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Hip Abductor Tears

What is a Hip Abductor Tear?

Hip abductors are a major group of muscles found in the buttocks. It includes the gluteus maximus, gluteus medius, gluteus minimus, and tensor fascia lata muscles.

The Gluteus medius arises at the top of the pelvic bone and runs to attach on the outer side of the thighbone or femur. The muscle controls side-to-side movement of the hip and stabilizes hip movement.

Gluteus medius tear is a condition characterized by severe strain of the gluteus medius muscle that results in partial or complete rupture of the muscle. It is also referred to as rotator cuff tear of the hip.

Causes of Hip Abductor Tears

The tear or rupture of the gluteus medius muscle is commonly seen in runners and athletes involved in high-impact sports such as soccer or basketball due to sudden bursts of activity or poor flexibility of the gluteus muscle. Any traumatic or overuse injury, or degenerative changes may lead to partial or complete tear of the gluteus muscle.

Symptoms of Hip Abductor Tears

The symptoms include pain and tenderness over the lateral aspect of the hip which may aggravate with activities such as running, climbing stairs, prolonged sitting or walking, and lying on the affected side of the hip. One of the main symptoms of gluteus medius tear is the presence of Trendelenburg’s sign - dropping of the pelvis towards the unaffected side by being unable to bear weight on the affected limb.

Diagnosis of Hip Abductor Tears

The diagnosis of gluteus medius tear is based on physical examination of the patient, followed by palpation of the affected muscle, testing muscle power and assessing walking pattern or gait of the patient. Certain special tests such as single-leg squat test or a positive Trendelenburg’s sign confirm the diagnosis of gluteus medius tear. Sometimes, MRI or ultrasound may be helpful to show the pathological changes of the muscle.

Untreated Hip Abductor Tears

Untreated cases of gluteus medius tear may result in gait disturbance and disability.

Treatments for Hip Abductor Tears

The aim of treatment is to restore the normal function of the gluteus medius tendon.

  • Immediately following the rupture of the tendon, RICE therapy is advised as follows:
    • Rest your hip by refraining from activities until it is healed.
    • Apply ice to your hip to reduce pain and inflammation caused by injury.
    • Compression with an ACE bandage helps to reduce tenderness and swelling.
    • Elevation involves keeping the affected hip raised above your heart to minimize swelling.
  • Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or steroid injections may be given to reduce the pain and inflammation.
  • Assistive devices such as a cane or crutch may be used temporarily to facilitate pain free ambulation.
  • Your surgeon may recommend physical therapy to strengthen the muscles and increase stability of the hip.
  • Surgical treatment may be recommended to repair a complete, full-thickness gluteus medius tear. The rupture can be repaired arthroscopically to help restore the strength and function of the gluteus medius.

Surgical Treatment

Surgery may involve open surgery or endoscopic surgery. Open surgery has a higher rate of surgical complications and chances of re-tear, but certain tears require open surgery. Endoscopic surgery is minimally invasive and may be associated with a faster recovery. Your surgeon will discuss the ideal technique for you.

The procedure of Endoscopic Surgery

Endoscopic surgery involves the following steps:

  • General or regional anesthesia is administered.
  • A few small incisions are made over the hip and three portals are created to access the gluteus tendons.
  • An arthroscope consisting of a tiny camera is inserted through one of the portals to view the torn tendon.
  • Instruments are passed through the other portals to carry out the procedure.
  • Your surgeon uses a device known as a suture anchor to repair your torn tendons or fix them back to the bone.
  • For severely damaged tendons, a reconstruction may be performed using a gluteus muscle flap or a donated Achilles tendon graft.

Recovery After Gluteus Tendon Repair

  • Your surgeon suggests the use of crutches for 8 weeks to decrease stress on the repaired tendon
  • Physical therapy is necessary and is initiated the day following surgery
  • You will need to follow certain precautions to avoid a re-tear
  • Complete healing may take up to 4 months