Abductor tendon problems are a common source of Greater Trochanteric Pain Syndrome (GTPS) that fails to respond to conservative treatment, often described erroneously as “recalcitrant trochanteric bursitis”. The gluteus medius is the more frequently involved of the two. These tendon problems range from tendinitis to partial or complete tendon tearing. Tears can occur from an acute injury, but often occur as an attritional process with age, especially over the age of 40. In fact, attritional tearing is sometimes seen coincidentally on imaging studies, such as MRI, where it is not even causing symptoms.
The Gluteus medius and Gluteus minimus reside along the outer side of the hip and abduct the leg (swing the leg out to the side). They are also critically important to stability of the hip and pelvis during ambulation.
Tendinitis (inflammation) or Teninosis (partial deterioration) within the tendon near its attachment to the Greater Trochanter of the Femur.
Tendinitis mostly responds to usual conservative measures, including activity modification, supervised physical therapy, nonsteroidal anti-inflammatory medication and, lastly, judicious use of a cortisone injection. Painful tendon tears may also respond to nonsurgical treatment, and there are other types of injectable products that can be tried, including platelet rich plasma (PRP) and stem cells. Sometimes, tendon healing can be jumpstarted with resolution of symptoms. For those that fail efforts at nonsurgical treatment, surgery to repair or reconstruct the tendon damage may be an option, with various endoscopic and open treatments available, depending on the magnitude of the damage.
Structural damage to the Gluteus is most conclusively determined by ultrasound examination.
The area of damage can be precisely injected with ultrasound guidance. Relief confirms that the damage is the source of pain; and can sometimes help resolve the problem.
Diagnosing problematic abductor tears can be tricky. Tendon problems are often seen on MRI and by ultrasonic inspection. In fact, ultrasound guided injections are a mainstay in confirming the diagnosis as well as a last line of conservative treatment. (Related Study: Perioperative Care) Assessing these problems requires a clinician knowledgeable and experienced in these and other hip disorders. The symptoms can overlap with other problems, and other joint problems may coexist with painful tendon lesions. Treatment often involves sorting out the various contributing components and prioritizing which needs the most specific attention.
Video deomnstrtes injection of a gluteal tear, which literally takes seconds.
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