Gluteus minimus tendon tear—update 3/25/2024

[Kyrabee]

I did look up an old thread on this subject but wondered if there is anyone else out there dealing with this?

My left lateral hip started hurting last September. Nothing horrible but persistent and no particular inciting incident that I can think of. I went on vacation and was able to walk 2 miles a day (1 at a time on the ) with no difficulty. However, once home and moving my horse to a barn that is on a hillside, things quickly got worse. Walking up steps or up hill was torture. Luckily, riding itself doesn’t bother it…one place I am mostly pain free. I finally made it to a doctor after the first of the year and he empirically treated for bursitis and tendonitis. A couple steroid injections (2 months apart) and they did help for about 4 weeks. I was also doing PT…have done 2 rounds with different PT practices. I tried PRP…one round. That is all I could afford and it did help maybe 20%. Not enough to pony up another $1500 for more. Finally got an MRI and I have a high grade tear of the Gluteus minimus. I think I read high grade means </= 70% is torn. It is not complete. Doctor I have been going to offered an open surgery. Bummer is I have a trip booked to Iceland next May that I really want to do so I need to be able to walk. I am also my 92yo Mom’s caregiver. Currently she is mostly independent but I do the house work and cooking. I will have to get some extra help.

I am going to speak to my PCP and ask him to recommend someone for a second opinion. I was hoping for a scope procedure. I personally don’t think steroids are great for tendon health. I know rehab would be the same and somewhat brutal. I have had pain for a year and probably the worst thing is how it affects my sleep. I am primarily a back sleeper but like to side sleep to give my back a break. I cannot sleep on either side currently and my back can only take so much pressure so I have been averaging about 6 hours of sleep/night…not enough.

Experience anyone? I am 67. I would like to be more active and sleep better than I have been able to be for the last year. Vacation is 7 months off. It seems like winter would be the time to get it fixed. I would certainly prefer a positive outcome. I don’t feel like continuing the way I am for another 20+ years.

Susan

[Simkie]

Where did they put the PRP if the tendon tear hadn’t yet been identified? It can only work where you put it, so it may be worth repeating, focusing it at the injury site.

I only know sort of tangentially that glute tendon tears are one of those things that skill of the surgeon matters A LOT and there aren’t many out there with much experience in this. I’d very highly recommend hitting up pubmed and doing some research yourself at who is really working in this field, and seeing them…which might require traveling.

Here’s one to get you started:

Endoscopic Repair of Full-Thickness Gluteus Medius and Minimus...

[Kyrabee]

Yes…I need to do a lot of research. I doubt anyone locally does many of these repairs. I don’t have a lot of $$ for more PRP. I guess if it might work when it is injected in the proper place, it might be worth another try. He was aiming at the bursa and that is probably why it feels some better because I have bursitis too and that is where the pain localized. The doc I saw was one of those that hurries you through. Probably haven’t been seen him for more than 30 minutes over 4 appointments with most of that coming from the PRP treatment.

I did this song and dance with my tailbone pain. It took years of trying to advocate for myself and insist on certain procedures to finally get the problem diagnosed and treated. I wish it was as simple as my other hip…just replace it!

Susan

[Simkie]

$1500 for the meh PRP that most surgeons use is a bummer. If you’d be willing to consider it again, I’d very highly recommend hitting up a Regenexx guy. All PRP isn’t the same, and the Regenexx process gives you a PRP with a higher cell count and better purity than the tabletop machines most surgeons use. You could spend about the same money (or less) for a much better product that’ll give you a better shot at success.

Where abouts are you in the country? With a quick look, it seems like there are a few guys working on this in Boston, and Nho and Domb in Chicago.

And just to ask–are you sure this isn’t a hip arthritis issue? It’s surprisingly hard to really assess the state of the cartilage. Has there been an intra articular anesthetic hip injection? It might be a good thing to at least cross off the list.

[Kyrabee]

I have mild arthritis in that hip. That has been confirmed with X-rays when I have had my yearly follow-up for my RTH. MRI stated same degree. MD said it is pretty normal wear and tear for my age. TH surgeon said I had quite a bit of mileage left on it. This pain is way different from arthritis and totally lateral…no groin pain.

There is a Regenexx in Idaho Falls…about a 4 hr drive. I would be tempted to try that before surgery so I sent through my info under am I a candidate? page so we will see. All we have locally is QC Kinetix. They are a big sell on TV. Awfully commercialized and from reviews I have read, big $$$.

Thanks, Susan

[Simkie]

From Idaho, Nho and team at Rush in Chicago are probably your closest best surgical option. A virtual consult might be possible? You could certainly ask!

