Treatment of Gluteus Medius Tear

Diagnostic Confirmation

The American College of Radiology recommends initial imaging with standard hip radiographs to exclude bony pathology, followed by non-contrast MRI of the hip as the definitive diagnostic study, with MRI sensitivity ranging from 33-100% and specificity of 92-100% for detecting tears 1, 2
MRI can assess critical prognostic factors including tear size, degree of retraction, and fatty degeneration, with evidence supporting its use as the mainstay for evaluating gluteus medius tendinopathy 1, 2, 3, 4

The American College of Surgeons recommends surgical repair as the preferred treatment option for acute full-thickness tears, with optimal timing within 3 weeks of injury producing superior outcomes compared to delayed repair, and early surgical intervention preventing worse outcomes from tendon retraction and fatty degeneration 1
Conservative treatment may be attempted for less than 6 months only in highly select cases, including patients with minimal functional deficit, no Trendelenburg gait, and strong preference for non-operative care, with a treatment plan that includes activity modification, physical therapy with eccentric strengthening of hip abductor muscles, NSAIDs for pain management, and cryotherapy for acute pain relief 1

The American Academy of Orthopaedic Surgeons advises against delaying surgical repair beyond 6 months or waiting for Trendelenburg gait to develop, as tendon retraction and fatty degeneration are poor prognostic factors for functional outcomes and tendon healing, and against repeated corticosteroid injections, which have deleterious effects on tendon substance 1
The American College of Sports Medicine recommends avoiding direct injection of corticosteroids into the tendon, instead injecting into the peritendinous space 1