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    Old 11-21-2010, 09:41 PM   #1
    Lynne720
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    gluteus medius tears

    Has anyone here been diagnosed with a partial tear in the gluteus medius? My boyfriend had a THR in 2008 and hasn't been the same since. It hurts him alot when he walks and feels that its instable. An ortho at Columbia Pres. here in NYC sent him for an ultrasound which shows a "suggested partial tear in the gluteus medius". The surgeon said he can fix it by using donor tendon/muscle (not exactly sure of all the donor parts he uses). He said its not a very common surgery and its supposedly not even a procedure done at ***. Its a tough recovery..one month with hardly any weight on the leg and using a walker. We have a lot of stairs at home so we aren't sure how he will manage this. Is there anyone here who has had this surgery or a similiar one? I really want to try and find out as much as possible. I have a call into the surgeon. Thanks.

    Lynne

     
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    Old 12-13-2010, 03:34 PM   #2
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    Re: gluteus medius tears

    I have no personal experience with this but, there is a 4 yr thread on this in this web site. It was discontinued this year. If you can find it it has quite a bit about various treatments and surgeries. In general my take from the thread is that the condition is underdiagnosed/missdiagnosed and finding Dr with expertise/surgical experience is difficult. Many of the posters who had surgery had rather lengthy recover times.

     
    Old 12-21-2010, 09:57 PM   #3
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    Re: gluteus medius tears

    Hi

    From my limited vantage point, it would seem to me very strange to utilize donor tissue for this repair, so it sounds as if the surgeon does not expect much viable tissue and there's probably not a lot of prior research on how to circumvent that. Columbia Presby is really on the cutting edge in many areas (no pun intended), so there may be zip data outside a very few surgeries, not easily accessible to the public as the results may not even yet be published.

    If you want a second opinion, there's a doc in NYC who people are willing to fly out to due to his high expertise in this area and who might provide an informative second opinion. His info is given within the beginning posts of the older thread' started by 'Tomorrow'. I noticed you're a senior member, so I don't know if you've accessed the long thread yet--it does not have any references to the use of donor tissue, but there is a lot of relevant and helpful information. I do think you're going to have to find a solution that doesn't include using stairs for at least a few months, but your surgeon will help you our with those issues.

    The following doesn't relate to your question but gives a sense of what I'm learning in dealing with my own problem. I thought of starting another thread, as there are more of us who need to learn ongoing developments on this topic, but I think your post was a good way to re-start one, although the tissue grafting (?) is more specific than most people can address. I'm too new to know how this works.

    I just joined tonight and am in the process of finding competent covered, repeat covered, treatment for a gluteal tear. (I felt really bad for the poster who is now uninsured and plan to post privately with some suggestions.) I have no family or real friends where I am living--hard to make friends when you're housebound--but am too compromised to move back to where my friends are, although I may have no choice. I can't even go food shopping without feeling like I'll pass out right now. (I do have two lovely Hungarian Sheepdogs, one--the 110 lb. Komondor--is probably implicated in my bilateral shoulder injuries, as well as the probable gluteal tear. Neither tolerates less than complete subservience to their needs.) In reading of the recovery process from the several treatments that posters have undergone, I'm really getting frightened, but the pain has become really unbearable and relentless.

    The MRI of my pre-op L shoulder completely missed the 'significant' chondrolysis and labral tear, in addition to the expected findings, which enchanted (not) my surgeon during an arthroscopic repair. The R shoulder MRI does note the labral tear in addition to the tendon tear, etc., without mention of severe chondrolysis and my doc has this false hope that the surgery in Jan will not be so bad. I had an MRI of my hip on the 14th with several findings, tendinopathy, bursitis, subchondral cyst, and some unidentifiable little bugger. The info provided on the shoulder was simply to indicate that I don't have massive faith in MRIs, as actual op findings seem to be at frequent variance with them, and I think the consensus is that clinical findings are more accurate in diagnosing hip problems. Of course the typical course is to send a patient through a series of different specialists, which is sort of like the three blind men describing an elephant while holding different parts. Humorous if you weren't in such pain and losing your life. Then you add in the insurance requirement for 'evidence' that justifies the expenditure for treatment.... (Having worked in healthcare, the purpose of sending patients through this gauntlet of ineffective therapies is not to follow a systematic path of less invasive treatment, as purported, but to induce the patient to drop out before the really costly alternative of surgery is utilized. It's really not cost-effective, but healthcare executives are not financial wizards, just greedy ones.)

