■ ■ ■ Description

Gluteus medius syndrome is characterized by inflammation and pain at the outer hip caused by strain of the gluteus medius muscle and its tendon attachment to the femur. The gluteus medius muscle attaches the pelvis to the outer hip. This muscle stabilizes the hip when walking, running and jumping, and moving the leg and thigh away from the other leg and thigh. The syndrome is usually a grade 1 or 2 strain of the tendon. A grade 1 strain is a mild strain. There is a slight pull without obvious tearing of tissue (it is microscopic muscle-tendon tearing). There is no loss of strength, and the muscle-tendon unit is the correct length. A grade 2 strain is a moderate strain. There is tearing of fibers within the substance of the muscle-tendon unit in the tendon, in the muscle, or where the tendon meets the muscle or bone. The length of the whole muscle-tendon-bone unit is increased, and there is usually decreased strength. A grade 3 strain is a complete rupture of the muscle-tendon unit and is rare.

 

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■ ■ ■ Common Signs and Symptoms

• Pain and often a limp with walking or running

• Tenderness over the outer hip

• Pain, tenderness, swelling, warmth, or redness over the outer thigh, often worsened by moving the hip

• Often, weakness of the hip (especially when spreading the legs and hips against resistance)

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■ ■ ■ Causes

Gluteus medius syndrome may occur without any injury. It may be due to strain from a sudden increase in the amount or intensity of activity or overuse of the lower extremity. Usually, this condition is associated with tilting of the pelvis with running.

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■ ■ ■ Risk Increases With

• Endurance sports (distance runners, triathletes, race walkers), especially running along street curbs and banked

       surfaces or if the foot crosses the midline toward the other

       leg when running

• Poor physical conditioning (strength and flexibility)

• Inadequate warm-up before practice or play

• Legs of unequal length (affects longer leg)

• Alignment problems of the lower extremity, including wide pelvis and excessively knocked knees

 

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

  • Hip, pelvis, and trunk strength

  • Flexibility and endurance

  • Cardiovascular fitness

• Use proper running technique.

• Wear shoe lifts (orthotics) if legs are not equal in length.

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■ ■ ■ Expected Outcome

This condition is usually curable with time and appropriate treatment. Healing time varies but usually averages 2 to 6 weeks.

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■ ■ ■ Possible Complications

• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• Chronically inflamed tendon, causing persistent pain with activity that may progress to constant pain

• Recurrence of symptoms if activity is resumed too soon, with overuse, with a direct blow, or if using poor technique

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. An orthotic (shoe lift) for those with legs of unequal length may be prescribed to reduce stress to the tendon. An injection of cortisone to the area of inflammation may be recommended. Surgery to remove the inflamed tendon lining or degenerated tendon tissue is rarely required and often only considered after at least 6 months of conservative treatment.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers are usually not prescribed for this condition. If prescribed by your physician, use only as directed and only as much as you need.

• Cortisone injections reduce inflammation. However, this is done only in extreme cases; there is a limit to the number of times cortisone may be given because it weakens muscle and tendon tissue. Anesthetics temporarily relieve pain.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)