Gluteus Medius Tendonitis Treatment – What You Need to Know

Gluteus medius tendonitis, also known as hip tendonitis, is a condition characterized by inflammation of the tendons surrounding the gluteus medius muscle, a key stabilizer of the hip joint. This inflammation often results from overuse, muscle imbalances, or repetitive stress on the hip, leading to pain and discomfort in the outer hip and buttock region.

Proper treatment is crucial to alleviate symptoms and prevent the condition from worsening. In this guide, we’ll explore various aspects of gluteus medius tendonitis treatment, including self-care strategies, exercises, and medical interventions, to help individuals better understand and manage this condition effectively.

What Is Gluteus Medius Tendonitis?

The gluteus medius plays a crucial role in stabilizing the hip joint and facilitating movements such as walking, running, and hip abduction. Tendonitis in this area can develop due to overuse, repetitive stress, muscle imbalances, or traumatic injuries, leading to pain and tenderness in the outer hip and buttock.

The Gluteus Medius Tendon Repair Surgical Procedure

Gluteus medius tendonitis can be repaired by two techniques: open surgery and arthroscopic surgery. Both techniques aim to address gluteus medius tendonitis by restoring the integrity of the tendon and alleviating symptoms. The choice of surgical approach depends on factors such as the severity of the injury, the surgeon’s preference, and the patient’s overall health.

The techniques are explained below.

Open Gluteus Medius Tendon Repair

Open gluteus medius tendon repair is a surgical procedure that involves creating a larger incision to directly access and repair the damaged tendon. This technique is typically employed for more extensive cases of gluteus medius tendonitis. The procedure involves four steps:

• Incision: A sizable incision is made over the hip, allowing the surgeon a clear view of the gluteus medius tendon and the surrounding structures.
• Tendon examination: The surgeon carefully assesses the extent of tendon damage, identifying tears or inflammation that may be present.
• Tendon repair: The damaged portion of the gluteus medius tendon is then repaired. This may involve suturing tears, removing damaged tissue, or reattaching the tendon to the bone, depending on the severity of the injury.
• Closure: Once the repair is completed, the incision is closed with sutures or staples, and the surgical site is bandaged.

Arthroscopic Gluteus Medius Tendon Repair

Arthroscopic gluteus medius tendon repair is a minimally invasive surgical technique that utilizes a small camera (arthroscope) and specialized instruments to perform the repair. This method offers the advantage of smaller incisions, potentially leading to reduced pain and a faster recovery. The procedure involves the following steps:

• Small incisions: Instead of a large incision, several small incisions (portals) are made around the hip joint.
• Arthroscopic visualization: An arthroscope is inserted through one of the incisions, providing the surgeon with a clear view of the internal structures, including the gluteus medius tendon.
• Tendon repair: Using specialized instruments, the surgeon repairs the damaged tendon. This may involve suturing, removing damaged tissue, or reattaching the tendon as needed.
• Closure: After the repair is completed, the small incisions are closed with sutures, and a bandage is applied.

What Are the Indications for a Gluteus Medius Tendon Repair?

Gluteus medius tendon repair may be recommended in certain conditions where conservative treatments have proven ineffective, and the severity of the gluteal tendinopathy warrants surgical intervention. Here are the indications for gluteus medius tendon repair in specific conditions:

Gluteal Tendinopathy

Gluteal tendinopathy, characterized by inflammation and degeneration of the gluteus medius tendon, can lead to persistent pain and functional limitations. Surgical intervention may be indicated in the following scenarios:

• Failed conservative treatment: When conservative measures such as physical therapy, anti-inflammatory medications, and activity modification fail to provide significant relief.
• Significant tendon tears: In cases where there are substantial tears or damage to the gluteus medius tendon that cannot be adequately addressed without surgical intervention.
• Chronic symptoms: When patients experience chronic, debilitating pain, affecting their quality of life and daily activities.