    Anyway, I'm here to learn as much as I can from those kind souls who've allowed others to benefit from their difficult journeys in trying to get adequate treatment for gluteal tears. As the previous poster noted, there is a very long thread that has been closed, and which I wish remained open, as there will be plenty more of us trying to find answers on this topic which are not being provided by our 'providers.' Thank you so much to those who did provide information to the rest of us in that thread. I wish I could do the same for the initial poster in this one.

     
    Old 01-05-2011, 04:57 AM   #4
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    Re: gluteus medius tears

    Gosh, I hope you feel better soon and I'm so sorry to hear that it's still that bad for you. I can only imagine how difficult it is having a recurrence after the hope that surgery might be an answer. The thought that there might be a solution is the only thing that's keeping me from losing it right now. I hope for your sake that this pain is not based on re-tearing the muscle (how do you think that could have happened?) and is maybe due to some overuse or pressure on the area while it heals. Has your MD said anything?

    Wasn't the surgeon that someone mentioned in the thread--Fletcher (?)--in your area? I wouldn't worry too much that your surgeon hadn't done that many of these repairs. I think that even a few of this specific nature would be enough, coupled with all the other similar types of repairs he has done, to provide competency. The fact that he had any experience puts him well ahead of the pack to begin with.

    I just lost all confidence in the surgeon who's going to do my R shoulder when he told me last week, with great authority and complete ignorance, that 'no one tears their gluteus, that only happens when a surgeon tears it accidently during joint replacement.' He did no gait eval or other differential diagnosis and reiterated his only explanation for hip pain by giving me a cortisone shot for my 'bursitis'. He doesn't do hip surgery but I was forced to see him since he's already doing my shoulders--some sort of proprietal keeping the money in his camp, despite the disservice to the patient. Actually, I looked at my shoulder records tonight and his original exam was very superficial, he never recommended an MRI, basically gave me an exercise band and wrote that he thought I was fine. When the pain became unbearable and I insisted on surgery, after he went in he said he had possibly seen one other shoulder that looked like mine. I can't believe that a thorough exam wouldn't have revealed the limitations of my very damaged anatomy and prompted recommendation for surgery earlier.

    Sorry to vent about this--it's almost 5 am and I should have gone to bed hours ago. Let me know what the source of your pain is, if you have time. I really hope it improves--I think sometimes the course of recovery can have setbacks like this, where the knitting back together is almost as painful as pre-op. I'll post anything I think is helpful on the topic. The best of luck




    I hope you have good pain management--it's really difficult to strike a balance, as it's easy to hurt yourself overdoing while you're medicated. I once worked in an inpatient pain unit and taught some of the self management skills for dealing with pain. Now I'm making as many mistakes as someone who never heard of them. I know I've aggravated my injuries and possibly hurt my healing. (My Komondor dragged me down a hill three weeks after my shoulder repair because I just couldn't stand to leave her home...I wasn't even supposed to be driving yet but took my dogs to the park...I think the last three times she dragged me may have been the source of this. I'm being more careful now.)

