Gluteus Medius / Gluteus Minimus Injuries

The gluteus medius tendon can be torn or ripped from the trochanter as the result of a traumatic injury, from repetitive forces exerted during athletics and other physical activities, or as a result of degeneration of the tendon in older patient populations where the tendon becomes weaker and repetitive “microtrauma” can cause tearing.

Overuse

Repetitive activities or sports that involve excessive hip and leg movement, such as running, cycling, or dancing, can put strain on the gluteus medius tendon, leading to injury over time.

Aging

Tendons naturally degenerate and become less flexible with age, making them more susceptible to injury. This is especially common in older adults.

Trauma

A sudden, forceful impact or injury to the hip or buttock area can damage the gluteus medius tendon. This can occur in accidents, falls, or sports-related collisions.

Poor Biomechanics

Improper body mechanics, such as poor running or walking form, can place excessive stress on the gluteus medius tendon, increasing the risk of injury.

Muscle Imbalances

Weakness or imbalances in the muscles around the hip and buttock area can alter the mechanics of the gluteus medius tendon and increase the likelihood of injury.

Inflammation

Conditions like tendinitis or bursitis in the hip can irritate and weaken the gluteus medius tendon, making it more prone to injury.

Repetitive Stress

Engaging in activities that involve frequent pivoting or lateral movements, such as certain sports or jobs, can strain the gluteus medius tendon. Additionally, repetitively running on an incline or decline can also add excess strain to the gluteus medius tendon.

Inadequate warm-up and stretching

Failing to properly warm up or stretch before engaging in physical activities can make the tendon more vulnerable to injury. Additionally, runners who rapidly increase their routine instead of gradually increasing activity often wind up overstraining the gluteus medius muscle or tendon.

Most patients with a gluteus medius tendon injury have a combination of sharp pains and persistent dull aches in and around the hip (usually on the outside, or lateral aspect, of the hip). Pain is worse when lying on the injured side, and weakness and tenderness often lead to limping. Symptoms also tend to become worse after a long period of standing, sitting, or walking. Gluteus medius tendon tears are classified by “grades,” with Grade 1 injuries including the mildest tears and Grade 4 comprising the most severe tears.

• Grade 1 Tear: patient experiences mild pain and little to no loss of mobility or strength.
• Grade 2 Tear: patient has a partial tear with mild pain and some loss of mobility and strength .
• Grade 3 Tear: patient has a complete tear of the gluteus medius tendon and complete loss of mobility and strength.
• Grade 4 Tear: patient has a complete tear of the gluteus medius tendon and retraction of the muscle, potentially leading to muscle atrophy. Complete loss of mobility and strength is also present.

Typically, symptoms become more significant as the grade of severity increases.

Pain

Pain in the outside, or lateral aspect, of the hip, is one of the hallmark symptoms. The pain may be sharp, aching, or throbbing and can range in intensity from mild to severe. It is often aggravated by activities that involve the affected muscle, such as walking, running, or climbing stairs.

Weakness

You may experience weakness or difficulty in using the hip and leg on the side of the injured gluteus medius tendon. This weakness can affect your balance, stability, and ability to perform activities that require hip strength. Weakness of the gluteus medius tendon may also lead to a limp when walking, known as a Trendelenburg gait.

Tenderness

The area over the gluteus medius tendon may be tender to the touch. This tenderness is often localized to the outer part of the hip and buttock.

Swelling

In some cases, there may be mild swelling or inflammation around the hip or buttock area.

Pain at Night

Some individuals with gluteus medius tendon injuries may experience pain or discomfort at night, especially when lying on the affected side.

During your consultation with Dr. Jorge Chahla, a Chicago sports medicine surgeon and hip specialist, your medical history, gluteus medius tendon symptoms, and past injuries will be reviewed.

Physical Exam

He will conduct a physical examination checking range of motion, gluteus medius strength, and palpation of the painful hip region. Palpation may include Dr. Chahla or a member of his team gently pressing on the affected area to check for tenderness, swelling, or warmth. This can help identify the specific location of pain and rule out other possible causes. A comprehensive physical exam is key to determine the cause of your hip pain.

Imaging

In some cases, imaging studies may be ordered to confirm the diagnosis of a gluteus medius tendon injury and rule out other conditions that could be causing the lateral hip pain. X-rays are often the first imaging test done to rule out issues such as fractures or degenerative joint diseases. While they may not directly show gluteus medius tendon injuries, they can help rule out other causes of hip pain. Ultrasound imaging can provide real-time images of soft tissues like the trochanteric bursa and gluteus medius tendon, and can help identify signs of hip inflammation or tearing of the gluteus medius tendon. An MRI may be recommended to gain detailed images of the hip area, including the bursa, gluteal tendons, hip labrum, and muscles.