What is the management for a patient with a full thickness tear of the gluteus minimus tendon, severe tendonosis (tendinopathy) of the gluteus medius without a tear, and mild bursitis with iliotibial (IT) band tendinopathy?

From the Guidelines

Management for a patient with a full thickness gluteus minimus tear, severe gluteus medius tendinosis without tear, and mild bursitis with IT band tendinopathy typically begins with conservative treatment. Initial management should include relative rest, activity modification, and a structured physical therapy program focusing on hip abductor strengthening, core stabilization, and stretching of the IT band and hip musculature for 6-12 weeks, as recommended by 1. Pain control can be achieved with NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, as suggested by 1 and 1. Some key points to consider in the management of this condition include:

• Relative rest and reduced activity to prevent further damage and promote healing and pain relief, as recommended by 1
• Cryotherapy for acute relief of tendinopathy pain, with repeated applications of melting ice water through a wet towel for 10-minute periods, as suggested by 1 and 1
• Eccentric strengthening as an effective treatment of tendinopathy, which may reverse degenerative changes, as recommended by 1
• Limiting corticosteroid injections into the trochanteric bursa to 2-3 injections per year, as cautioned by 1 For persistent symptoms beyond 3-6 months of conservative management, advanced imaging such as MRI should be obtained if not already done, and surgical consultation may be warranted, considering the patient's age, activity level, functional limitations, and response to non-operative treatment, as suggested by 1. Surgical options for the full thickness gluteus minimus tear include tendon repair, particularly if the patient is younger, active, and experiencing significant functional limitations. This multifaceted approach addresses the inflammatory component of the bursitis and tendinopathy while promoting healing and functional restoration of the damaged tissues.

From the Research

Management of Full Thickness Tear of Gluteus Minimus Tendon

• The management of a full thickness tear of the gluteus minimus tendon, severe tendonosis of the gluteus medius without a tear, and mild bursitis with iliotibial (IT) band tendinopathy can be approached through both nonoperative and operative modalities 2.
• Nonoperative management options include home therapy, physiotherapy, infiltrations, image-guided infiltrations, shockwave therapy, platelet-rich plasma injection, and drug therapy 3.
• For patients with chronic gluteal tendinopathy, a single intratendinous leucocyte-rich platelet-rich plasma (LR-PRP) injection has been shown to result in greater improvement in pain and function than a single corticosteroid injection, with sustained improvement at 2 years 4.

Surgical Management

• Surgical intervention may be indicated for full thickness tears, and options include repair, reconstruction, or tendon transfer 2.
• Open and endoscopic repair techniques have demonstrated similar outcomes, with improvements in patient-reported outcomes and low complication and retear rates for both partial and full thickness tears 2, 5.
• A case series study reported favorable results in patient-reported outcomes at minimum 2-year follow-up for patients who underwent open repair of full-thickness gluteus medius tears using contemporary tendon repair techniques, with or without concomitant hip arthroscopy 6.

Treatment of Severe Tendonosis and Mild Bursitis

• For severe tendonosis of the gluteus medius without a tear, treatment options include nonoperative management with LR-PRP injection, which has been shown to be effective in improving pain and function 4.
• Mild bursitis with IT band tendinopathy can be managed with nonoperative modalities such as physiotherapy, infiltrations, and shockwave therapy 3.