From the Guidelines
An intrasubstance tear of the gluteus minimus muscle is fixable with appropriate treatment, prioritizing conservative management and rehabilitation to minimize morbidity, mortality, and improve quality of life. Most gluteus minimus tears can be treated successfully with conservative management, which typically includes rest from aggravating activities for 4-6 weeks, ice application for 15-20 minutes several times daily during the acute phase, and over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food) to manage pain and inflammation 1.
Key Considerations
- Physical therapy is crucial for recovery and usually involves a progressive program of gentle stretching, strengthening exercises, and functional training over 6-12 weeks.
- For persistent pain, corticosteroid injections may be considered, although the evidence for their use is inconclusive in the context of rotator cuff repairs 1.
- Surgery is rarely needed but might be an option for severe tears that don't respond to conservative treatment after 3-6 months.
- Recovery time varies depending on tear severity, with minor tears healing in 4-6 weeks and more significant tears taking 3-4 months.
Rehabilitation and Outcome
The gluteus minimus is an important hip abductor and internal rotator, so proper rehabilitation is essential to restore hip function and prevent recurrence. While the provided evidence primarily discusses rotator cuff repairs and does not directly address gluteus minimus tears, the principles of conservative management, physical therapy, and selective use of corticosteroid injections or surgery can be applied to the treatment of gluteus minimus tears, prioritizing the reduction of morbidity, mortality, and improvement of quality of life 1.
Evidence Quality and Recommendations
The recommendation for conservative management and rehabilitation is based on the most recent and highest quality study available, which emphasizes the importance of appropriate imaging and rehabilitation in the management of hip and gluteal tendon injuries 1. However, it's crucial to note that the direct evidence for gluteus minimus tears is limited, and clinical decisions should be made on a case-by-case basis, considering the patient's overall health, the severity of the tear, and the potential benefits and risks of different treatment options.
From the Research
Intrasubstance Tear of the Gluteus Minimus Muscle
- An intrasubstance tear of the gluteus minimus muscle can be fixable, with treatment options including conservative management and surgical intervention 2, 3.
- Conservative management may include physical therapy, anti-inflammatory therapies, and cortisone and platelet-rich plasma injections, with exercise intervention improving symptoms after 4 months to a year of therapy 2.
- Surgical management, including endoscopic repair, may be indicated in cases where conservative management fails or an abductor power deficit is associated with pain 3, 4, 5, 6.
- The success of surgical repair may depend on factors such as the extent of tendon degeneration and the presence of fatty degeneration or atrophy of the gluteus minimus muscle 4, 5.
- Endoscopic techniques have been developed for the repair of partial-thickness undersurface tears of the gluteus medius and minimus tendons, with satisfactory results reported in some studies 4, 5, 6.
Factors Affecting Treatment Outcome
- The degree of tendon degeneration may compromise the tissue left for reattachment, raising concerns over its healing capacity, durability, and ultimate strength of the repair 5.
- Fatty degeneration and atrophy of the gluteus minimus muscle may be factors of poor prognosis for functional results and tendon healing 4.
- Early intervention, before the onset of significant tendon degeneration or fatty degeneration, may be preferable to achieve optimal treatment outcomes 4.