Does L2-L3 Neuroforaminal Narrowing Change Assessment of Gluteus Minimus Tear?
No, moderate left and mild right neuroforaminal narrowing at L2-L3 does not alter the assessment or management of a gluteus minimus partial-thickness tear causing lateral hip pain, abductor weakness, and Trendelenburg gait, because L2-L3 nerve roots do not innervate the hip abductors or produce this clinical presentation.
Neuroanatomical Mismatch
The gluteus medius and minimus are innervated by the superior gluteal nerve (L4-L5-S1 nerve roots), not L2-L3, making the lumbar MRI findings anatomically irrelevant to the hip abductor pathology 1.
L2-L3 nerve root compression typically produces anterior and medial thigh pain, hip flexor weakness, and diminished knee reflexes—not lateral hip pain, abductor weakness, or Trendelenburg gait 1.
The clinical presentation described (lateral hip pain, abductor weakness, Trendelenburg gait) is pathognomonic for gluteus medius/minimus pathology and cannot be explained by L2-L3 pathology 2, 3.
Modic Changes Are Incidental
Modic type 1/2 end-plate changes at L2-L3 represent degenerative disc disease with inflammatory (type 1) or fatty (type 2) marrow changes that are extremely common in asymptomatic individuals and do not correlate with the patient's hip symptoms 2.
These findings should not distract from the primary diagnosis of gluteus minimus tear, which has been confirmed on MRI and correlates perfectly with the clinical examination 1, 3.
Management Remains Focused on Hip Abductor Pathology
For Partial-Thickness Gluteus Minimus Tears:
Initial conservative management for 3-6 months includes eccentric strengthening of hip abductors, activity modification, NSAIDs, cryotherapy, and consideration of a single ultrasound-guided peritendinous corticosteroid injection 2, 3.
Physical therapy should focus on supervised exercise programs with eccentric strengthening of hip abductor muscles, which have moderate-quality evidence for efficacy 2.
Avoid repeated corticosteroid injections as they have deleterious effects on tendon substance; inject only into peritendinous space, never directly into the tendon 3.
Surgical Considerations:
Surgical repair should be considered after failure of 3-6 months of comprehensive conservative treatment, particularly if there is progressive abductor weakness or persistent Trendelenburg gait 2, 3.
Endoscopic trans-tendinous repair techniques are available for partial-thickness undersurface tears of the gluteus medius/minimus 4.
Common Pitfall to Avoid
Do not be misled by incidental lumbar spine findings into pursuing unnecessary lumbar spine treatments (epidural injections, lumbar surgery) when the patient's symptoms are clearly from hip abductor pathology 2, 1.
The presence of lumbar degenerative changes does not warrant deviation from the established treatment algorithm for gluteus minimus tears 3.
If morning stiffness exceeds 30 minutes in a patient under 45 years, consider axial spondyloarthropathy and obtain sacroiliac joint MRI, but this is unrelated to L2-L3 findings 2.