Gluteus Medius Tendon Tear, diagnosis and treatment. скачать в хорошем качестве

Gluteus Medius Tendon Tear, diagnosis and treatment.

Join this channel to support the channel    / @nabilebraheim   Gluteus medius tendon tear. The gluteus medius tendon tear is recognized more as a cause of hip pain, and if that tear causes disability to the patient, then the treatment is repair of the tear. However, if the repair is not possible because the patient has advanced muscle atrophy, or there is a big gap between the tendon and its insertion, then we will do transfer of the gluteus maximus muscle to the greater trochanter. The pathology of hip abductor is common, and it is grouped under the greater trochanter pain or bursitis. And there is a spectrum between bursitis and tendinitis, tendinosis, to a partial tear, to a complete tear, to a massive chronic neglected tear. These tears happen more with hip arthritis, and it is clinically silent, and it is part of the greater trochanter pain syndrome, where the patient will have chronic lateral hip pain and tenderness over the greater trochanter, and the pain can mimic other serious causes of hip pain, including stress fracture, AVN, arthritis and piriformis syndrome. The lateral hip pain may not be limited to the greater trochanter. It may extend into the buttock or even to the lower back, and this may complicate the clinical picture more. The role of hip abductor tendon tear as a cause of hip pain is underestimated, and usually the condition is dismissed as trochanteric bursitis. When an elderly patient complains about trochanteric bursitis, especially if it is chronic and not getting better with treatment, careful exam is necessary and probably imaging is also necessary. So, the patient will come with symptoms of lateral or posterior hip pain with tenderness over the greater trochanter. Patient will have a limp and will have weakness of abduction and Trendelenburg gait. The symptoms and exam may be nonspecific, or it may be even confusing. The strength may be four over five, or even five over five, and the patient may present many months or years after the onset of the symptoms. The condition may be totally occult. MRI may be necessary to diagnose the tear. The MRI may show partial tear to tendinitis or tendinosis, or even retraction of the tear with atrophy of the muscle, which may need soft tissue release for repairing the tendon. The MRI may show significant muscle atrophy and the patient may need gluteus maximus transfer. If an elderly patient has hip replacement and continue to complain of symptoms of greater trochanteric pain and walks with a limp, consider in the differential diagnosis a gluteus medius tendon tear. And the MRI really can be helpful, even in the presence of prosthesis in the hip. Before we talk about the treatment of the tear, we need to talk about what is the role of the gluteus medius and minimus muscle. The gluteus medius and minimus muscle are important in stabilizing the ipsilateral hip in the stance phase of the gait cycle. A weakened medius allows the opposite side of the pelvis to tilt downwards during the stance on the weakened side. It's like the pelvis want to run away. The other side pelvis tips down. The trunk leans towards the weak side. That's called abductor lurch during the stance. Why? Because the trunk basically is try to help the weak side, giving the muscle assistance by leaning towards the muscle. That really help the weak side by moving the center of gravity near the fulcrum on the weak side. This shorten the moment arm from the center of gravity to the hip joint, and that will reduce the force and the effort. Treatment of gluteus medius and minimus tear. We need to understand the area of insertion of the tendons on the greater trochanter. The greater trochanter have four facets. The gluteus minimus insert into the anterior facet, and there is lateral and suproposterior facets. The gluteus medius insert into these two facets, and then there is a posterior facet for the gluteus maximus. Another important area of interest, early repair is better. The tendon goes into a progressive phase of deterioration from tendinosis to partial tear, degeneration to complete tear, retraction, fatty infiltration and atrophy. So, you got to think about the condition and treat it before it reaches that chronic advanced stage. Non-operative treatment of hip abductor like tendinosis, tendonitis, bursitis is successful in the majority of patients. Surgical repair for partial or complete hip abductor tendon tears is also successful in relieving the pain and improving the function of the patient. Not all tears are repairable even with soft tissue release. A complete tear plus muscle atrophy and fatty degeneration represent a bad prognosis and difficult, complex situation for the patient. When the tear cannot be repaired or the cause of the muscle atrophy is superior gluteal nerve injury, then a muscle transfer is necessary.