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 attaches to the outer side of the greater trochanter on the femur. The muscle controls side-to-side movement of the hip and stabilizes hip movement. The most common hip abductor tear is the gluteus medius tendon. It is also referred to as rotator cuff tear of the hip.
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.
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 sign – dropping of the pelvis towards the unaffected side by being unable to bear weight on the affected limb.
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 sign confirm the diagnosis of gluteus medius tear. Sometimes, MRI or ultrasound may be helpful to show the pathological changes of the muscle.
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 which involves:
- 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
- Dr. Faucett 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.
Untreated cases of gluteus medius tear may result in gait disturbance and disability. This is called a Trendelenburg gait and causes the patient to lean their body over the hip since the muscle cannot stabilize the hip.
Hip Adductor Tendon Tear
The Hip Adductors are made up of the adductor longus, adductor brevis, and adductor magnus. These muscles make up the inner thigh muscles and functions to bring the leg back into the midline. These muscles are critical to stabilize the hip when we walk run or do any sporting activity.
The most common cause is a traumatic tear. This is often due to a fall or pulling on the leg. It can occur when the leg goes into an unexpected split. Adductor tendon can cause partial tearing when it is overused.
The most common symptom is groin pain that originates in the pubic bone. This is where the longus and magnus attach to the pelvis. This is commonly associated with core injury (link out).
- Dr. Faucett will palpate the tendons and areas around the groin to see if there are areas of tenderness.
- He will also move the hip around to see if he can recreate any of the pain.
- Frequently in an acute injury there is a fair amount of bruising discoloration in the affected area.
- Xrays: Xrays are helpful to rule out any other causes of the pain and rule out a bony injury. Sometimes the tendon can rip the bone rather than just the tendon.
- MRI: A MRI will be able to locate the area and severity of the injury.
- Ultrasound: An ultrasound can be used to look at the soft tissues and diagnose injury.
The goal of treatment is to restore the function of the adductor and lessen pain in the injured area.
In strains and minor tears, Dr. Faucett often recommends treatment with physical therapy.
- Dry Needling
- Strength training.
Non-steroidal Anti-Inflammatory medication (NSAIDS) are helpful medications to limit pain
In more severe cases or mild/moderate cases that have not healed, Dr. Faucett will recommend surgery.
The goal of surgery is to relieve the pain and restore function.
For large acute tears with retraction (pulled away) the tendon will be sewn back to bone. For tears where the bone is not injured the tendon can undergo a combination of muscle lengthening and release and or repair of the tendon back to bone.
Hamstring Tendon Tears
Quadriceps Tendon Tear
The quadriceps tendon more commonly tears at the knee but sometimes can tear off at the hip.
Typically, these types of tendon injuries are rare. They most often occur because of trauma. Sometimes they can be caused by a weakening of a tendon most commonly from the use of a particular antibiotic called fluorquinolones (ciprofloxacin, levofloxacin, etc.).
- Inability to stand or walk
Dr. Faucett will perform a physical exam to evaluate for bruising. He will examine you if you have weakness and palpate the area to examine if there is a gap.
- X rays are usually ordered to evaluate if you may have torn off part of the bone it is attached called an avulsion.
- MRI: An MRI is often ordered to examine the soft tissues and determine if and how much of a gap has occurred due to retraction of the tendon. It can also identify associated injuries.
- Partial Tears: For partial tears, non -surgical treatment is very effective. Rest and using crutches will allow the tendon to heal itself. Physical therapy will help maintain range of motion and when enough healing has occurred will work to regain strength in the muscle.
- Full Thickness: For full thickness tears and unhealed partial tears, surgery is usually necessary to reattach the tendon. Physical therapy will also be required afterward to build the strength back in the muscle.
- Lifting heavy weights
- Taking fluoroquinolones can weaken the tendon
- Patients do very well after they have healed and recovered from these types of injuries.