Physician Maxim Healthcare Surprise, Arizona, United States
Case Diagnosis: Gluteus medius and minimus tear presenting as lumbar radiculopathy.
Case Description: A 75 year-old female initially presented with back pain radiating down her posterior thighs to the knees. MRI of L-spine showed spondylolisthesis with severe canal stenosis at L4-5 and she underwent L4-5 ILESI.
However, she returned within 2 months with no improvement, worsening low back pain, and tenderness at the bilateral greater trochanters. Despite ongoing PT with a focus on hip strengthening, she returned one month later with left hip weakness and reported a sensation that her hip was being thrust laterally when walking.
Exam was notable for left gluteus medius weakness (2/5), positive trendelenburg sign and negative Stinchfield, SLR, FABER/FADIR bilaterally. All other lower extremity muscle groups were at least 4+/5. MRI of Pelvis confirmed chronic full thickness rupture of the left gluteus minimus and lateral facet gluteus medius attachments at the left greater trochanter. Treatment included conservative management and a referral for orthopedic surgical repair.
Discussions: Gluteus medius and minimus tears are closely associated with chronic lateral hip pain and weakness, or greater trochanteric pain syndrome (GTPS). The prevalence of GTPS is estimated to be 10-25% of the population, however the true incidence of tears is unknown. Their etiology can be attributed to chronic degeneration of the trochanteric enthesis which results in tendinopathy and ultimately tearing at the attachment site. Although these injuries are commonly linked with GTPS, they can be misdiagnosed as lumbar radiculopathy due to the anatomic overlap of the iliotibial tract and lumbar dermatomes. Initial treatment for gluteus medius/minimus tears is usually conservative however surgical intervention may be required.
Conclusions: This case demonstrates an unusual presentation of a gluteus medius and minimus tear mimicking lumbar radiculopathy and highlights the importance of considering alternative diagnoses to initiate appropriate workup, rehabilitative therapy, and symptom management.
