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MRI Diagnosis of Tears of the Hip Abductor Tendons (Gluteus Medius and Gluteus Minimus)

Oliver Cvitanic1, Gregory Henzie1, Nicholas Skezas2, Jack Lyons2 and Jon Minter3

1 Southwest Oklahoma MRI, 13301 N Meridian Ave., Ste. 600A, Oklahoma City, OK 73120.
2 Department of Radiology, St. Joseph Hospital, 2900 N Lake Shore Dr., Chicago, IL 60657.
3 1459 Montreal Rd., Ste. 304, Atlanta, GA 30310.



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  		Fig. 1. —Illustration shows normal abductor muscles and tendons in coronal section as seen through hip at level of mid greater trochanter. a = gluteus minimus muscle, b = gluteus medius muscle, c = subgluteus minimus bursa, d = subgluteus medius bursa, e = subgluteus maximus bursa, f = zona orbicularis of hip joint capsule, g = superior neck recess of hip joint, h = inferior neck recess of hip joint, i = vastus lateralis muscle, k = iliotibial band.

 


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  		Fig. 2A. —72-year-old woman with surgically proven focal full-thickness tear of abductor tendon cuff. Coronal STIR image (TR/TE, 2,000/30; inversion time, 160 msec) of left hip reveals 2-cm pocket of high signal intensity superior to greater trochanter (pattern 1) in subgluteus medius bursa (asterisk) located in intermuscular fat (f) between gluteus medius (me) and gluteus minimus (mi) tendons. Tendon tear itself is not directly visualized.

 


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  		Fig. 2B. —72-year-old woman with surgically proven focal full-thickness tear of abductor tendon cuff. Sagittal T2-weighted spin-echo image (1,750/102) of left hip shows pocket of high signal intensity superior to greater trochanter (gt) corresponding to swollen subgluteus medius bursa (asterisk).

 


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  		Fig. 3A. —74-year-old woman with surgically confirmed focal full-thickness tear in right abductor tendon cuff with trochanteric (subgluteus maximus) bursitis. Coronal T2-weighted fast spin-echo image (TR/TE, 3,879/102) of hips (obtained at 0.2 T with postprocessing) reveals gluteus medius (me) and gluteus minimus (mi) muscles, elongated and distally discontinuous right gluteus medius tendon (solid arrow), and sheet of high signal intensity outlining lateral and superior margins of greater trochanter (pattern 2) (open arrow). In general, visualization of pattern 2 T2 hyperintensity superior to greater trochanter alone is sufficient to diagnose tear.

 


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  		Fig. 3B. —74-year-old woman with surgically confirmed focal full-thickness tear in right abductor tendon cuff with trochanteric (subgluteus maximus) bursitis. Axial T2-weighted fast spin-echo image (4,005/102) of hips shows area of high signal intensity corresponding to fluid or synovitis replacing distal right gluteus medius tendon (black arrow). Compare with intact appearance of left distal gluteus medius tendon (white arrow).

 


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  		Fig. 4. —Coronal STIR image (TR/TE, 1,400/30; inversion time, 110 msec) of hips in 66-year-old woman with left-sided greater trochanteric pain syndrome, surgically proven left-sided trochanteric bursitis, and surgically intact left abductor tendon cuff reveals 0.7-cm area of high signal intensity (arrow) immediately superior to left greater trochanter. Interpretation of this example of pattern 3 T2 hyperintensity superior to greater trochanter was false-positive for tear.

 


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  		Fig. 5. —Axial fat-suppressed proton density–weighted image (TR/TE, 4,100/38) of hips in 72-year-old woman with right-sided greater trochanteric pain syndrome reveals T2 hyperintensity corresponding to fluid or synovitis replacing distal right gluteus minimus tendon (open arrowhead). Compare with intact insertion of left gluteus minimus tendon (solid arrowhead).

 


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  		Fig. 6. —Coronal T1-weighted spin-echo image (TR/TE, 560/20) of hips in 73-year-old woman with surgically confirmed tear in left abductor tendon cuff shows unilateral elongation and mild thickening of left gluteus medius tendon (arrow). No areas of hyperintensity were depicted in region of greater trochanter on T2-weighted images.

 

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