Partial (high-grade) gluteus medius tear
Posted , 53 users are following.
Wrote in weeks ago, but maybe I was on the wrong discussion group - but would love to hear from anyone who had an accident and partially tore the GM tendon. It certainly interferes with a lot, and they don't like doing surgery there, but was a jogger for 25 years, yet now it hurts to walk. Thus, I'm headed to another kind of physical therapy, with deep massage and yoga, but it's hard to have much hope, after doing the same for over a year.
Thanks for any responses, -Annie
1 like, 113 replies
MSPS annie2418
Edited
Annie, years ago I hopped out of the car of the drivers side, and even though the car was in park it slipped to neutral catching my right foot and dragged me across the street (wide street) and because our driveway sits on an incline the car was moving quickly pulling me across then back across the street. It finally slowed enough that I could get out from under the vehicle. I had to have surgery to repair the foot but I was not having hip pain then.
After having the surgery, while my foot was in a boot i began to experience what I thought was a torn groin. It would nearly bend me over then disappear to come back again several months later. As the pain became more frequent my doctor thought it was from my back so to make a long story short the pain steadily increased until now at roughly eleven years later I am miserable , can't sleep in bed, and have excruciating pain 24/7. I see my Ortho next week to see what his response is. He is quite arrogant and didn't think there was anything wrong with my hip so it will be interesting to see what he has to say.
I wish I had an answer for you but I am trying to validate your experience and the gradual progression of it, particularly the long period of time before the onset of severe pain that requires prescription meds. As a person that has had chronic pain and surgery on every part of my body including eight back surgeries the best advice I can offer is that YOU are the only one who lives in your body so you need to find a doctor who will listen to you. The medical field is going to hell in a basket (too long to explain) so you have to keep track of your symptoms when, what, where, what makes it better/worse, how long does it last and so forth. While you may think something sounds ridiculous or silly to you write it down anyway. Keep a diary, of what I said above, who treated you, did it help, why not, what do you do to make it better. Even if it sounds stupid the best thing you can do is to keep a detailed history including any surgeries, hospitalizations and who did them, what did they do, and what medications you took. Save everything because it will be a legal diary should you need it. Actually you should get a copy of the hospitalization and separate doctors note as well. Do this for each incident you need surgery. This is a good thing to do with family members too! Actually one of the nicest things a person can give as a gift is a notebook or binder to keep their medical history in and if it for your children they will love it particularly as time goes by. This also applies to mental health experiences and to be thorough how social behaviors in school affected them.
I know this sounds tedious but it will give you a wonderful picture to your doctors and your family.
I am going to see my surgeon on Monday and I will let you know what he says so I can report new information to you. By the way, do not just go to any doctor because that's who they referred you to. The best thing you can do is listen to what other people say, and in this particular incident word of mouth is the best way to find a doctor. It should be a sports medicine doctor, orthopedic for this incident and then talk around and listen to what people say about them before you choose. I am not sure about how large a town you are in but even if you have to commute to get to the right doctor, do! It is worth a commute for a good doc and the ease of mind it provides. I guess that is all I have to say except hang in there, let your body speak to you, and find a doctor who inspires confidence in you and does not minimize you.
I wish you the best,
MSPS
pauline133 MSPS
Edited
Hi, I have been reading the comments (not all, didn't have the time) but in case any of you are still reading this thread I would just like to add my experience.
For several years I had bursitis in one hip after the other with shortening spells of pain free walking. I had steroid injections under ultra sound to no avail. More and more physio ordered which I was convinced was making it worse. Eventually my pain management GP (I'm in the UK), referred me to a Hip specialist surgeon. He also ordered physio but then decided on an MRI when I said it was getting worse, not better. He phoned and ask for me to return to see him and said I had 2/3rd complete tears in the gluteus medius, both legs and he suggested an operation on the slightly worse leg and if successful, he would do the other. It was a private hospital but were able to take NHS patients if they felt it was appropriate. I had my surgery on 20th Dec 2018 was home within 3 days, 6 weeks on double elbow crutches, partial weight bearing. Strict instructions on what movements I couldn't do for 4 & 6 weeks and although painful, at 6 weeks able to walk without crutches and with 4 months had wallpapered a bedroom and two hallways. I'm 75 so not bothered about being able to run, just to walk with improved pain relief was great and could climb stairs without doing it on all fours. Two weeks ago had second surgery and am struggling a bit this time, UTI's then bad case of hives, painful wound area but no infection so have slowed my physio down, resting up until it settles but I am very optimistic that by this Christmas I will be well on the way to a pain free future. My surgery was called a Tendon reconstruction and consisted of using harvested achiles tendon which is cut into strips and attached with screws to Trochanteric woven into the gluteus medius. I have the paperwork for anyone wanting proper details. It is a rarely carried out operation and none of my nurses or physios have dealt with patients having had it so it was a learning curve for us all. Apparently my surgeon has carried out over 5000 hip replacements but only 10 of the tendon repairs. I don't recall reading anything on this thread about a similar operation, forgive me if I'm wrong, I could have missed it. Good luck to you all.