I hope the Regenexx guy has some good news for you! I’ve had really good results with their PRP (after poor results with other PRP) … fingers crossed you have the same luck!

[hoopoe]

if you are talking torn tendon, discuss with a surgeon any data on the doing nothing approach. I tore deep flexors in my arm ( same grade as yours) due to an adverse event from an antibiotic I took, Nothing was done but rest 4 months then PT. It was so painful at the start that I could not open my car door latch ( pull against)

Mind you it is a far cry from a weight bearing limb.

When I separated my shoulder ( grade 3/5) with partially torn tendons, The surgeon said the outcome of surgery vs none was the same based on a very large study done with solders who got these injuries in basic training. Again rest ( first month in an isolation sling, even in bed) and my PT was to start pulling my bow and build up. It took a solid 6 months to get back to a reasonable ability level.

Recovery time of surgery and rehab vs no surgery… what data do they have?

also, while this may not be anything at all, consider what shoes you are wearing. is there any information on heel positive /negative aspect. I am not talking about pumps and heels. Some walking and running shoes put the heel slightly negative or positive. You might give Altra shoes a look;; neutral footbed and a wide ball area which allows the feet to spread. The minute I put them on it was angels singing. The pain in my foot from a fusing big toe is completely vanished. These might help balance and ease that hip area

[Kyrabee]

I suspect that my feet are a big contributor to the hip issue. I just haven’t found anyone that will address the whole person. I hate getting ‘parted’ out. I have had multiple tendon issues over the years and I don’t know why. I am sure it isn’t Ehlers Danlos syndrome. I am about as inflexible as they come.
I have tendinopathy in both feet. I think all but one peroneal tendon is torn to one degree or another. The right ones were surgically repaired and the left, I had a reconstruction to lower my arch and correct the tipping out. It did help but then I did something to the left, unrelated to the surgery and now have some mid-foot arthritis. I have a horrible time finding shoes and yes, need a very flat or neutral arch. I think I tried on some Altra’s but they weren’t wide enough. Yes I have duck feet and majorly over supinate. Brooks have worked out the best lately and they do have a few in neutral footbed and wide widths. I put some lateral wedges in them and then can walk OK.

I have contacted Regenexx per Simkie’s recommendation. Otherwise, yes, I think it will have to heal however it will. Surgery just does not sound pleasant and have enough success for me to try. It has already been a year. It is better than it was last winter and spring. But the sleep thing and not being able to lay on either side is annoying. I only managed 5 1/2 hrs last night before my back called it a night .

Susan

[Simkie]

While I totally agree that it’s worth exploring all conservative measures, surgical outcomes as reported in the literature are overall pretty positive. If conservative measures fail, there’s no reason to suffer.

Voos et al. reported that all 10 patients undergoing repair showed 100% resolution of pain and return of full strength in hip abduction at 25 months. Of the 10 patients, 7 reported that their hip was normal and 3 reported that their hip was nearly normal. Domb et al. showed an average improvement in patient-reported outcome scores of more than 30 points with satisfaction reported as good to excellent in 14 of 15 patients. Although this technique carries the inherent risks of surgery, it affords the opportunity for anatomic repair of abductor tears, which has been shown to decrease pain and improve function in the literature.

This is from here:

Diagnosis, Evaluation, and Endoscopic Repair of Partial Articular Gluteus...

Which is a pretty excellent overview.

Shane Nho is the first author, he’s in Chicago at Rush. His whole group is very good.

Ben Domb is also in Chicago.

James Voos is at HSS in NYC.

Also authoring that paper is Mather at Duke in NC and Salata at Case Western in OH.

Mark Nazal, lead author of this paper, is at Mass General in Boston:

Endoscopic Repair of Full-Thickness Gluteus Medius and Minimus...

He also had good outcomes.

In this study of 15 hips with full-thickness gluteal tendon tears managed endoscopically, we found excellent outcomes that exceeded the MCID thresholds in the majority of patients at an average of 31.2 months follow-up, while offering the potential advantages of less tissue violation, ambulatory day surgery, and fewer complications compared with open repair.

This is a pretty new thing, we’ve just been even identifying these tears over the last 20-30 years, nevermind fixing them. Skill and experience are going to matter a lot, so go to the guys who do them with frequency and get these good results.

Nho and Domb are closest to Idaho, and it’s nice they’re in the same city, you could get a couple opinions and decide which you like best.