     
    Old 01-13-2011, 06:50 AM   #5
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    Re: gluteus medius tears

    Hi everyone with the glu/med tear,
    Last March, I developed a Trendelenberg ["limp"] gate and pain with every step. I went to PT, a personal trainer at the Y, a chiropractor, and an acupuncturist [sp?] to try and resolve the problem. None of these efforts were at all helpful. In July, I went to a well known orthopedic surgery and after a series of expensive tests, the dx of a glu/med tear was reached by MRI eval.. The doc had never repaired a tear like this that did not happen post THR. I also was not too happy with my interchange with him [too much to go into in this post]. He recommended that I make an app't with someone at the ***
    in NYC, which I did. After several calls, I found out that the surgery alone [not counting the hospital or anesthesia cost] was $20-25,000 and I was told that if my insurance did not think that this was a fair and reasonable fee, I would be responsible for the remainder of the bill. I then called all the major medical centers in my area [I live in Lynchburg, Va] and heard back from all of them. I chose to go to the Un. of Va Medical Center. Dr. James Browne met with me and my husband and we liked everything about him. He was the head fellow in orthopedics at Duke and has won numerous awards. He admitted that he had never done this exact surgery, but that it not "rocket science" and he explained exactly what he would do. Rather than exploring every other medical center, we decided to go with our gut feeling and have the surgery. This open repair was done on 12/28/10. Dr. Browne had informed us that the use of a donor tendon may be necessary to secure the tendon. He was very pleased with the condition of the tendon, muscle and bone, and no donor tendon was necessary.
    I am now in the long process of letting the tendon heal by using a walker with only toe touching for balance, never crossing or abducting my leg, and sleeping exclusively on my back. Tendons have a limited blood supply, and take much longer to heal that bones or muscles. I have also had a torn rotator cuff tendon and a torn, distal bicep tendon, so I know of which I speak. I have also been a RN for over 30 years, so have a little more of an understanding of these kinds of things.
    "Cabin fever" is really my biggest problem, but at least, as time goes on, I am able to do for myself more and more. My husband [bless his heart] took 3 weeks off to care for me, and during the first few days, I could not have managed without him. He is also an RN and is a great caregiver.
    Hope this has given a few answers, I know from other posts {ie the one that was discontinued] this injury is rare and difficult to diagnose. One other thing, I think is very important to add, is that my doc told me that cortisone injections [I have had 6 in the last 10 years for what I thought was bursitis] can be very damaging to tendons and he thought that those injections were a contributing factor to the tearing of my tendon.
    Take care, everyone and keep posting so we can all support one another.

     
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    Old 01-13-2011, 09:54 AM   #6
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    Re: gluteus medius tears

    I have surgery today and am really short on time but I wanted to say thank you very very much. I was pretty concerned when the doc--who's doing today's surgery--injected my thigh with cortisone (no guidance) given his lack of knowledge and what I've learned to this point, but the pain has been such a hindrance in getting things together for the shoulder surgery that I just decided to take a chance on it. (The constant use of oxycodone and pain isn't doing much for my judgment right now. I'll be by myself post op and was having a hard time doing setting up what I needed to. I am really dreading the next few days but don't have any options.) Anyway, your post was extremely helpful and I meant to just thank you for it rather than start whining, aargh. Please update your progress as you go--it would give some of us hope that we're not condemned to our current situations becoming permanent. It's hard to tolerate this without at least some hope....

     
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    Old 01-13-2011, 10:57 AM   #7
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    Re: gluteus medius tears

    Hi fmrcm,
    I know you probably won't read this for a few days, since your surgery is today. I sincerely wish you the best of everything with that. I have learned a couple of things: 1. any kind of pain med that contains narcotics like oxycodone really did not help me very much. I had a terrible time with constipation and used mirilax and ate prunes to get relief. [Sorry if this is too graphic for some of you!] I tried OTC sleep aids which did not help, and after about a week, called and got a prescription sleep aid and that made an enormous difference. I did take NSAIDS with food for discomfort relief and I think the anti inflammation aspect of these drugs helped more than the narcotics. The first couple of days, I thought there was no way I would be able to make it alone, but that gradually got much easier and I can now putter around, get myself something to eat, clean up the kitchen, and be much more independent.
    Good luck with everything. Let us know how you are doing.
    Weegie1

     
    Old 01-15-2011, 11:27 PM   #8
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    Re: gluteus medius tears

