Gluteus Medius and Minimus tear vs. Greater Trochateric Bursitis

In this video I demonstrate how to differentiate between a Gluteus Medius and Minimus tear vs. Greater Trochateric Bursitis. The gluteus medius and minimus act upon the hip almost like the rotator cuff works for the shoulder. Quite rare but you don't want to miss it.
SUBSCRIBE to our channel for more great videos to help you with orthopedic evaluations.
Want to LEARN orthopedics on the run? Check out our PODCAST show-Ortho Eval Pal: orthoevalpal.co...

[@happycamper4193]

Thank you for the great video. I hope by now your patient is doing well. I have a 50% tendon tear on my gluteus Minimus. Going in for PRP injections with PT next week.

[@island661]

My gluteus medius burns when I touch it. I think I injured it running. It also hurts when I walk. Mine hurts closer to the iliac crest on the side, not the greater trochanter area. What can I do to repair it? Thanks 🙏🏻

[@oceanwinds2584]

Since 1990, I was told I had hip bursitis from an auto accident. I was able to get rid of pain for years til recently when it flared WAY up forcing me to seek PT. Turns out, the reason I never responded to bursitis treatment is because I have gluteus medius tendinosos. Different exercises so hopefully pain free in a few weeks.

[@GoodByeSkyHarborLive]

ddi you have an mri to show the tendinosis?

[@oceanwinds2584]

@@GoodByeSkyHarborLive No, just the PT diagnosing it. I’ve had to stop PT due to finances, so I’m on my own.

[@46Orca]

What sort of injections were tried, cortisone injections or nerve block attempted? I am trying to figure out if my Glute Medius issue is a tear or not. Like is mentioned in the vid, it's an issue that's often missed.

[@pennygill9375]

Thank you Penny from South Africa

[@OrthoEvalPal]

Thanks for watching Penny!! More to come.

[@suem.3651]

This is the BEST video I’ve seen explaining these often-confused diagnoses! How I wish that someone had put these things together and caught that I had a glute medius tear and significant muscle atrophy of the glue medius! Now I have been told by 2 surgeons that my condition is too bad as to be operable. My case was confusing because I had 3 cortisone shote, 2 this year and only the first one worked. QUESTIONS: What causes the muscle atrophy and will it worsen over time? Will I eventually be in a wheelchair? Could the tendon tearing cause excruciating quad pain and later numbness and weakness down to the foot? Please be honest if so! I am in PT now and finally able to walk with a cane after the tear detached completely and put me in agonizing pain for months. Thank you!!

[@OrthoEvalPal]

So sorry to hear this. Anytime a muscle is detached, it gets smaller because it has nothing to pull on and inflammation can shut it down. You should not end up in a wheelchair. A glute medius tear should not cause quad pain and foot weakness. Need to look for another cause like nerve root impingement in the back.

[@46Orca]

@@OrthoEvalPal You mentioned it shouldn't cause foot weakness, but would it cause overall weakness in the leg immediately following injury? The first 3-4 weeks after injury I could put my affected leg into the correct position to stand on tip toe (so not a nerve issue) but the injured side could take ZERO weight. It's better now but still not nearly as strong as it should be. Is what I describe consistant with a Glute Medius tear? ---- My "injury" is currently thought to be caused as a side effect of an antibiotic, ciprofloxin (according to my PCP)

[@AbstractMindsThinkAlike]

I have a partial tear of 1.1 cm. I was told it cannot be operated on unless it tears completely. I'm 40yo, so getting a cortisone shot was not recommended for me as it can make things worse. I was told to do PRP and continued dedicated PT. Thoughts?

[@waynecallan4743]

Do partial gluteal minimus tears always require surgery or can rest and specific exercises work?

[@unassailable6138]

surgery only when more than 50% of the ligament tore, if less , the ligament regenerates

[@46Orca]

@@unassailable6138 Would you happen to know how long it takes to regenerate on average?

[@unassailable6138]

@@46Orca 6 to 18 months

[@SuzaVision55]

If the patient is not a surgical candidate, is there some sort of brace for this ? Or prosthetic that aides with permanent glute med weakness?

[@kelleylondon]

Great video! Im working with a patient now who has a suspected full thickness tear. ( I say suspected bc one of her physicians disagrees with the diagnosis) Because of her age and other comorbidites her doctors do not recommend her to have surgery. In your clinical experience or research have you seen any positive outcomes for patients attempting a non conservative approach for glut med tears?