dawn34084 annie2418
Posted
Four months ago I was scheduled to have a procedure done on the ITband. The technical term was (iliotibial band window over the greater trochanter/ Then a trochanteric bursitis was done-removal of the bursa sac.
I had had 3 years of constant hip pain when walking. I have tried a myriad of things, many of which have been mentioned.
To make a long story short after the hip procedure it simply was not right. I couldn't walk normally on it. If I tried to stand on one leg, the hip would twist out and collapse. That is what I felt every time my rt leg has all the weight bearing on it.
The dr follow up was 2 months later....physical therapy....2 months. On the first day of pt the physical thearapist recomended using one cruthch on the left side. What a difference that made in my back and hip pain. No one had mentioned that to me 2 months out from my first procedure. Then one pt even comented that it was in my head. I totally lost it. When you have pain for 3 years, you do start to think it is in your head. I knew that was incorrect in this case because I could squat no problem, do other things as well, just not walk without a crutch.
Finally, after 2 months of pt, the dr confirmed something was not right and ordered an MRI. Findings: Complete tear involving the gluteus medius tendon just proximal to its insertion on the greater trochanter and fluid filling within the tendon.
Obviously I am frustrated that I did all the pt and exercises that may have caused further damage. I am fine with having surgery again for tendon repair but would like any input oe what to expect from others that have had this procedure done as well. Surgery is scheduled for Jan. 30th. Any thoughts on how many days one should take off work? I walk a great deal during the day.
Any feedback would be greatly appreciated.
Sincerely,
Dawn
mike30605 annie2418
Posted
Hi Annie. I just discovered this discussion group & am so glad I did. I have been suffering from right hip pain for over 10 years. Was told by a specialist I had bursitis and for many years my pain was controlled by cortisone injections. Seemed like I needed them more frequently and eventually they quit working altogether. Extremely painful, especially at night’ no matter what position I slept in. Ended up going to a DO who ordered an MRI, which revealed I had a partial tear of my Gluteus Minimus and tendonopathy. He suggested PRP injection and PT. Been 4 months and there has been improvement thanks to an excellent PT. I still walk with a “John Wayne Swagger”, but not much daytime pain. Just weakness on that side. Nighttime pain still there, but not as bad. My DO said my tear is substantial and may not heal. Said I needed to strengthen quads and Maximus and medius muscles to make up for Minimus weakness. Working on that, but fear I may aggravate my tear. My PT, who I totally trust, said to trust the process. No Dr has talked surgery. Not sure I’d do it unless it became much worse. Good luck to you Annie.
lynda0808 mike30605
Posted
annie2418 mike30605
Posted
Hi Mike, and all of the folks who've written in about the gluteus medius tear. First, I apologize for being so tardy in replying, but we've had some extended (older) family illnesses - so that took priority, such that I wasn't even looking in on this old thread. In any case, I feel for all of your concerns, but have learned the the GM tendon is so pivotal in everything we do (they say it's analogous to the rotator cuff in the shoulder) - and although I didn't feel anything for a few week, when it did kick in, my low back was throbbing intensely. It's now about 2.5 years, and although some quacky PTs say we can "bang" the scar tissue out, that's pure myth. And we all know that tendons don't heal well because of a having a low blood supply and being so pivotal in so many functions. Eva in Australia had surgery about a year ago (and is doing VERY well), but due to some curvature in my spine, about 25 degrees (which isn't a lot to the human eye) - they say it makes a person "load" left and 'rotate' a bit - which I still don't get. All I know is that for a while, I couldn't walk up stairs well, and there was a somewhat 'antalgic' gait - but one doctor thinks that the scar tissue provides some stability in its way - vs. what a tendon tear would be like without it (i.e., MUSH, in the part in which it was affected). Sleep is terrible, especially with throbbing that never stops, and then standing w/o pain is next. However, sitting is okay, and that relates to what I do for a living (writing academic grants and editing manuscripts).
