VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

18 A Case Report of a Non-Traumatic Complete Avulsion Tear with Retraction of the Right Gluteus Medius Muscle Tendon from the Greater Femoral Trochanter

Christopher Mariano, DO: Steven Cromer, DO; Benjamin Cobbs, MD; Briana Beach, DO Corresponding author:

Carilion Clinic Institute for Orthopedics and Neuroscience

Background: Avulsion tears of the gluteus medius tendon are often challenging to diagnose. They do not always present after acute traumas and can have symptoms that make it difficult to distinguish from other hip pathologies. History/Physical Exam: A 69-year-old male presented to the sport’s medicine clinic complaining of right sided hip/gluteal pain with radiation down the right thigh. The pain began insidiously without any inciting injury along the lateral portion of the hip to the greater trochanter and had been going on for about two weeks. The pain was dull, achy and constant but was worsened with activity such as walking. Normally he is able to walk 5 miles daily with his wife but since the pain onset, he has only been able to max out at 1 mile. He does have a history of a lumbar surgery in 2005 but had not had gluteal or hip pain prior to this. At the initial presentation the pain had resolved but after a few weeks the pain returned. Physical exam again was relatively benign but pertinent positives/ negatives included 4/5 strength in isolated right hip abduction testing. Positive Trendelenburg sign present with antalgic gait. No atrophy or deformity in the gluteus was observed. He did not endorse any tenderness to palpation

Differential Diagnosis: Spinal stenosis, lumbar radiculopathy, partial tear of the gluteus was considered due to the location of pain and exam findings. Imaging: R of right hip and lumbar spine revealed no fractures and disc space narrowing at L4-L5. MRI of hip and lumbar spine to further evaluate. A complete avulsion tear of the right gluteus medius tendon from the greater trochanter with 5.0 cm of retraction and fluid gap was observed on the study. Additionally, significant neuroforaminal stenosis at L4-L5 was observed Management: The patient was referred to surgery. The patient was deemed to be a good candidate for tendon repair due to the lack of atrophy on MRI. Other alternative treatments discussed included targeted injections, physical therapy, osteopathic manipulation therapy and OTC anti-inflammatories. He was informed that if his neuroforaminal stenosis was contributing to the pain then it would be unclear as to how much benefit the surgery would have. The patient took time to discuss options with his wife and ultimately decided to pursue surgical repair which is being scheduled.

Discussion: This case illustrates the potential for complete gluteal avulsion tears presenting without trauma. Recognition of this and narrowing the physical exam to isolate abduction strength can help clinicians with earlier suspicion leading to more prompt imaging and appropriate diagnosis.


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