What is the treatment for a complete rupture of the distal left gluteus minimus tendon attachment with underlying fluid accumulation?

From the Guidelines

For a complete rupture of the distal left gluteus minimus tendon attachment with underlying fluid, I strongly recommend a comprehensive treatment approach combining rest, physical therapy, pain management, and possibly surgical intervention, prioritizing the patient's morbidity, mortality, and quality of life as the primary outcome. The treatment should initially focus on reducing pain and inflammation, followed by a gradual progression to strengthening and functional exercises.

Initial Treatment

• Rest the affected area to decrease repetitive loading of the damaged tendon, as suggested by 1
• Apply Ice for 20 minutes every 2-3 hours, use Compression with an elastic bandage, and Elevate the hip when possible, following the RICE protocol
• Pain management should include NSAIDs such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks

Physical Therapy

• Physical therapy should begin after acute pain subsides, typically within 1-2 weeks, focusing on gentle stretching, progressive strengthening exercises, and gait training, as these are crucial for restoring function and reducing the risk of further injury
• The program should last 6-12 weeks with 2-3 sessions weekly, allowing for gradual progression and adaptation

Surgical Intervention

• For severe cases with significant functional impairment or for athletes, surgical repair may be necessary, as it is an effective treatment option in carefully selected patients, as noted in 1
• The decision for surgical intervention should be made on a case-by-case basis, considering the patient's overall health, activity level, and treatment goals

Outcome and Follow-Up

• Complete healing typically takes 3-6 months, with gradual return to full activities
• Regular follow-up with your healthcare provider is essential to monitor progress and adjust treatment as needed, ensuring the best possible outcome for the patient's morbidity, mortality, and quality of life.

From the Research

Treatment Options for Complete Rupture of the Distal Left Gluteus Minimus Tendon Attachment

• The treatment for a complete rupture of the distal left gluteus minimus tendon attachment may involve surgical intervention, as there is low-level evidence to support surgical repair for full-thickness tears 2.
• Surgical intervention aims to reapproximate and secure the torn tendon to the tendon footprint on the greater trochanter via suture anchors, and both open and endoscopic techniques have shown to be effective methods for treating gluteus medius tears 3.
• However, the choice of surgical technique may depend on the severity of fatty infiltration, with open repair potentially being more beneficial for patients with more severe fatty infiltration, and endoscopic treatment being more suitable for patients with less severe fatty infiltration 3.

Underlying Fluid Treatment

• There is no direct evidence in the provided studies regarding the treatment of underlying fluid associated with a complete rupture of the distal left gluteus minimus tendon attachment.
• However, the treatment of gluteal tendinopathy, which may involve underlying fluid, includes physical therapy/exercise, injections (corticosteroids, platelet-rich plasma, autologous tenocytes) with or without needle tenotomy/tendon fenestration, shockwave therapy, and therapeutic ultrasound 2.

Diagnostic Considerations

• Radiological confirmation of the diagnosis is most commonly obtained using magnetic resonance imaging, and ultrasound or magnetic resonance imaging studies can demonstrate a torn tendon, which is an indication for surgery 2, 3.
• Patients with gluteus medius tears, which may be similar to gluteus minimus tears, commonly present with lateral hip pain aggravated by weight bearing and sleeping on the affected side, weakness in abduction, and the Trendelenburg sign observable on physical examination 3, 4.