BTW, I think we all need to develop more core strength, and though I used to be an excellent swimmer, just walking in a pool without any weight-bearing stress led to severe sternum pain - which one spine doctor said was from the rotation of the curve. They've tried many epidural steroid injections on me, all to no avail, since I seem to fall into the 45% whose body cannot absorb them. And although Eva did wonderfully with surgery, my curve probably wouldn't allow the screws and hardware to stay in place (not to mention loading L, which could probably disrupt the healing and retear it). I was pushed to do PRP, but I know 50 people who did without any success for many body parts - and I've read many articles on PubMed and nih.gov that call it a scam (even the NY Times)!
In any case, it seems that these kind of injuries take a toll on 'quality of life' - because without normal sleep, your life seems to revolve around the tear. One neurologist said that it's such a critical tendon, that it stabilizes the pelvis - so it's hard to even assess how much is amiss because of it. In the beginning, they took x-rays to rule out any factors of the coccyx or tailbone - but those were fine. And I wasn't savvy enough to ask for soft imaging - until a year later, when I knew that the throbbing was telling me something - and that's when the partial tear was found. Still, steroid injections and PT have not helped a bit - so maybe for me, it's been time, in the sense that there's no antalgic gait anymore, but I do still have throbbing in the low back (which could be from a host of issues, especially the curvature). The idea is that I was "out of whack" to some degree, and then the GM tear just threw everything out even more. I see that Lynda below is writing about full GM tears, but that wasn't my situation, even though it felt that way.
As we all get older (mid-40s now), wear and tear and micro-tears can do a number too - and some spine physicians think that even without my storage bin collapse (the event that seemed to elicit it) - it would've happened sooner or later anyway. Who knows, but trying to live with it has been the most unpleasant pain I've known - and as mentioned, steroid injections do. nothing for me, and I really shouldn't have surgery. So as they say, I'm caught between a rock and a hard place (as they say) - which we probably all are to some degree. And even though philosophy 101 in health matters tells us that the body tries to heal these things, I think that tendons are special issues (a long enough tendon is so strong, that it could hold a small car up in a tree) - but a damaged tendon can truly turn to 'mush,' hard as that it is to say. Not ALL mush, since there's some tendon left that can regenerate, and although they're all pushing PRP, and now Tenex (no independent studies have been done on it) and stem cells - stem cells need a number of years of being refined before they can safely be given (even though clinics are springing up everywhere, but it can cause a number of problems if you guys want to read up on, or a tumor called a teratoma). So I'd stay away from all these things until they're refined. PRP is not even clear yet on the optimal amount of platelet cells to administer - so if they give too little or too much, it probably won't do a thing. Plus, anything injected into us is perceived by the brain as an injury, and certain chemicals and collagen go to the injured area (from the supposed solution, not even the original tear).
It has definitely made a mess of things, and no analgesics do a thing for me either - so sometimes it just simply elicits tears. In any case, until I learn more, please feel free to write and ask away. I do know about the IT band and the piriformis and the glute max, and the like - but I've come to feel like a specialist in GM tendon tears which I've seen can wreak so much havoc. The body and brain are meant to try to heal themselves - but I've had wrist fractures from jogging at night (straight into pot hole) - and they heal fine. So I think that tendons are a very fine-tuned part of us that have special jobs, without which they can inflict so much suffering. Still, my regular doctor knows how I describe the suffering, but he says that the scar tissue alone may be giving you more stability in the area than you know. Plus, don't forget that SURGERY comes with plenty of risks too, which is why so many surgeons specialize in "revision surgery" - so it boils down to persistence and reading on our own and being very careful with what's being promoted. I actually think that surgery can cause more problems than what we might each be facing - but from the other side, it often feels as if we cannot live with it either. So what's the answer, since pain is basically intolerable - and as I wrote earlier, can deplete most of the QoL we used to know.
Would love to hear from all of you, and I'll do my best to answer what I've come to understand - but all the old consumer warning comes into play: BUYER BEWARE, especially since these clinics for PRP or Tenex or stem cells are springing up everywhere, since they know desperate people will do much more than they should. I've worked with a hospital Pain Mgt. department - and although nothing has gone wrong, nothing has helped either.
