Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Gluteus Medius Tear


Related Terms

  • Abductor Tear
  • Gluteal Strain
  • Gluteus Medius Muscle Injury
  • Gluteus Medius Tendon Rupture
  • Greater Trochanteric Pain Syndrome
  • Hip Abductor Tear
  • Hip Rotator Cuff Tear
  • Torn Hip Abductor Muscle

Differential Diagnosis

  • Avascular necrosis of femoral head
  • Bursitis, greater trochanteric
  • Femur fracture
  • Gluteal compartment syndrome
  • Gluteal nerve injury
  • Iliotibial band syndrome
  • Lumbosacral radiculopathy
  • Meralgia paresthetica
  • Osteoarthritis of hip
  • Pelvic fracture
  • Piriformis syndrome
  • Stress fracture
  • Tendinitis

Specialists

  • Family Physician
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Sports Medicine Physician

Comorbid Conditions

Factors Influencing Duration

Length of disability depends on the severity of the gluteus medius tear (grade 1, 2, or 3), whether the condition is managed nonoperatively or operatively, and the individual's job requirements.

Medical Codes

ICD-9-CM:
843.8 - Sprains and Strains of Other Specified Sites of Hip and Thigh

Overview

A gluteus medius tear is a severe strain of one of the major hip stabilizer muscles. The gluteus medius muscle is located at the outer part (lateral region) of the hip, and functions as a hip abductor and internal rotator of the thigh while keeping the pelvis level during ambulation. A tear in the gluteus medius muscle often occurs at its tendinous insertion onto the greater trochanter of the femur bone and can be a major cause of lateral hip pain.

Muscle strains are graded according to severity: Grade 1 strains are mild and are associated with pain but no loss in range of motion or strength. Grade 2 strains are partial tears in which there is incomplete loss of flexibility and strength. Grade 3 strains are complete tears (full-thickness tear, or rupture) in which the musculotendinous unit has been severed; individuals with grade 3 strains will have complete loss of strength and difficulty in actively moving the affected limb (Armfield).

Gluteus medius tears may be traumatic (acute) or degenerative. With an acute trauma, a partial- or full-thickness tear may occur in the gluteus medius muscle or tendon that causes localized bleeding (hemorrhage) and subsequent scar tissue formation, tendon calcification, and weakness. However, the majority of gluteus medius tears are degenerative, caused by chronic inflammation of the gluteus medius tendon (tendinopathy) that results from many small tears over time from overuse, repetitive movements, or friction from a tight iliotibial band. In many cases, degeneration of the gluteus medius tendon is associated with greater trochanteric bursitis; the combined injury is called greater trochanteric pain syndrome. When chronic gluteus medius tendinitis occurs, the gluteus medius tendon is vulnerable to subsequent injury and degeneration that may result in a tear (Miller).

Incidence and Prevalence: In one study of individuals with lateral hip pain, 45.8% had a gluteus medius tear (Margo). Degenerative tears of the gluteus medius are observed incidentally in up to 20% of individuals undergoing total hip arthroplasty (Howell).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals at increased risk for gluteus medius tear are those who participate in athletic activities that require repeated or forceful hip abduction (Fiechtl) and those with an altered gait pattern from underlying pathology (e.g., back pain, hip osteoarthritis, bursitis, or iliotibial band syndrome) that causes friction on the gluteus medius tendon (Childers). Aging is another risk factor.

Source: Medical Disability Advisor



Diagnosis

History: The individual may report a slow (insidious) or sudden (acute) onset of lateral hip pain. Symptoms are worsened with prolonged sitting, standing, and walking, and there may be reported hip tenderness with attempts to lie on the affected side.

Physical exam: Upon exam, there may be tenderness and increased soft tissue density noted when feeling (palpating) the lateral hip area over the gluteus medius muscle, located above (proximal to) the greater trochanter of the femur. Strength testing of the leg may reveal pain and weakness with resisted hip abduction. The individual may exhibit a limping gait pattern that reflects a lateral pelvic tilt, in which the pelvis drops toward the unaffected side when weight bearing on the affected limb (Trendelenburg gait pattern); alternatively, the trunk may lurch toward the affected side (abductor lurch) when the affected limb is in stance phase.