Degenerative Scoliosis

Degenerative scoliosis, a condition marked by the curvature of the spine due to age-related changes, can contribute to gluteus medius tendon issues. Surgical repair may be considered under the following circumstances:

• Functional impairment: When degenerative scoliosis leads to altered biomechanics, causing strain on the gluteus medius tendon and resulting in significant functional impairment.
• Persistent pain: In cases where patients continue to experience persistent and severe pain, impacting their ability to perform routine activities.
• Structural changes: If imaging studies reveal structural changes in the gluteus medius tendon associated with degenerative scoliosis that are amenable to surgical correction.

Hamstring Tendinopathy

Hamstring tendinopathy, involving inflammation and degeneration of the hamstring tendons, can contribute to hip pain and dysfunction. Indications for gluteus medius tendon repair in conjunction with hamstring tendinopathy include:

• Compromised hip stability: When hamstring tendinopathy leads to compromised hip stability, impacting the function of the gluteus medius and necessitating surgical correction.
• Persistent symptoms: If patients experience persistent symptoms, despite conservative measures, affecting their ability to engage in physical activities.
• Structural defects: When imaging studies reveal structural defects or tears in the gluteus medius tendon that coexist with hamstring tendinopathy and require surgical attention.

Factors to Consider Before Undergoing the Surgery

Before undergoing gluteus medius tendon repair surgery, several crucial factors must be carefully considered to ensure informed decision-making and optimize the overall success of the procedure.

Success Rate

Success is often defined by the degree of symptom relief, restoration of function, and overall patient satisfaction. The success rate may vary depending on the extent of tendon damage. In cases of minor tears or inflammation, the procedure may have a higher likelihood of success. 

Individual patient factors, such as age, overall health, and adherence to postoperative care, can influence the success of the surgery. Timely intervention, especially when the condition is addressed in the earlier stages, may contribute to a more successful outcome. The experience and skill of the surgeon performing the procedure play a significant role in the success rate. 

Choosing a qualified and experienced surgeon is crucial.

Recovery Period

The recovery period can be influenced by whether the surgery was performed through open or arthroscopic techniques. Arthroscopic procedures often entail a shorter recovery time. Patient-specific factors, such as overall health, adherence to rehabilitation protocols, and the body’s natural healing response, contribute to the recovery timeline. 

The inclusion of a structured physical therapy program is crucial for a successful recovery. It helps restore strength, flexibility, and functionality in the hip joint. Patients may need to temporarily modify their activities to avoid stressing the repaired tendon during the initial stages of recovery.

Life After the Surgery

Patients should understand that the return to regular activities may be a gradual process, with a phased approach guided by their surgeon and physical therapist. Depending on the severity of the initial condition, some patients may need to make long-term lifestyle modifications, such as incorporating specific exercises or avoiding certain high-impact activities. 

Regular follow-up appointments with the healthcare team are essential to monitor the healing process, address any concerns, and make adjustments to the rehabilitation plan if necessary. While successful surgery can alleviate symptoms, there is a possibility of recurrence or the development of new issues over time. 

Regular monitoring and communication with healthcare providers can help manage any emerging issues effectively.

Risks and Complications of the Procedure

While gluteus medius tendon repair is generally considered safe and effective, like any surgical procedure, it carries certain risks and potential complications.

Infection

Infection is a potential risk associated with any surgical procedure, including gluteus medius tendon repair. The risk arises from the introduction of bacteria into the surgical site during the procedure. To mitigate the risk of infection, surgeons adhere to strict aseptic techniques during the surgery, and patients are often prescribed antibiotics before and after the procedure. 

Patients must also adhere to postoperative care instructions to minimize the risk of infection. Patients should promptly report any signs of infection, such as increased redness, swelling, warmth, or discharge from the surgical site, to their healthcare provider for timely intervention.

Bleeding

Bleeding during or after gluteus medius tendon repair is a potential complication. Excessive bleeding can lead to hematoma formation and increased postoperative pain and may require additional interventions. 

