Gluteus Medius and Minimus Percutaneous Tenotomy

Other Names

• Gluteus Medius and Minimus Percutaneous Tenotomy
• Gluteus Medius Needle Tenotomy
• Gluteus Minimus Needle Tenotomy
• Gluteal Tendon Tenotomy
• Gluteus Medius Needle Tenex
• Gluteus Minimus Needle Tenex

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Background

Illustration of gluteus medius and minimus and schematic of the facets

Key Points

• Needle: 20 gauge, 3.5 inch needle
• Probe will depend on patients body habitus
• US: orient from the greater trochanter

Anatomy Glute Medius and Minimus

• Glute medius: originates from ilium and inserts on greater trochanter
• Glute minimus: deep to glute medius, originates from the ilium, inserts onto greater trochanter
• Bursa: subglute max, subglute medius, subglute minimus

Palpation vs Ultrasound Guidance

• Neither palpation or ultrasound guided needle Tenotomy is well studied or published
• We recommend ultrasound guidance to increase needle precision and accuracy

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Indications

• Greater Trochanteric Pain Syndrome
• Gluteal Tendinopathy

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
• Relative
  • Can be treated with less invasive means
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

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Procedure

Illustration of the procedure

Patient, probe and needle position

Coronal ultrasound image demonstrating the needle ultrasound probe at the gluteus medius tendon insertion site on the greater trochanter.

Equipment

• Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
• Gloves
• Needle: 20 gauge, 3.5 inch needle
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic
  • Corticosteroid
• Sterile probe cover

Ultrasound Findings

• Probe: Depends on patient body habitus
• Evaluation
  • Begin with the patient lateral in the lateral decubitus position, affected side up
  • Scan over the short axis of the femur to find the greater trochanter
  • It appears flat anterior and the lateral facets are seperate
  • Glute minimus: seen over anterior facet
  • Glute medius: seen over lateral facet
  • Glute maximus can be seen more posterior
  • Rotate probe 90 degrees to get over the tendon in long axis
• Common ultrasound findings include:
  • Abnormal hypo echogenicity
  • Tendon swelling
  • Cortical irregularity of the greater trochanter
  • Possibly calcium deposition
  • Bursal distension, if present can be anechoic (simple fluid) to hyperechoic (complex fluid or hypertrophy)

Technique: Long Axis, In Plane

• Patient Position
  • Patient should be in the lateral decubitus position
  • Affected side up
• Transducer position
  • Long axis to gluteal tendon
• Needle Approach/ Orientation
  • In plane
  • Inferior to superior
• Target
  • Gluteus minimus/ medius tendons
• Pearls and Pitfalls
  • Repeatedly fenestrate the abnormal tendon
  • Can rotate transducer 90 degrees to ensure adequate coverage of entire tendon
  • Number of passes varies from 15 to 30
  • Can perform barbotage if calcifications are present

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Aftercare

• No significant restrictions
• Can augment with ice, NSAIDS

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Complications

• Skin: Subcutaneous fat atrophy, skin atrophy, skin depigmentation
• Painful local reaction
• Infection
• Hyperglycemia
• Tendon, nerve or blood vessel injury

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See Also

Internal

• Procedures Main
• Ultrasound Main
• Hip Pain Main

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