What is Mild Left Gluteus Minimus/Anterior Medius Insertional Tendinosis?

Mild Left Gluteus Minimus/Anterior Medius Insertional Tendinosis

Mild left gluteus minimus/anterior medius insertional tendinosis is a degenerative condition of the hip abductor tendons where they insert onto the greater trochanter of the femur, characterized by collagen disorganization and tendon thickening without significant inflammation. 1

Pathophysiology and Clinical Presentation

Gluteus minimus/medius tendinosis involves degenerative changes in the tendon structure where these muscles attach to the greater trochanter. Key features include:

• Degeneration of the normally highly arranged collagen fiber structure
• Tendon thickening and decreased echogenicity on imaging
• Often misdiagnosed as trochanteric bursitis, though the two conditions may coexist 1, 2

The condition typically presents with:

• Insidious onset of lateral hip pain
• Pain that worsens with weight-bearing activities, particularly those involving hip adduction
• Pain when lying on the affected side (side-lying)
• Localized tenderness over the greater trochanter
• Possible weakness in hip abduction 1, 2

Diagnostic Evaluation

Physical Examination

• Well-localized tenderness over the greater trochanter
• Pain reproduced with resisted hip abduction
• Possible muscle atrophy with chronic conditions
• Pain with maneuvers that load the tendon 1

Imaging

• MRI is the gold standard for diagnosis, with sensitivity of 33-100% and specificity of 92-100% for detecting gluteus minimus/medius tendon pathology 1
• MRI findings include tendon thickening, increased signal intensity, and possible partial tearing
• Ultrasound can detect tendinopathy but is less sensitive (79%) than MRI 1
• Plain radiographs are typically normal but may rule out other pathologies 1

Management Approach

Conservative Treatment (First-line)

1. Relative rest and activity modification to reduce repetitive loading of the damaged tendon 1
2. Eccentric strengthening exercises for the hip abductors, which can reverse degenerative changes 1, 3
3. Cryotherapy (ice application for 10-minute periods) for acute pain relief 1
4. NSAIDs for short-term pain relief, though they don't affect long-term outcomes 1
5. Deep transverse friction massage to help reduce pain 3

Interventional Options (For persistent symptoms)

1. Corticosteroid injection under ultrasound guidance for short-term pain relief 1, 3
   • Typically using 40-80 mg methylprednisolone with 2-3 mL of 1-2% lidocaine
   • Ultrasound guidance ensures accurate placement

Advanced Treatment (For refractory cases)

1. Extracorporeal shock wave therapy - safe, noninvasive option for chronic cases 1
2. Surgical intervention if symptoms persist despite 3-6 months of conservative treatment 3
   • Endoscopic repair techniques have been developed for gluteal tendon tears 4, 5
   • Double-row repair techniques can recreate the normal tendon footprint 4

Prognosis and Follow-up

Most cases respond to conservative management within 3-6 months. Factors affecting prognosis include:

• Duration of symptoms before treatment
• Severity of tendon degeneration
• Patient compliance with activity modification
• Presence of contributing biomechanical factors

Important Clinical Considerations

• Gluteus minimus/medius tendinosis is more common in females than males 2
• The condition can be confused with trochanteric bursitis, and the two may coexist 1, 2
• In patients with hip arthroplasty, similar symptoms could represent adverse reactions to metal debris 1
• Bilateral involvement is possible but rare 6
• Proper diagnosis is critical as this condition is often misdiagnosed as simple trochanteric bursitis 5

Early recognition and appropriate management of gluteus minimus/anterior medius insertional tendinosis can prevent progression to more severe tendon damage and chronic disability.