[@bjc203]

Same here. I'd like to know.

[@suem.3651]

I think they meant “conservative “ not “non” in last sentence. This is also my question.

[@turtlesarecool1488]

This sounds like my problem. My surfboard stabbed my right hip/side of my butt on a fast fall into the barrel. My pain is mostly on the outside of my hip towards the glute muscles and not really in the groin area.

[@OrthoEvalPal]

Would be a good idea to see an orthopedic surgeon to rule in a tear or rule it out

[@vivianaespinoza4110]

Could you also feel a little pinching feeling from damage to this muscle ?

[@prathamgiri2169]

Exactly

[@user-uj6xg5lq1c]

This is an excellent video. Thank you! I was diagnosed with proximal hamstring tendinopathy and conservative treatment didn't work (for years!). Eventually had surgery to repair. I have now developed severe pain in my lateral hip, on the same side as hamstring. I suspect glute med tendinopathy, but worried it could be a tear requiring surgery again. I don't want to wait years for surgery this time, so wondering how you diagnosed tear needing repair in this case versus tendinopathy. Is it from a scan, or from the tests you show in the clip? Thanks!

[@OrthoEvalPal]

MRI would be the best test. Good Luck!! and you are welcome.

[@chickadeeacres3864]

How did this lady injure herself? I have similar hip pain but no idea how it happened. Could overstretching during yoga cause it?

[@connieashworth3004]

Yes - overstretching is exactly how I ended up with a gluteus minimus tendon tear. It happened performing a stitting cross legged stretch (with the foot even wrapped around one leg) where one pulls knee in one direction stretching hip. It's been over four months and I had to demand an an MRI whichshowed the partial tear (NOT bursitis or muscle strain as originally diagnosed). OMG I wish I had just stayed with the yoga I'd been doing for twenty years. It was a yout tube fascia stretch video. :-(

[@jlamn]

is it safe to do jump rope with a glue tear?

[@OrthoEvalPal]

I would not. The Glute contracts a lot when you land

[@annelanders2462]

If the leg cannot be moved but has pain would you still suspect a tear?

[@BBwisco]

Nicely done. I've actually seen a lot of glut med soft tissue injuries not have the Trendelenburg because the nerve is still intact. It's easy to miss sometimes.

[@OrthoEvalPal]

Thank you! Yes, often missed. Thanks for the comment! Regards, Paul

[@majrebel]

Very helpful. Thank you!

[@OrthoEvalPal]

Glad it was helpful!

[@sevalsonmez96]

@@OrthoEvalPal Could the leg go inward slightly in this injury while walking and creates walking problems?

[@OrthoEvalPal]

@@sevalsonmez96 it could. The telltail sign is pain loading the leg while going upstairs

[@sevalsonmez96]

@@OrthoEvalPal Thank you! Can I ask this means I need a surgery or PT can help to make my leg straight again? It goes to right whenever I bend it (standing up position). IT has been 2 weeks and I feel like my whole body mechanism messed up :(

[@christinebubwatson1593]

I have a Gluten Minius tear. Was wanting to know if surgery helped her. I'm going in for a prp injection Monday.

[@OrthoEvalPal]

Yes. She did very well.

[@happycamper4193]

I have a 50% glut Minimum tear as well. Scheduled to have A PRP injection on the third. Also going to start PT with dry needling. Did the PRP injection help you? I have a sharp pain in the groin on pivoting when walking.

[@sashaa911]

My doctor just told me I tore my Glut Med or the tendon attached to it. I have Ehlers Danlos and heard a ripping and definitely felt a ripping/tearing feeling. I often dislocate my hips but this was different. I rolled over in bed from on my back to my side but my leg did not follow my torso. They are saying surgery is not recommended for me, but rest and some PT exercises unless it persists for more than six weeks. Is that a fairly common approach in your experience?

[@OrthoEvalPal]

Hi Sasha, I actually just finished a patient who had a repair and she is doing great. I also have another patient who did not have repair and is also doing great. She had injections and PT. Every one has to be treated independently. I would follow your doctor's recommendation. You can never go wrong with some guided strengthening and PT.

[@GoodByeSkyHarborLive]

what can you not do with it?

[@GoodByeSkyHarborLive]

@@OrthoEvalPal what do short intact hip abductors on mri mean? I think it sounds like the muscle has shortened due to injury but the tendon is intact.

