Clinical, radiological features, and surgical management of 6 patients with rupture of the gluteus medius tendon
Dr Fabrice MICHELa, Dr Sébastien AUBRYa, Dr Pierre DECAVELa, Dr Etienne ALETONa, Mr Etienne DROZ-BARTHELETa, Prof Patrick GARBUIOa, Prof Bernard PARRATTEa
a CHRU Jean Minjoz
Objectives: The rupture of the anterior part of the gluteus medius tendon has remained an ill-defined entity. The objectives are to develop some specific clinical signs, to emphasize the importance of MRI and to discuss the place of surgery.
Patients and Methods: Six patients were treated in the physical medicine department (Besançon) from 2009 to 2014 for trochanteric pain, with tears of the gluteus medius tendon confirmed by MRI. They all received suture surgery.
Results: It was 4 women and 2 men (mean age 71 years).
The interrogation at diagnosis: pain lasting for 5.4 months [3.5-9], no injuries reported, visual analog scale(VAS) 7.6 [5-9], sudden onset (83%), night pain (100%), Blazina score ≥ 3 (100%).
Clinical examination: normal and symmetric range of motion except a limitation of 10 degrees of lateral rotation on the symptomatic side for 5/6 patients (83%), symptomatic triad (stretching, resisted contraction, palpation) in 100% of cases , positive Trendelenburg sign for 5 patients (83%) and 4/6 patients with decrease of the gluteus medius strength (cotation 4/5).
All patients had an MRI: Partial rupture (1 case), complete rupture (5 cases) of the anterior fibers of the gluteus medius. After failure of medical treatment, conducted on average 4.7 months [3-11 months], a surgical treatment was chosen for all patients.
Clinical reassessment 6 months after surgery: significant improvement on pain: VAS = 2.4 (0 to 5.5) (p <0.01), disappearance of night pain in 5/6 cases (83%), disappearance of lameness (4/5 cases) except for one patient with persistent loss of gluteus medius muscle strength (cotation 4/5).
Conclusion: Tears of the gluteus medius tendons are likely to be a more common cause of pain in the greater trochanteric region than previously thought, especially if there are sudden onset, night pain, loss of muscle strength or Trendelenburg sign. The most useful examination technique for diagnosis is MRI. The surgical suture is recently proposed. That produce good to excellent functional results and reduce pain in this series.
Keywords : Pain, clinical assessement, tendon surgery