    Its been a while since I've had a chance to check this board. Thanks for all the responses. My boyfriend had his surgery on 1/11 at Columbia Pres. in NYC. The surgeon said he would be ready for anything since he has done alot of these glut repairs. As it turned it out, it was a partial tear that did not require total reconstruction with allograft. He only needed to sew up the tear. He was surprised that there was alot of bursa fluid around the hip and in the buttocks area. That was probably due to the body's reaction of trying to heal itself because of the tear. The surgeon also anchored the muscle to the bone and now we just have to hope for the best. Its going to be 4 weeks of light pressure on the muscle..just tippy toe pressure and he is using a walker. The total recovery takes about 3-4 months. My boyfriend said the pain after surgery was as bad as having the THR but that has settled down a little bit. The hip is very swollen and he is icing it. This surgeon has written some papers on this procedure with his colleagues and has had alot of experience. He was the only surgeon to have even found the tear with an ultrasound. (An MRI wouldn't be too helpful because of artifacts). Anyway, I will try and keep you all posted on his recovery.

     
    Old 01-16-2011, 05:00 AM   #9
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    Re: gluteus medius tears

    Hi Lynn720,
    I am glad your boyfriend is at least past the initial post op period. I, fortunately, did not have much pain and was only given oral narcotics in the hospital [was only there over night] and then switched to motrin and sleeping aids when I got home. I hope the pain as subsided for him by now. I have to "tippy toe" for 6 weeks and use the walker, then progress to walker and gradual increase in weight bearing, hopefully graduating to a cane and then after strengthening exercises, be free of all devices! I read a thread on another site from coastalgardener which was very encouraging. One year after surgery, she was completely pain free, walked with no limp and was able to do whatever she wanted, stated she was "completely normal" If that is where I am in a year, it will be worth it. Tell your boyfriend to hang in there, for me it is getting better everyday.

    Last edited by weegie1; 01-16-2011 at 05:07 AM.

     
    Old 01-17-2011, 07:31 AM   #10
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    Re: gluteus medius tears

    Hi Weegie, Thanks for the reply. Unfortunately for my boyfriend, he has been on very strong pain meds for a few years because of his back & hip pain. His goal was to stop most of his pain meds this so hopefully this surgery will help him reach that goal in due time. The hard part for him will be starting tomorrow when I have to go back to work and he will be alone all day. The nursing service was supposed to call to set up an appointment for an evaluation and since he got home on Friday night they haven't called all weekend since their office is closed. I am hoping I can reach someone today because we have stairs in the house and they need to come when I am home. I don't know if he will really need them for anything but insurance covers so they may as well come. Thanks for the encouraging news regarding the other person who had this surgery. And good luck with your recovery! Please keep in touch and let me know how you are doing. By the way, when was your surgery and do you have a hip replacement?

     
    Old 01-18-2011, 08:25 AM   #11
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    Re: gluteus medius tears

    Hi Lynn,
    I certainly hope your boyfriend is doing okay without you at home. I have been fortunate, my husband, who is an RN, has stayed home with me for 3 weeks [he goes back to work on Thur] and we have no stairs that I have to manage. Carl [my husband] does all the laundry which is in the basement, and everything else is on the main floor.
    I, also, am an RN [for over 30 years] and have taken care of many people, like your boyfriend, who have chronic pain. I certainly hope this surgery will be the key for him becoming pain free, or at least, pain medication free.
    I had my surgery on 12/28/10. It was a gluteal medius tendon repair only, THR was not necessary, at least not yet. I have read that these glut tears are often associated with THR and more uncommon to occur by themselves. One of the things that has helped me tremendously, is to get out of the house. I have the use of a walker and a wheelchair, and even though, I can't drive, my husband and I have been going out frequently. Seeing something, other than 4 walls, is very good for me. We love to dance and often frequent a small blues club. The other night, Carl piled me in the car and off we went to the club. Even though I can't dance, I loved being there, seeing our friends, and listening to the music.
    Best of everything to both of you, hope he is doing well and the home health people were able to offer some good suggestions.
    I am also anxious to hear how fmrcm is doing after surgery. Hope things are going well.
    Keep in touch, I think it is great to be able to share experiences and encourage each other.
    Weegie

     
    Old 01-22-2011, 04:24 PM   #12
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    Re: gluteus medius tears

    Hi Weegie, thanks again for the reply. I wish I could take my boyfriend out of the house but between the frigid temperature, snow, ice and the stairs its not a good idea. Of course he will have cabin fever soon but I would rather him stay inside and not take any chances.