[@MrMrAzad]

great vid, thanks!

[@OrthoEvalPal]

Glad you liked it!

[@nemxomen]

Which doctor type of doctor do I need to go to get this eval done. Im still pretty young but it looks like I have a glute min tear based on this video.

[@OrthoEvalPal]

An orthopedic surgeon. Some specialize in hips. Best of luck!

[@swatireddy1527]

Hi My mri says I got gluten minimum and medium tear in Jan 2021 but no doctor explained to me after looking at my mri report but recently when I visited pain management doctor she told it’s clearly mentioned on mri. It’s almost 2 years not I’m suffering with left gluten pain and since a week the pain is 9/10 on my under cap knees and thighs. Please help me. I spend lot of money and time. Doctors are not really helpful even after I gave my mri report. They are coming and saying I tour mri nothing is there. I feel bad for heard lies from doctors. The mri is readable it says clearly about tear. Please help to recover from this painful issue

[@kishoreks4382]

Same issue here

[@mariamarino138]

I’ve wasted 6 years, thinking everything was my back( doctors didn’t say differently) so, many epidurals, facet joint injections, and now, a doctor tells me I have tears in both hips!!!

[@rajgupta6448]

@@mariamarino138 Can you still repair those tears after 4-5 years ???

[@christinebubwatson1593]

@@mariamarino138 I'm at 4 years in now. And just found out about Glute Min. Tear. I had to go through the hole seeing every doctor and doing every procedure. Thought to be back then S I joint, hip, Bursitis on and on. Finally saw the tear in the MRI. Had a couple injections with no luck. Seeing doctor now that specializes in gluteau minimus tears and said that steroid injections only can make it worse. Going in for PRP injection on Monday hoping this helps before I try surgery.

[@suem.3651]

Same here but Drs did tell me right away. I also have quad and knee pain and weakness to the point it buckled, plus tingling/numbness each time I get up. Best to you.

[@sharonh5399]

I have a gluteus minimus tear. I have pain just below my bottom all the time. I also had a labrum tear, but it was repaired arthroscopicly. The surgeon couldn't find the glut tear at that time, but a post op mri still shows. It hurts when my right hip is moved inward. I also now have hertotopic ossification. Not sure where to go from here since the last surgeon wont do surgery.

[@OrthoEvalPal]

Hi Sharon, I might recommend a second opinion with an orthopedic hip surgeon. Good luck!

[@GoodByeSkyHarborLive]

When they couldn't find the tear, what did they do? Just leave it alone?

[@sharonh5399]

@@GoodByeSkyHarborLive Tried more physical therapy and needling. Yes, other than that nothing.

[@kishoreks4382]

I think my tore my gluteas medius about a 1.5 years ago I can't feel the muscle at all but my MRI is normal Shows no tears. What else could be the issue? Is the MRI showing up as normal cause it's been over a year?

[@rajgupta6448]

How are you doing now ? Do u still experience pain ?

[@kishoreks4382]

@@rajgupta6448 I still have pain and find difficulty standing or walking for long

[@shadaruiz]

I had 2 MRI’s that didn’t show a gluteus med tear. I want to a hip specialist and he said he disagreed with the MRI report. I did have arthroscopic surgery and he found a large hole in my gluteus medius and repaired it. I’m 4 weeks post surgery and no longer tender at the insertion point. Long recovery but I think totally worth it.

[@kishoreks4382]

@@shadaruiz which doctor did you go to? Are you based in Bangalore? How exactly was the damage repaired?

[@shadaruiz]

@@kishoreks4382 I went to an Orthopaedic doctor in the Los Angeles area. His specialty is hips. He attached 2 anchors into my bone above the hamstring and pulled the edges of the torn area together with sutures. Also removed the ischial bursa sac.

[@MommaBearsCorner]

wonder if those keep you from standing up long

[@OrthoEvalPal]

Yes. Painful to stand for long. More painful going up stairs.

