Gluteus Medius Tears (Hip Adductor Tears)
What is a bursa?
A bursa is a fluid filled sac that cushions a friction point in the body. At the side of the hip in the upper thigh, there is a bony bump called the greater trochanter. Three structures come together at this point: the trochanteric bursa, the gluteus medius muscle and the IT band. The trochanteric bursa is a small, fluid-filled sac that pads the bone over the greater trochanter. Bursitis is inflammation of this bursa, which causes pain along the side of the hip. Bursitis can occur from direct pressure, after injury or with overuse. It is also linked to tears of the gluteus medius.
What Is a gluteus medius tear?
The gluteus medius is one of the primary muscles surrounding the hip. This muscle starts in the buttock and attaches at the greater trochanter, on the side of the hip. Contraction of this muscle allows us to lift our leg to the side (adduct).
Tendonitis or tears of this muscle can occur after injury or with long-term wear and tear. These tears generally cause pain and weakness on the side of the hip (not the groin). The iliotibial (IT) band is a stiff band of tissue. It runs along the outside (lateral part) of the leg from hip to knee. It extends over the prominence of the greater trochanter and can become tight in this area.
What are the symptoms of trochanteric bursitis and gluteus medius tears?
Bursitis causes pain and irritation on the outside of the hip. This is unlike pain from the hip joint, which generally occurs in the groin area or front of the hip. Most people with pain on the side of the hip simply have irritation of the bursa or iliotibial band. But, in severe cases, tendonitis or a tear of the gluteus muscle may be the problem. Tears in the gluteus muscle can cause pain at the side of the hip, too. This pain can extend to the buttock and result in weakness when lifting the leg to the side.
How are trochanteric bursitis and gluteus medius tears diagnosed?
Your orthopedic surgeon can often diagnose bursitis based on your symptoms and by examining your hip. In severe cases, an MRI may be helpful to check for a muscle or tendon tear.
How are trochanteric bursitis and gluteus medius tears treated?
Initial treatment involves ice, non-steroidal anti-inflammatory drugs (NSAIDs) and activity modification to decrease pain and inflammation. Physical therapy may be prescribed to stretch the IT band and strengthen the gluteus medius and other muscles around the hip. If a severe, full-thickness gluteus medius tear is present, surgical repair may be required.
Endoscopic Gluteus Medius Repair
An endoscopic gluteus medius repair is a “minimally-invasive” procedure involving three to four “poke-hole” incisions around the hip joint. A camera is introduced and the attachment site of the gluteus medius is visualized on a monitor. All “hip bursitis” tissue is removed initially. If a full-thickness or partial-thickness tear is present, it is repaired with bone anchors into the greater trochanter and suture passed through the ruptured tendon. The tendon is then pulled down to its normal anatomic position and tied over the bone.
Open Gluteus Medius Repair
In rare situations, if the tear is determined to be chronic and retracted significantly, an open procedure may be necessary to repair the gluteus medius tear. This would involve a several centimeter incision on the outside of your hip. The gluteus medius tendon is repaired with bone anchors into the great trochanter and suture is passed through the ruptured tendon. The tendon is then pulled down to its normal anatomic position and tied over the bone.