Hope to hear from you guys soon !!! -Annie
hobbette mike30605
Posted
Hi Mike,
ive just found this forum and wondered if you are still here? ive finally been diagnosed with Gluteal tendinopathy early 2020. since covid lockdown i wasnt to see any pt except doing the glute strengthening at home. glad to hear its working for you. can share the exercise you are doing please?
mike30605 hobbette
Posted
I had a PRP injection first, then underwent extensive and rigorous PT. After several months and lots of hard work, I am symptom free.
julianna73035 annie2418
Edited
Hi Annie,
I am so happy to have found this group! I had a series of two snowboarding accidents in 12/15 and 1/16 and unsuccessfully tried to PT my way out of my injuries. After a year and a half I finally had appropriate imaging ordered which showed bilateral labral tears (hips), a proximal hamstring and glute medius tear on the right leg. I also had a full thickness supraspinatus and ulnar collateral ligament tear on my right shoulder, axillary cording from axila to fingers and long thoraric nerve damage. I did 5 PRP treatments on each area (22 treatments in total) and had shoulder surgery in 8/17. I was set to have a repair on my glute and hamstring in December but wanted to try stem cells first. I did umbilical stem cells in both the glute medius and the hamstring about 6 weeks ago and still haven't had any improvement. I still drive with my left foot, am unable to take my dogs on walk/hikes, can't exercise or teach fitness classes, no winter or summer sport, unable to comfortably have sex.
I have been an athlete my entire life, exercising 1-2x/day for almost my entire life. This past 2 years has been a nightmare - I couldn't sit down for about a year and have done 3-5 day a week of PT for the past 2 years. I also have hypermobility so I feel like without either girdle (hip or shoulder) stable and both external rotators injured, I can't gain any real traction. I feel like I am on a hamster wheel and am now revisiting the idea of surgery. The only thing that's deterring me is looking at the extensive recovery and my job...
I am in California and the only orthopedic clinic that was open to surgery is Kerlan-jobe in Los Angeles. They proposed to do both surgeries in one visit, re-positioning me in the middle of surgery. I am a senior executive and I am concerned about how I will be able to function and how much time I would need to take off.
This has been a major disruption to my social, sport, sexual and activities of daily living.
Questions:
Do those of you who have had surgery, feel like it was a better outcome than without?
How many of you did arthroscopic repairs (vs open)?
Did anyone else experience pelvic manifestations due to their injury?
How was recovery compared to living with the injury?
How long until you were able to return to work?
Thanks in advance for any answers, insight or feedback you may have. This has been a lonely journey and I'm glad to find other that have had this experience and found solutions.
mike30605 julianna73035
Edited
julianna73035 mike30605
Posted
How did your visit go? What's your next step?
mike30605 julianna73035
Posted
annie2418 julianna73035
Posted
Hi Julianna: When I read your post, I felt very badly for all the injuries you've incurred from the snowboarding accident. Everyone seems to agree that the more we do, the more likely we are to be injured - but it can nevertheless make me cringe for the pain we each have. You wrote about the bilateral labral tears (hips), a proximal hamstring and glute medius tear on the right leg - and that you also had a full thickness supraspinatus and ulnar collateral ligament tear on your right shoulder, axillary cording from axila to fingers and long thoraric nerve damage. Also, that you did 5 PRP treatments on each area (22 treatments in total) and had shoulder surgery on 8/17. I was set to have a repair on my glute and hamstring in December but wanted to try stem cells first. I did umbilical stem cells in both the glute medius and the hamstring about 6 weeks ago and still haven't had any improvement.
I would love to try stem cells as well, but they say that refining the process is at least 5 years away (to preclude teratomas from forming, etc). Umbilical stem cells would seem to simulate embryonic stem cells most closely (esp. if it's from an embryo - but that seems to be frowned upon in the US even if couples are discarding their overproduction of embryos from IVF treatment. If I may ask, where did you find the umbilical stem cells, and do they tend to be safer than stem cells from adipose tissue in our abdomens. I feel conflicted, not on an ethical level, but sometimes treatments of any kind can cause more problems than success - as I guess you're experiencing too (surgery being the worst, as I wrote the other day, since "revision surgery" is a big field in this country - so they must not be doing it correctly the first time, and any revision is inherently more problematic than the first time around. Eva-Oz had a good surgery the first time and is doing quite well, but if there are any comorbidities - it would seem judicious to go slow and easy.
I was pushed to do PRP, but refused - in that they still don't know the optimal level of platelets to used for it. I would love to try a safe form of stem cells, but the research is not at that point yet. Have you heard of Tenex, in which a hot-tipped ultrasound is used to destroy the injured tendon or muscles, and then allow the normal part to regenerate - but there have been no controlled or placebo-based studies done on it. Thus, my feeling is that it could cause more harm than good (have talked to a few people who had disasters from it - as it's mainly used for tennis elbow and knees, but one guy had it done for plantar fasciitis, another issue some people face in the foot. My gosh, what's that expression: "What can go wrong, will?"