Surgeons take precautions to minimize bleeding during the procedure, and patients are often advised to avoid certain medications that can increase bleeding risk in the days leading up to surgery. 

Close monitoring of postoperative bleeding is essential, and patients should promptly report any signs of excessive bleeding, such as persistent or increasing pain, swelling, or changes in the color of the surgical site.

Postoperative Pain

Postoperative pain is a common occurrence after gluteus medius tendon repair. The level of pain can vary between individuals, and factors such as the extent of the procedure and individual pain tolerance contribute to the experience. Pain management strategies, including prescribed medications and physical therapy, are implemented to alleviate discomfort. 

Patients should adhere to the prescribed pain management plan and communicate any concerns or changes in pain intensity to their healthcare provider. Patients should have realistic expectations regarding the temporary postoperative pain and the gradual improvement in comfort as the healing process advances.

Damage to Nerves and Vessels

During gluteus medius tendon repair, there is a risk of unintentional damage to nearby nerves and blood vessels. This can result in sensory or motor deficits and, in rare cases, may necessitate additional surgical intervention. The surgeon’s expertise and precision are critical in minimizing the risk of nerve and vessel damage. 

Detailed preoperative planning and careful execution of the procedure help mitigate this potential complication. Close postoperative monitoring for any signs of nerve damage, such as numbness, tingling, or weakness, is essential. Patients should promptly report any unusual sensations to their healthcare provider.

Thromboembolism or Blood Clots

The formation of blood clots (thromboembolism) is a potential complication after any surgical procedure, including gluteus medius tendon repair. These clots can travel to other parts of the body, leading to serious complications such as pulmonary embolism. 

Patients are often provided with measures to prevent blood clot formation, such as compression stockings, early mobilization, and, in some cases, blood-thinning medications. Patients should be aware of the signs of blood clot formation, including swelling, redness, and pain in the legs. Prompt reporting of such symptoms to healthcare providers is crucial for timely intervention.

Alternatives to Gluteus Medius Tendon Repair

For individuals experiencing gluteus medius tendonitis, various alternative treatments and procedures exist as alternatives to surgical intervention. These alternatives aim to alleviate pain, promote healing, and improve overall function. 

Below are two notable alternatives offered at the Centeno-Schultz Clinic (CSC):

Platelet-Rich Plasma Injection

Platelet-rich plasma (PRP) therapy involves the extraction of a patient’s own blood, which is then processed to concentrate the platelets. These platelets, rich in growth factors and healing properties, are then injected directly into the affected area, such as the gluteus medius tendon. 

The concentrated platelets stimulate the body’s natural healing processes, promoting tissue repair and reducing inflammation. In the context of gluteus medius tendonitis, PRP injections aim to enhance the healing response and alleviate symptoms.

Bone Marrow Concentrate

Bone marrow concentrate (BMC) therapy involves extracting a small amount of the patient’s bone marrow, usually from the hip or pelvis. The bone marrow is then processed to concentrate the regenerative cells, growth factors, and other healing components, which are subsequently injected into the affected area. 

The concentrated regenerative cells and growth factors aim to stimulate tissue repair, reduce inflammation, and support the natural healing process. BMC therapy is utilized as a regenerative medicine approach for various musculoskeletal conditions, including gluteus medius tendonitis.

Provide Proper Treatment for Your Condition

In conclusion, addressing gluteus medius tendonitis requires a comprehensive approach that considers the severity of the condition, individual health factors, and patient preferences.

While gluteus medius tendon repair surgery is an option for some, alternative treatments such as platelet-rich plasma (PRP) injections and bone marrow concentrate (BMC) therapy offer non-surgical alternatives with the aim of promoting healing and reducing symptoms.

For individuals seeking proper treatment for gluteus medius tendonitis, the CSC stands as a reputable institution specializing in regenerative medicine. The clinic provides a range of cutting-edge treatments, including PRP and BMC therapies, designed to harness the body’s natural healing abilities.

Are you unsure of your diagnosis or treatment? Here are some of the questions to ask when getting a second opinion.

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Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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