Epidemiology Gluteus medius pathology
|Gluteus medius pathology||In biomechanical terms, the gluteus medius can be seen as a part of the abductors, or the rotator cuff of the hip “, just as the rotator cuff of the shoulder.|
|Incidence||Etiology of the gluteus medius tendon tear remains unclear. One factor might be tendon impingement caused by undersurface trochanteric bony overgrowth. Another consideration is lateral degenerative wear from fascial friction. Only further research can complete our understanding of gluteus medius tears.4|
|Function||Functional evaluation of the hip abductor muscles with use of MRI or EMG shows that the gluteus medius and the gluteus minimus, play an important role in hip abduction, and stabilization of the pelvis during walking and standing.1|
|Pain location||Hip joint / greater trochanter / Pelvis and RPP into the leg|
|Pain sensation / Symptoms||Tenderness and increased soft tissue density noted when palpating the lateral hip area over the gluteus medius muscle, located above the greater trochanter of the femur.|
|Pathology||The abductors group are essential for walking, resulting in inclination of the pelvis on the leg where weight is taken. This component of hip biomechanics is the basis of the Trendelenburg’s sign.2When there is a gluteus medius / minimus dysfunction, the pelvis of the leg where weight is taken stands up and the side where no weight is taken stands downwards, a positive Trendelenburg sign is present.3In the diagnosis of a tear in the gluteus medius, it is important that osteoarthritis of the hip is excluded.|
|Prognosis||With gluteus medius strain, the majority of individuals improve with conservative treatment. If surgery is performed for a gluteus medius tear, one study reported excellent outcomes at approximately 2 years after surgery, with 70% of individuals reporting a normal-feeling hip, and the remaining 30% reporting a nearly-normal hip.7The low rate of gluteus medius tendon tears recorded during primary THA, 1.6%, is considerably lower than the 22% reported by Bunker and colleagues5and the 20% reported by Howell and colleagues.6|
|Nerves of the plexus sacralis|
|Nerves||Segments||Innervated muscle||Skin leaves|
|n.gluteus inferior L5-S2||L5-S2||
|n.cutaneus femoris posterior||S1-3||
– nn. clunium inferiores
– rr. perineales (sensibel-innervation)
|Direct leaves from the plexus|
|n.musculi obturatorii interni||L5-S2||
|n.musculi quadrati femoris||L4-S1||
|Motor-innervation area of the n. gluteus superior|
|Along with the same vessels leaving the n.gluteus superior leaves the pelvis through the foramen suprapiriforme. The nerve passes through the Spatium intergluteale and innervates the small gluteus muscles (gluteus medius and gluteus minimus) and the tensor fascia latae.|
|Signs for weakness of the small gluteus muscles: Trendelenburg sign and Duchenne gait|
- Anatomische atlas, prometheus. Algemene anatomie en bewegingsapparaaat. Michael Schunke, Erik schulte, Udo Schumacher, Markus Voll, Karl Wesker. p: 476
The implementation and scientific evidence of the two main tests, are described in the EBP header which can be found below.
For testing inspection visual imagery has been collected.
Trendelenburg sign + gait/ambulation/walking (visual information)
Evidence Based Practice
|Quadas: Quality Assessment of Diagnostic Accuracy StudiesThe Quadas helps the reader to get clarity about what BIAS in a study had influence.WhentheQuadasscore is low, there shouldbecriticallylooked atthevalueofthestudy.The Quadas consists of a scoring system of 14 points that being tested.|
|Trendelenburg’s Sign||Utility 2|
|Study||Sensitivity||Specificity||QUADAS Score 0-14|
|Bird et al.4||73||77||11|
|Comments: The test is performed while standing and confirmed during the gait analysis.|
|Resisted Hip Abduction||Utility 3|
|Study||Sensitivity||Specificity||QUADAS Score 0-14|
|Bird et al.4||73||46||11|
|Comments: Weakness is not a positive result in this test. The low specificity is due to the testing of multiple disorders by this test, such as bursitis and tendinitis abductor.|
|1.The patient lies on his or her side.
2. The therapist will instruct the patient to make 45 degrees of abduction of the leg.
3. The therapist provides resistance to the abducted hip.
4. a positive test is a reproduction of the symptoms during the test.
Physical examination results. The sensitivity and specificity of the clinical signs in predicting a gluteus medius tear (partial or complete) were assessed using MRI as the surrogate gold standard. A positive Trendelenburg’s sign provided the highest sensitivity and specificity overall. The results were as follows: Trendelenburg’s sign sensitivity 72.7%, specificity 76.9%; pain on resisted hip abduction sensitivity 72.7%, specificity 46.2%; pain on resisted hip internal rotation sensitivity 54.5%, specificity 69.2%.
The intraobserver reliability (kappa score) for each of the 3 physical signs was calculated. Trendelenburg’s sign demonstrated the highest intraobserver reliability. Kappa scores were as follows: Trendelenburg’s sign 0.676 (95% confidence interval [95% CI] 0.270, 1.08), resisted hip abduction 0.625 (95% CI 0.155, 1.09), and resisted hip internal rotation 0.027 (95% CI −0.016, 1.10).