I've heard many times that any injury to the gluteus medius tendon can destabilize the pelvis, and that may be why my throbbing continues. What do you think in your case, or maybe it's a host of issues all coalescing to cause pain in a number of places? I have not done any surgery - since as I was saying, too many people are going back for revision surgery (not a good sign) - and some confounding factors in me could make any surgery on a musculoskeletal issue become even worse.
I've been a 5-mile per day runner since college and grad school, but due to this tendon injury, I look out the window and watch people walking briskly or jogging - which makes this an extremely lonely journey, as you wrote - since all QoL has been undermined in a maximal way. So please let me know anything else on your mind and we'll hopefully come up with some answers. The Hospital for Special Surgery in NYC is supposed to be the BEST hospital on earth for what you've described - but it'd be on the other side of the country, not to mention that insurance will likely not pay for any procedures. Another problem we all face, but pain can be so detrimental to our lives, that I'd rather use whatever money I do have and get the most reasonable help possible - and even then, we can never know how we'll react to any procedure.
Try to keep your chin up, because until we each find some lasting solutions, what else can we do - since panic raises its ugly head often enough, yet I realize that won't help anything either. Hope to hear from you soon, and if you have any thoughts about the umbilical stem cells and why they didn't help yet, I would be extremely interested in hearing your perceptions about it (and/or what the MDs said). All my best, -Annie
julianna73035 annie2418
Posted
Annie,
I completely relate to your statements re: QoL and going from being an athlete to this... I am determined to get back though so keep my focus on that.
The umbilical stem cells came from a bank here in the US. The rationale is they're closer to embryonic in age and potency whereas my stem cells (from adipose) would be 41 years old and potentially less potent. I do feel like I was able to get a little more stability after the gluteus medius injection and the outcome probably would have been better had the doctor injected under ultrasound guidance. I feel that my situation is exacerbated by the fact I have a proximal hamstring tear also on my right leg. I feel the if I only had one or the other, it'd be easier to address. I went ahead and had both injected and the physician followed up to see about doing a second but honestly, I can't rationalize the money at this point.
I agree this injury has the potential to destabilize the pelvis and create a cascade of effects. I am also extremely hypermobile and they believe there's an underlying connective tissue issue such as ehlers-danlos. I don't know if that is the reason or because I am so deconditioned but with these issues, my core has become completely destabilized and my transversus abdominis is non-functional. Has anyone else experienced this?
For me, the underlying connective tissue issue would be my concern with a procedure such as Tenex. Do you know if that is offered in combination with stem cells?
Anyway, I feel that one of the biggest challenges at this point is trying to figure out whether I pursue surgery or live with this as-is... I have a very demanding job (coincidentally in IVF) and will not be able to take the time off advised to recover from the surgery in the near future. This is why I am so curious about the outcomes for those of you who have undergone the surgical procedure.
How was recovery? Are you better or worse after surgery? Was the procedure done open or closed? Did you have any other issues from the injury (pelvic or GI) that improved as a result of surgical intervention?
I am confident about Kerlan-Jobe's ability, more so than anyone else on the west coast - I am just trying to figure out the logistics of if, how and when.
Good luck to those of you still on this journey. It's so helpful to read others stories as this is such a lonely journey. Please continue to post progress, feedback and any tips you come across.
nerv66102 annie2418
Posted
were you able to walk after the tear?
annie2418 nerv66102
Posted
Hi nerv66102 -- the odd thing was that I was able to run up and down stairs for the first 2 months and thought that since the X-rays showed no fractures, I was "safe." However, probably all the activity I did only made things worse - but at the time it occurred, it only hurt really badly from the 1 foot fall into the storage bin on which I was sitting (hugging my new puppy) - and then it was a slower process until severe pain kicked in with the low back throbbing (e.g., a few months). Since then, no medical procedures have done a thing, and although I worked hard in PT, I have some doubts about that too. Swimming or even walking in a pool would be good for most people, since there is no weight-bearing and the water provides its own pressure, such that we ARE getting some exercise at the same time. Pushing a shopping cart also helped me, as it allows us to get some support, and my doctor said it opens the vertebral foramen from which the spinal nerves are trying to exit. My gosh, we are complicated organisms, you know.
Let me now how you're doing, and will try to write as often as I can! What is the worst pain you have now? I'd suggest a good Pain Mgt. Center in a hospital, but they usually stick with a protocol of steroid injections - which I only hoped would elicit some relief, so that I could engage in PT more actively.
Such a vicious cycle, but knowing you're not alone helps a bit (I hope), -Annie