    We had the visiting nurse over today and she was kinda of concerned about his pain, swelling and the incision so we called the doctor and he seemed okay with everything. He explained everything which made more sense and said he would see my boyfriend this week if he didn't feel any better. Not sure on that decision yet since its a long ride to his office and it also depends on the weather. I was just wondering if you have alot of swelling? My boyfriend is on a blood thinner so that also affects swelling and slows down healing as you probably know.

    Thanks again for keeping in touch. It definitely helps alot, And hope you are recovering well.
    Lynne

     
    Old 01-23-2011, 07:43 AM   #13
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    Re: gluteus medius tears

    Hi Lynn,
    Sorry to hear your boyfriend is having so much swelling and pain. Pain was not much of an issue for me before or after surgery, I did gain 6 lbs of fluid weight after surgery. There was a fair amount of pitting edema around the incision [when you press on an area, remove your finger, and the imprint of your finger remains on the skin] I lost the weight and edema in a few days. Keep an eye on your boyfriend's incision, and if there is an increase in pain, redness, heat to the touch, fever or drainage, I think a trip to the doctor is worth the effort.
    I live in central Va. and although it is cold here, we have not had the weather to contend with that you have in NY. I, also, only have 2 stairs to go down before I am in the yard, so it is easy for me to get out.
    Hope things are going better, thanks for keeping in touch,

    Weegie

     
    Old 01-23-2011, 09:16 AM   #14
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    Re: gluteus medius tears

    Hi Weegie, unfortunately chronic pain has been a problem for my boyfriend for years. Several surgeries later you would think it got better but it only has gotten worse. His outlook on life is not very good right now (yes, he needs help on that end) and he has no patiences left. Now he thinks that going off the blood thinner might help speed up the healing and reduce the swelling but is not an option since he has had 2 clots in his legs and a PE since he had his THR in 2008. He wants me to call the hematologist about this. By the way, the skin around his incision is not red. There was a drop of discharge from just one spot but I think its dry now. About 2/3 of the steri strips are still on the incision but its basically dry. He doesn't have a fever and hasn't had one at all since surgery but he just has an increase in pain. I'm sorry if I am repeating what I said earlier. I'm just trying to figure out if anything needs to be done. Its been 12 days since surgery and he didn't feel this way when he came home and he is at his wits end. Its hard for him to cope..he is not an easy patient.

     
    Old 01-23-2011, 10:45 AM   #15
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    Re: gluteus medius tears

    Hi Lynn,
    I am so sorry for all that you are both going through. Being the patient is no fun, but many times, being the caregiver can be just as difficult, only in a different way. Do you have any other support people around, who can give you a break? Even though, it may sound selfish, you need to take care of yourself first, because, if you don't you won't have anything left to give to anyone else.
    With a history of blood clots and a PE, I would think there would be no way he could go off blood thinners. I am on aspirin 2x/day for 4 weeks. Even though I get up and move around frequently, I am still sitting for much of my awake time, and am at risk for a DVT.
    I would think, from what you said, because of pain, he is probably more immobile than I am, by a long shot. I do not remember ever hearing that thinners lengthen healing time, but for his peace of mind, he certainly needs to hear this from his doctor.
    Is he still on the same pain meds he was on prior to surgery? If he is trying to decrease what he takes, this may be a factor in the increase of pain he is feeling. I also wonder if he is on an antidepressant. If he is, this may need a dosage or medication change, if he is not, it is something to think about.
    Hang in there, hopefully, things will get better sooner than later.
    Weegie

     
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