[@MommaBearsCorner]

@@OrthoEvalPal pressure pain for me, not really all nerve pain. i can't walk anymore further than 25 ft holding on to a roller or cane for life. tires me out trying to stand. is why i cant hardly walk. they finally figuring it out after like this past year 1/2! STEPS? WHATS THOSE? lol

[@cbisme6414]

I had a side on car accident in '94 at the age of 41, smashing down a traffic light, back into a steel side rail and then back to the other side of the road shattering the middle console with that hip and with the steel catch of the seatbelt on that hip also (in Australia we drive on the left). From that day I had terrible pain in my left hip, couldn't sit or stand for any length of time, can't lay on that side, walk now with a limp and my hips are uneven. In all this time I've been told by specialists it's pain radiating from your back! When physio, taping, ultrasound, aqua therapy didn't work and collapsed passing out due to the pain in clinical Pilates I was sent for an MRI and was told I has a "full thickness tear of the gluteus minimus, which would be very painful and if it'd been picked up within 6-8 weeks of it being done it could have been easily reattached unfortunately too late now, nothing can be done." It's nice to finally have a diagnosis after all these years of being brushed off with it's back pain just take a tablet!! I'm now 67.5 years and it's impacting on my knees compensating for the weakness of my hip. Is there any hope of repair at this late stage??

[@bensago7506]

@@cbisme6414 Yes ! There is a way out . It is called the Whiteside Operation , in which the Gluteus Maximus muscle is mobilized to replace the function of the injured Gluteus Medius and Minimus . Thanks . I am an Orthopaedic Surgeon from Nigeria , West Africa .

[@bensago7506]

@@cbisme6414 Yes ! There is a way out . It is called the Whiteside Operation , in which the Gluteus Maximus muscle is mobilized to replace the function of the injured Gluteus Medius and Minimus . Thanks . I am an Orthopaedic Surgeon from Nigeria , West Africa .

[@barbarawebb7185]

Can a chiropractic adjustment cause these tears?

[@OrthoEvalPal]

Not likely

[@pocketdrone6930]

cant you do a MRI to see whats going on there?

[@OrthoEvalPal]

She went to 3 orthopedic surgeons before one finally ordered the MRI to find it was torn as we had predicted.

[@pocketdrone6930]

@@OrthoEvalPal Nice! Congrats for that accuracy!

[@GoodByeSkyHarborLive]

@@OrthoEvalPal did she go through insurance to all of them?

[@colorgravity8153]

Why just do an MRI?

[@OrthoEvalPal]

She didn't need anymore. It identified the tear and once she had it fixed, she was better.

[@sunrisehealth9652]

I have an new mri showing a gluteal medius low level tear with edema in the gluteal minimums. It’s been 9 months without any improvement. Stretching, PT makes me worse. I cannot stand, sit or walk beyond 20 mins. I fell 9 months ago-4 times!! right after a recent labral hip repair surgery. I’m in excruciating pain. Doesn’t this type of gluteal tear require surgery if I haven’t healed after 9 months from a fall? The mri looks fine inside my hip joint post surgery. The dr tried to tell me I have gluteal tendinitis. He NEVER mentioned the tear: I asked for the mri report and read the tear on there. Any thoughts?

[@OrthoEvalPal]

My most recent glute medius repair patient did awesome. Night and day.

[@sunrisehealth9652]

Ortho EVAL Pal With Paul Marquis My orthopedist has told me that surgery isn’t indicated for a low level partial tear. He’s recommending a cortisone injection into the gluteal medius. It’s been 9 months since my pain started. 3 rounds of physical therapy. I ice it all day off/on. Rx meloxicam for a year. Muscles relaxers and pain meds barely touch it. The mri shows a low level tear in the medius and inflammation/edema in the minimus. I also had a anterior labral repair FAI in my hip done 9 months ago. I fell 4x on my bottom after surgery and think my gluteal issue is from that. This surgeon is now becoming angry when I ask what’s going on, saying “he’s working after hours to answer my questions” Any opinions on this?

[@OrthoEvalPal]

@@sunrisehealth9652 First thing that comes to mind is that there might be something else going on. ie. L5 herniated disc can cause pain there. So hard to say without evaluating you one on one. A cortisone shot can be helpful but more importantly, diagnostic.

[@sunrisehealth9652]

Ortho EVAL Pal With Paul Marquis I agree. The surgeon didn’t do an re-exam re the gluteal. Just diagnosed by mri. Getting the ultrasound guided shot today 11/14. How long before a patient knows if cortisone works? I understand your response is an opinion and not medical advice. Thanks for any thoughts. (FYI-The recent mri showed a low level tear on gluteal medius)

[@OrthoEvalPal]

usually 2-3 days to see improvement. If there is, then the shot has helped you diagnose it. Best, Paul