Is a left acetabular labral tear the same as a partial gluteus medius tear?

No, These Are Completely Different Anatomical Structures

A left acetabular labral tear and a partial gluteus medius tear are entirely distinct injuries involving separate anatomical structures in different locations around the hip joint. These conditions affect different tissues, cause different symptoms, require different diagnostic approaches, and necessitate different treatments.

Anatomical Distinctions

Acetabular Labral Tear

• The acetabular labrum is a fibrocartilaginous ring that lines the rim of the hip socket (acetabulum), functioning as a stabilizing structure that resists femoral head dislocation and maintains joint stability 1
• Labral tears occur inside the hip joint (intra-articular pathology) and typically present with anterior groin pain in 92% of cases 2
• These tears are commonly associated with femoroacetabular impingement, trauma, dysplasia, or degeneration 3

Gluteus Medius Tear

• The gluteus medius is a muscle-tendon unit that attaches to the greater trochanter on the lateral aspect of the hip, functioning as a hip abductor 4
• Gluteus medius tears occur outside the hip joint (extra-articular pathology) and cause lateral hip pain, often associated with greater trochanteric pain syndrome 4
• These tears can present with a Trendelenburg gait and weakness of hip abduction 5

Clinical Presentation Differences

Location of Pain (Critical Distinguishing Feature)

• Labral tears: Predominantly groin pain (92% of patients), with activity-related pain in 91% and night pain in 71% 2
• Gluteus medius tears: Lateral hip pain over the greater trochanter, which represents a different "quadrant" of hip pathology 6

Physical Examination Findings

• Labral tears: Positive anterior impingement test in 95% of cases, with 39% demonstrating a limp and 38% showing a positive Trendelenburg sign 2
• Gluteus medius tears: Trendelenburg gait is more prominent, with direct tenderness over the greater trochanter and weakness on resisted hip abduction 4

Diagnostic Imaging Differences

For Acetabular Labral Tears

• MR arthrography with intra-articular gadolinium injection is the gold standard for confirming labral tears 7
• High-resolution 3T MRI improves visualization of the acetabular labrum 7

For Gluteus Medius Tears

• Non-contrast MRI of the hip is the definitive imaging study, with sensitivity of 33-100% and specificity of 92-100% for detecting gluteus medius/minimus tendon tears 4, 5
• MRI provides comprehensive assessment of peritrochanteric structures including the abductor tendons and trochanteric bursa 4
• Ultrasound has inferior sensitivity (79%) and is not recommended as the primary diagnostic tool 4, 5

Treatment Approaches Differ Completely

Acetabular Labral Tear Management

• Conservative management includes rest, NSAIDs, activity modification, and physical therapy 3
• Surgical options include arthroscopic labral debridement or repair when conservative treatment fails 7, 3
• Untreated labral tears may lead to progressive cartilage damage and potential osteoarthritis 7

Gluteus Medius Tear Management

• Acute full-thickness tears: Surgical repair is preferred, particularly when performed within 3 weeks of injury, as early repair produces superior outcomes compared to delayed repair 5
• Conservative treatment (for select partial tears only) includes activity modification, eccentric strengthening exercises, NSAIDs, and a single ultrasound-guided corticosteroid injection into the peritrochanteric space—not into the tendon itself 5
• Repeated corticosteroid injections should be avoided due to deleterious effects on tendon substance 5

Important Clinical Caveat

These conditions can coexist in the same patient. The prevalence of gluteus medius pathology in patients with femoroacetabular impingement is as high as one-third 6. When both pathologies are present and symptomatic, both require treatment 6. A systematic quadrant approach to hip examination helps distinguish between anterior (intra-articular/labral) versus lateral (gluteus medius) pathology 6.

Common Diagnostic Pitfall

The diagnosis of acetabular labral tears is often delayed, with patients seeing an average of 3.3 healthcare providers over 21 months before definitive diagnosis 2. The complexity arises because both conditions can cause limping and positive Trendelenburg signs, but the location of pain—groin versus lateral hip—is the key distinguishing feature 2, 6.