Tests: In most cases, laboratory testing is not indicated to diagnose a gluteus medius tear. Plain x-rays may be performed to rule out alternate causes of hip pain (e.g., osteoarthritis, avascular necrosis); in some cases of degenerative gluteus medius tendinitis, calcium deposits within the gluteal tendon may be observed on x-ray. Rarely, magnetic resonance imaging (MRI) or ultrasound may be indicated to confirm gluteus medius pathology if symptoms are not resolving.

Source: Medical Disability Advisor



Treatment

Initially, treatment of a gluteus medius tear involves ice, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation, and activity modification to avoid prolonged exercises and positions that overstretch the affected muscle (e.g., sitting with the legs crossed). The individual is instructed to place a pillow between the knees (adductor pillow) when sleeping on the unaffected side to minimize painful stretching of the torn muscle. An assistive device (i.e., cane, crutch) may temporarily be needed to facilitate pain free ambulation.

Surgery may be necessary to repair a severe, full-thickness gluteus medius tear; it is typically performed endoscopically. With endoscopic gluteus medius repair, tiny incisions are made through which instruments are passed to reattach the torn gluteus medius tendon onto the greater trochanter with stitches (sutures).

Source: Medical Disability Advisor



Prognosis

With gluteus medius strain, the majority of individuals improve with conservative treatment. If surgery is performed for a gluteus medius tear, one study reported excellent outcomes at approximately 2 years after surgery, with 70% of individuals reporting a normal-feeling hip, and the remaining 30% reporting a nearly-normal hip (Voos).

Source: Medical Disability Advisor



Rehabilitation

Initially the goal of physical therapy is to control pain and swelling (edema) and to promote independent ambulation with assistive devices as needed. Modalities such as ice may be used for pain and swelling. The rehabilitation protocol depends upon the severity of the tear and whether operative or nonoperative management is needed. If the tear is managed operatively, the treating physician guides postoperative rehabilitation with weight-bearing restrictions as indicated to allow healing to occur without re-rupture.

Once the acute phase of inflammation has subsided, rehabilitation of a gluteus medius tear focuses on gentle hip range of motion and progressive strengthening exercises as tolerated, with an emphasis on hip abductor, extensor, and internal rotator muscles. Soft tissue mobilization and myofascial release may help to reduce local gluteal muscle spasms. If the individual has developed an altered gait pattern to reduce pain (antalgic gait pattern), gait training may be necessary to restore normal movement patterns as the individual transitions from using an assistive device to ambulating independently. Balance and proprioception exercises are introduced as hip strength returns.
A home program should be taught to complement supervised rehabilitation and should be continued after the completion of physical therapy.

Source: Medical Disability Advisor



Complications

Many times, gluteus medius tears are associated with greater trochanteric hip bursitis, resulting in greater trochanteric pain syndrome. If only one component of the syndrome is addressed, symptoms may fail to resolve. Gait problems, muscle weakness, and stiffness of the hip sometimes persist.

Small, partial-thickness gluteus medius tears that go unrecognized or untreated may lead to a full thickness tear (rupture). An individual with a full-thickness gluteus medius tear will experience chronic pain and impaired mobility and ambulation.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual may need to use crutches or a cane temporarily when walking. Repeated movements, sustained sitting or standing and prolonged walking may need to be limited temporarily. Time off to attend rehabilitation sessions may be necessary.

Source: Medical Disability Advisor



Regarding diagnosis

Regarding diagnosis:
  • Did individual report pain at the lateral aspect of the hip?
  • Did symptoms worsen with prolonged sitting, standing, and walking?
  • Was there hip tenderness with attempts to lie on the affected side?
  • Does individual participate in athletic activities that require repeated or forceful hip abduction?
  • Does individual display an altered gait pattern from comorbid back pain, hip osteoarthritis, or bursitis?
  • Did individual have tenderness and increased soft tissue density noted when feeling (palpating) the outer (lateral) hip area over the gluteus medius muscle?
  • Did strength testing of the leg reveal pain and weakness with resisted hip abduction?
  • Did individual exhibit a limping gait pattern with a lateral pelvic tilt in which the pelvis drops toward the unaffected side when weight bearing on the affected side (Trendelenburg gait pattern)? Does the trunk lurch toward the affected side (abductor lurch) in stance phase?
  • Was MRI or ultrasound testing necessary to confirm the diagnosis?
  • Was gluteus medius tear grade 1 (mild), grade 2 (partial thickness), or grade 3 (full thickness/ruptured)?