Or hit up HSS. They’re the #1 orthopedic hospital in the country and are fantastic, they’ve got a really top notch hip team. I’ve had multiple procedures there, with the best doctors I’ve ever met.

Boston would be a train ride away, too, if you wanted a second opinion after being seen at HSS.

I absolutely would not use a local surgeon, though. Go to one of these guys/groups.

[Kyrabee]

Unfortunately, the elder care piece and the expense of finding caregivers and travel are probably the limiting step there. Not to mention I will have to hire caregivers for both of us for I don’t know how long (2-4 weeks?) It is kind of daunting. I do not have the bankroll to do that. I wish I did.

[hoopoe]

check out the shoes. For real I would have not believed it but the comfort in me feet was immediate.

remember the saying, no foot , no horse. It wont harm and could certainly go a long way to help balance and stabilize the whole leg.

[Kyrabee]

As above…the Altra’s don’t fit me unfortunately. I am currently wearing a Brooks with neutral insole and I have some On Clouds that are good. You are right…footwear if very important.

[hoopoe]

Ahh I missed the Altra mention. Difficult feet are tough to live with. It is hard to swallow the expense of some shoes

[Kyrabee]

No kidding. I used to be happy with New Balance but was lucky to get 3 months then they felt “broke down”. They just didn’t support my feet anymore. The Brooks, so far have held together better than most others I have tried. My barn pair are 8 months old I think and still supportive.

My PCP is referring me to a local surgeon that does a lot of complicated hip work outside of hip replacements. I will see what he says.

[hoopoe]

my favorite Altra model appears to be discontinued. It is a very low profile, casual, walking type shoe. I got them primarily for shooting because I need a level neutral footbed and want comfort and stability plus the ability to “feel the ground”. Reluctantly I ordered a running model and was happy that the footbed is level and comfortable. There is a slight loss of the feeling of being in contact with the ground ( thicker base) , but that might be a good thing for outdoors

the first pair is still going strong after 1 1/2 years of daily wear.

[Kyrabee]

Simkie, I failed to say thank you for all this info. Travel for surgery is a little overwhelming in light of the caregiving but I will note the information if the more conservative things don’t help… The hip is better than it was last Spring. It was torture at the barn where I had to walk uphill all the time. I’m guessing the anemic PRP (they probably didn’t draw enough blood) I did receive into the bursa in July helped the bursitis quite a bit. I will definitely work through Regenexx if I choose that route again.

[Simkie]

No worries, you’re welcome! I hope the Regenexx guy is able to help, I’ve really had fab results with it.

I hear you on wanting someone to look at the WHOLE person. Doctors–surgeons in particular–are so often SO laser focused and silo’d. A good PT can really help put it all together, but it’s often kissing frogs to find the right one. (Worth it, but so tiresome!) A top notch pain specialist can also be a great ring leader.

When you talk to your local fancy hip surgeon, don’t be afraid to ask who he fellowed with on this procedure, how many of these he does a year, and how he tracks his results. I know traveling for surgery can be a really daunting thing, but going to the best really does make a big difference. You only get one first time in here, every subsequent procedure adds scar tissue & trauma, nevermind the chronicity of pain & how that changes pain perception in your brain. So much better to just do it right the first time.

But hopefully conservative measures are all you need! Good luck!

[Kyrabee]

Well, the Regenexx price tag is kind of . Of course the rep on phone didn’t know what I would need (PRP vs stem cells). PRP was up to twice what I paid the local MD although I am sure the Regenexx procedure would at least get the stuff to the right place. The stem cells…6k to 7.5K. I have to ponder. I just had to have my roof replaced. Trying to stretch out my retirement money and not blow it all this early into retirement. But then if I can’t walk comfortably, the quality of that retirement is going to suck.

I will get it figured out. I know the technology costs but when it has to come out of pocket I have to figure out how.

[Simkie]

They’re quoting you $3k plus for PRP? I’m always amazed at how much this varies. In my very high cost of living area, my Regenexx guy is $1500 ish for PRP, which is the same as the PRP the surgeon offers. But the surgeon is using the Arthrex platform, which roughly doubles the platelet concentration, where Regenexx is concentrating it 20X.

I always encourage going with PRP first. It’s very often successful, and man… the cost of stem cell is downright eye watering.

[Kyrabee]

Yes…I will probably fork over the $200 for an evaluation…rep wasn’t sure if they took Medicare. Insurance will pay for that part but she didn’t know about Medicare…they probably don’t because Medicare pays squat.
Then I will know for sure. She gave me a range but seems hips are more? I know the joint is bigger but this issue isn’t the joint.