Were you able to get them repaired?
Hi. So sorry to hear your story. Was it your gluteus Tendons? Were you able to get them repaired?
time passed. lots of pain. I begged for lower MRI and nope would not do it all throught virus situation i hurt. Said it was just more arthritis in pelvis. NOPE! turned out i had would had not only such, but had 5 large cancer tumors... advance stage cancer 4TN3... they should have done whole pelvis MRI to begin with. now i fight for life... DONT let them keep you in SHOTS and you still have such issues and not get a whole Image of where it hurts vs guessing! yea, my left gluteus muscles are gone full of a rolled up muscle now like a tootsie roll and they cant not remove it. I was told to only do chemo last cause of other health issues. other 4 wrapped around colon up into descending colon by time I finally got my MRI lower request... thanks for asking and caring of others. :)
This provides great understanding. If there is a mild tear in the gluteus medium, is it possible for it to heal on its own?
Nope
Are u alright now , what did u do ? I guess I teared my glutes tendon at gym and m in pain from past 30 days and now I am felling pain in by back too
@@revantshukla1442 I saw an osteopath who helped to loosen the muscle tightness and realign my lower body since the right leg was over compensating. he taught me some exercises to restrengthen the muscles. My left hip flexor is really tight. I use a roller and also worked on elasticity and flexibility. I was doing well. Hip dips are also good but I did need to back off on intense cardio. Just walking on treadmill, no running and mostly cycling. Yoga helped too.
Have you healed yet or had any surgery?@@revantshukla1442
How do I seek help for this since it is "clinically silent"?
Did you ever find a physician to help you? Clinically silent it is absolutely the best description. I have torn detached Fatty atrophy medius and minimus tendons in my hip.
Thx heria look at what u done 2 me!
Just received MRI results which report “severe tendinopathy… and partial tear of 1.7cm x 1.0 cm” on right and mild- medium tendinopathy on right … as well as bursitis in both.
Question -is that tear a size that should be operated on? Do you consider that small, medium or large tear?
How are u now ? And what is the best advice to heal faster ? Thank you
I fell down a flight of stairs and landed on my glutes. My left glute is atrophied and I fall to the left when sitting. My hips are so tight I can't even put on shoes or socks. My left foot faces inward when I walk....does this sound like a tear??
To put on my socks I sit on my knees bum on feet and use both hands behind me on either side to place sock on from.behind my.back. for shoe I have to go on a squat on balls.of feet but still major difficult
Amazing and insightful to understand whats going on in my butt!
This is me I need an mri. Iv been told I have sciatica and everything bloody thing else I’m just about done
I'm having this done March 19 the.
I know it hurts. I just got my mri report about 5 minutes ago. I follow up with my ortho on tuesday. Wish us both luck.
Does it makes ur legs uneven ?
What kind of MRI to diagnose this.
How has your recovery been? Did your opposite side have some greater trochanteric pain while you were healing?
what type of doctor does one need to visit when you have this problem?
physiothérapie
Thank you so much for such a detailed and clear explanation. Where r u practicing? I am in south Jersey and need Orthopaedic surgeon. I have exactly the same condition that u explained. What luck! Startedwith sudden and then sustained onset pain of left hip radiating to front upper thigh and upper lateral part below. Have been a walker and did do glut exercises besides. bending down a lot to mop and push heavy grocery cart. Duration 4 - 6 months. Pain level now with no walking n little work is 4 n before was 6- 7. MR I shows partial tear of left glute medius n minimus n with greater trochanteric Insertional tendinitis with some fluid in bursa n similar but less pronounced situation on the right side as well. Please tell me where I can come to see you. You sem very academic n knowledgeable along with great deal l of experience. Thank you so much Surgeon!
Tendinosis. Not tendinitis auto correction made a mistake.
s
When the tendon tear
going to the Electro Acupuncture, right?
Can U answer me, please?
When the tendon tear is rupture
going to the Electro Acupuncture, Right?
No. Stick to Medicine not Woo.
i habe this i will have Mri now 1 year in pain
Sir please translate in hindi
I’m a dancer and when I went into the splits heard my muscle rip and the rest of the night it hurt. The next month it really hurt but it started to get better; today I went on a bike ride and now it hurts sooo much
Man same here I was stretching and I heard a pop and now around my buttocks it hurts when I use that muscle how are u doing now
@@dudedude9528 me too I went into my splits and heard pops it’s been about 7 weeks for me how long did it take you to recover
@@samanthaantopia1975 6months I’m good now
Early repair wont happen with Tricare. They will want conservative measures first, anti inflammatory, injections and PT for a certain amount of time. I get PT can help strengthen muscles, but if you have a tear in a tendon and or muscles can't PT make it worse. And if there is a tear can't injection do more harm than good?
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