ABDUCTOR ENTHESOPATHY: A DISTINCT ENTITY? HOW TO MANAGE?

Abstract

Introduction: We present here the clinical features and management strategies of patients with gluteus medius and minimus enthesopathy.

Methodology: We studied seven patients with lateral hip pain and tenderness on palpation, worse over the tip of the greater trochanter. All of them had a positive Trendelenburg’s sign, and a transient relief of pain on injecting local anaesthetic in the abductor mechanism. All of these patients were tertiary referrals from the rheumatologists, who had at least once injected them with corticosteroids.

Results: Four of these seven patients underwent exploration. An insertional tendinopathy of the abductors was noted in all the patients, and was debrided. Two of the patients had, in addition, a tear in the gluteus medius tendon, which was repaired. One patient had an injection of local anaesthetic and Aprotinin in the abductor mechanism with resolution of symptoms.

Discussion: Gluteus medius and minimus enthesopathy is a distinct clinical entity. Although the condition has been described in the radiological literature, we were unable to find any reference to the orthopaedic management of this condition. We observed only a small number of patients, and we are thus unable to provide definite answers. Patients presenting with the above clinical features warrant consideration of the diagnosis of abductor enthesopathy. Ultrasound scan or MRI scan helps in confirming the diagnosis. At present, our management protocol involves injecting a local anaesthetic / Aprotinin in the abductor mechanism. However, we are cautious in injecting more than once, as, at operation, we have observed necrosis of the abductor mechanism at its insertion in two patients, similar to that described for Achilles tendon. If this fails, we undetake surgical exploration. The exact surgical procedure is difficult to predict and may involve debridement and repair of the pathological tendon.