Regarding treatment:

  • Has individual responded to conservative treatment?
  • Does individual place a pillow between the knees (adductor pillow) when sleeping on the unaffected side to minimize painful stretching of the torn muscle?
  • Does individual need an assistive device temporarily to facilitate pain-free ambulation?
  • Was physical therapy indicated?
  • Is individual compliant with home exercise program for stretching and strengthening? Is this helpful?
  • Is surgery necessary to repair a severe gluteus medius tear?

Regarding prognosis:

  • Did individual undergo surgery?
  • Has adequate time elapsed for full recovery?
  • Were modifications made to the individual’s work environment during recovery?
  • Does individual have any comorbid conditions (e.g., hip osteoarthritis, rheumatoid arthritis, obesity) that may interfere with a full recovery?

Source: Medical Disability Advisor



References

Cited

Armfield, D. R., et al. "Sports-related Muscle Injury in the Lower Extremity." Clinics in Sports Medicine 25 4 (2008): 803-842. MD Consult. Elsevier, Inc. 24 Nov. 2009 <http://www.mdconsult.com/das/article/body/173128343-8/jorg=clinics&source=MI&sp=16447419&sid=921582326/N/547982/1.html?issn=0278-5919>.

Childers, Martin. "Chapter 97: Trochanteric Bursitis." Pain Management. Ed. Steven D. Waldman. 1st ed. Saunders Elsevier, 2006. MD Consult. Elsevier, Inc. 24 Nov. 2009 <http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-7216-0334-6.50101-1--cesec6&uniq=173128343&isbn=978-0-7216-0334-6&sid=921582328#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-0-7216-0334-6.50101-1%3Bfrom%3Dtoc>.

Cormier, Gregoire, et al. "Gluteus Tendon Rupture is Underrecognized by French Orthopedic Surgeons: Results of a Mail Survey (Abstract)." Journal of Bone and Joint Surgery 73 4 (2006): 411-413. Science Direct. 24 Nov. 2009 <http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W90-4JXRHXD-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1108595134&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f9608e0321a4f3c836c68fad5319f6a9>.

Fiechtl, James F., and Robert W. Fitch. "Chapter 53: Femur and Hip." Rosen’s Emergency Medicine. Eds. John A. Marx, et al. 7th ed. Mosby Elsevier, 2009. MD Consult. Elsevier, Inc. 24 Nov. 2009 <http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-323-05472-0.00053-0--s0480&uniq=173128343&isbn=978-0-323-05472-0&sid=921582328#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-0-323-05472-0.00053-0--s0445%3Bfrom%3Dtoc%3Btype%3DbookPage>.

Howell, G. E., R. E. Biggs, and R. B. Bourne. "Prevalence of Abductor Mechanism Tears of the Hips in Patients with Osteoarthritis (Abstract)." Journal of Arthroplasty 16 1 (2001): 121-123. PubMed. 24 Nov. 2009 <PMID: 11172282>.

Margo, Katherine, Jonathan Drezner, and Daphne Motzkin. "Evaluation and Management of Hip Pain: An Algorithmic Approach." Journal of Family Practice 52 8 (2003): 607-617. PubMed. 24 Nov. 2009 <PMID: 12899815>.

Miller, Theodore T. "Common Tendon and Muscle Injuries: Lower Extremity." Ultrasound Clinics 2 4 (2007): 595-615. MD Consult. Elsevier, Inc. 24 Nov. 2009 <http://www.mdconsult.com/das/article/body/173128343-8/jorg=journal&source=&sp=20606705&sid=921582327/N/638042/1.html?issn=1556-858X>.

Voss, James E., et al. "Endoscopic Repair of Gluteus Medius Tendon Tears of the Hip (Abatract)." American Journal of Sports Medicine 37 4 (2009): 743-747. American Journal of Sports Medicine. 24 Nov. 2009 <http://ajs.sagepub.com/content/37/4/743.abstract>.

General

Wheeless, Clifford R. "Gluteus Medius." Wheeless' Textbook of Orthopaedics. Wheeless' Textbook of Orthopaedics. 6 Dec. 2008. Duke Orthopaedics. 23 Nov. 2009 <http://ajs.sagepub.com/content/37/4/743.abstract>.

Source: Medical Disability Advisor






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