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Sports Medicine & ShoulderSpecialist in Gilbert Arizona
Matthew L. Hansen, MD

Matthew L. Hansen, MD

Orthopedic surgeonBoard Certified in Orthopedic SurgeryBoard Certified in Sports Medicine

Abductor Tendon Repair Vignette

Patient Vignette – Hip Abductor Tendon Repair

History

M.B. is a 67-year-old female. She enjoys socializing with friends and world travel. She had a long history of pain associated with hip trochanteric bursitis, but had never had a specific injury. M.B. had received 3 or 4 corticosteroid injections into the bursa in 2013-2014. The injections were helping, and she was doing well until June 2014, when she slipped at the airport while preparing for an international flight. She completed her trip, but reported worsening pain, new weakness, and a new feeling of instability in her hip. For the first time, M.B. began using a cane. She was seen in clinic shortly after her cruise.

Clinic Visit #1

M.B. had an MRI prior to her visit with Dr. Hansen. X-rays were done in clinic, as X-rays reveal additional information about the structure of the hip not seen on MRI. When the provider entered the room, he started by reviewing the complete history related to the hip pain. The provider then did a series of exams, including a careful evaluation of both hips, and several maneuvers to test for discomfort to the touch (tender over the lateral hip), range of motion, and strength (decreased strength in abduction, which is moving the leg away from the body).

X-rays showed a small piece of bone over the greater trochanter of the femur (red arrow). Also seen was prominence and flattening of the area between the ball and the neck of the femur, referred to as a CAM lesion (white arrow) and calcification around the labrum (green arrow).

Abductor Preop AP Arrows
Abductor Preop AP Arrows

MRI [MRI_abductor tendon tear_arrow.jpg] showed fluid collection and complete tears of the gluteus minimus and medius tendons (responsible for abduction) with the tendons pulled away from the bone. Additional degenerative changes of the hip were also seen.

MRI Abductor Tendon Tear Arrow
MRI Abductor Tendon Tear Arrow

Dr. Hansen discussed the diagnosis of abductor tendon tears as well as the wear-and-tear of the hip. He recommended surgical repair of the tendon tears, but also recommended a diagnostic injection of the hip joint to determine how much pain was being caused by the degenerative changes.

Clinic Visit #2

M.B. blocked out 30 minutes on a Monday afternoon for her next visit. On arrival she read and signed consent for the injection, and asked questions that were not addressed. The procedure was done with M.B. lying on her back. (Ultrasound was used to ensure proper placement of the needle and medication within the hip joint.) Both the area to be injected and the ultrasound machine were prepared in a sterile fashion. The needle was inserted into the front of the hip. In the picture the needle tip (red arrow), ball (white arrow) and socket (yellow arrow) are visible. Lidocaine was used to numb the skin, and then a second needle was advanced into the hip joint. More lidocaine was used which served to numb the hip joint. After the injection, she had significant improvement in her “deep hip” pain where the medicine was injected, but her chief complaint of lateral hip pain had very little relief.

Ultrasound Injection Arrows
Ultrasound Injection Arrows

M.B. tolerated the injection well and was able to drive herself home after the procedure. The relief, as expected, was temporary. With additional confidence that the correct source of pain had been identified, M.B. decided to proceed with surgery.

Surgery

For 2 days prior to surgery M.B. used a special soap while showering that decreases the amount of bacteria in the skin. She received a call on the afternoon prior to her surgery with final arrangements and surgery time. M.B. was at the hospital 2 hours before her surgery time to check in to the hospital, start an IV, and sign the requisite paperwork. The surgeon signed her leg and M.B. was wheeled off to the operating suite.

Surgery included diagnostic hip arthroscopy and abductor tendon repair.

Please see more information about details of the surgery itself here, and a surgical video. An arthroscopic picture of the tendon repair is seen below.

Abductor Tendon Repair scope Pics Repair
Abductor Tendon Repair scope Pics Repair

M.B. was discharged home after less than 2 hours in the recovery room.

After the Surgery

The immediate post-operative period was frustrating for M.B. The brace that was used to protect the repair kept her leg away from her body, and made it difficult to walk. She used a walker, and even a wheelchair because of pain associated with a separate foot injury. Although there was a love-hate relationship with the brace, she still used it faithfully for the first 6 weeks.

Post-Operative Course

M.B. reported back to the surgeon about 2 weeks postop to have her sutures removed. By that time she could already feel a difference in her level of pain and range of motion! New X-rays were taken at 2 weeks, to ensure no problems associated with the surgery. At that time she was still having significant pain, and even had some discomfort with the brace rubbing on her surgical incisions.

M.B. started physical therapy about 3 weeks after her surgery. This was also difficult and painful at first, but she quickly began to see the benefits of the advancing range of motion. 6 weeks after the procedure she weaned use of the walker. She was elated to find that her pain level was now better than before surgery, especially given how challenging the first few weeks had been. M.B. worked diligently in physical therapy for approximately 4 months, and faithfully performed the home exercises she was taught. M.B. progressed, but did have several setbacks including a fall onto her hip. When she was seen at 8 months postop, her limp had completely resolved, and she was no longer having any pain.

How Is She Doing Now?

Today the patient reports she is very happy with her surgical outcome. M.B. reports that she has significantly improved strength, and that her long-standing hip pain and discomfort with range of motion has resolved. M.B. has been able to return to her hobby of cruising around the world with friends!

AOSSM AAOS: American Academy of Orthopaedic Surgeons® / American Association of Orthopaedic Surgeons® ORS | Orthopaedic Research Society ARIZONA ORTHOPAEDIC SOCIETY OrthoArizona