Category: Clinical Sciences/Health Conditions
Gluteus Medius Tendinopathy
74-year-old female with post-polio syndrome presented with generalized left-leg weakness and new right lateral hip pain. The patient endorsed favoring her right leg for several years, and as a consequence was at increased risk of incurring an overuse injury to the right gluteal abductor muscles. Examination revealed tenderness over the right lateral hip, weak hip abductors (4/5) and positive Trendelenburg sign. Right hip MRI showed a small labral tear, gluteus medius tendinopathy and mild osteoarthritis. Electrodiagnostic studies did not reveal lumbar radiculopathy. The patient’s pain was refractory to prolonged treatment with oral medications, PT, HEP, and corticosteroid injections. The patient was then seen at a tertiary PM&R clinic and received prolotherapy to the right gluteus medius tendon, after which she reported significant decrease of at least 50% of her pain after several months.
Gluteal tendinopathy presents as lateral hip pain. There is increased prevalence among women aged above forty years compared to men, about 23.5% and 8.5%, respectively. Its effects are significant, considering that it interferes with basic weight-bearing tasks.
Mechanical factors are responsible for the pathophysiology. The combination of high tensile loads and excessive compression within tendons lead to the most damage.
From evidence-based studies, gluteal tendinopathy can be managed with shock wave therapy, exercise, corticosteroid injections, and surgery. Considering that there are limited treatment options, the best way to assess and manage gluteal tendinopathy is through the management of the patient’s tendons loads, which can be achieved through exercise, possibly tendon regenerative treatments, and patient education on underlying pathomechanics.
Gluteal tendinopathy is a result of stress and compression of the musculotendinous fibers. The existing treatment is aimed at relieving pain through physical and pharmacological methods. Development of more effective management strategies of gluteal tendinopathy may be achieved through prolotherapy, as was demonstrated in this case.