MRI Diagnosis of Contracture of the Gluteus Maximus Muscle
Clement K. H. Chen1,2,3,
LeeRen Yeh1,2,
Wei-Ning Chang4,5,
Huay-Ben Pan1,2 and
Chien-Fang Yang1,2
1 Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st
Rd., Kaohsiung 813, Taiwan.
2 Department of Radiology, School of Medicine, National Yang-Ming University,
Taipei 112, Taiwan.
3 Yuh-Ing Junior College of Health Care and Management, Kaohsiung 807,
Taiwan.
4 Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung
813, Taiwan.
5 Department of Surgery, School of Medicine, National Yang-Ming University,
Taipei 112, Taiwan.
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Fig. 1A —19-year-old man as healthy volunteer. Spin-echo T1-weighted
coronal image (TR/TE, 567/16) shows coarsely fasciculated healthy gluteus
maximus muscle (Gmax) in superficial portion of buttock. It is quadrilateral
with its fasciculi directed downward and outward obliquely. Fat streaks are
evenly distributed in muscle. In muscle portion medial to greater trochanter,
low-signal-intensity tendon is barely seen.
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Fig. 1B —19-year-old man as healthy volunteer. Spin-echo T1-weighted
coronal image (567/16) shows healthy gluteus maximus muscle (Gmax) inserts on
iliotibial tract of fascia lata (black arrow) around lateral aspect
of greater trochanter. Lowermost portion of its tendon (white arrow)
curves medially and posteriorly to gluteal ridge of femur. Gmed = gluteus
medius muscle.
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Fig. 2A —21-year-old man with unilateral (right-side) gluteal
contracture. Healthy left buttock can be used for comparison. Spin-echo
T1-weighted coronal image (TR/TE, 567/16) of both buttocks discloses thin
low-signal-intensity fibrotic cord (white arrows) coursing obliquely
in atrophic right gluteus maximus muscle.
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Fig. 2B —21-year-old man with unilateral (right-side) gluteal
contracture. Healthy left buttock can be used for comparison. Spin-echo
T1-weighted axial image (600/16) at lower portion of both buttocks shows
atrophic and medial retraction of right gluteus maximus muscle
(arrowhead), thickening and mild retraction of its tendon and
iliotibial tract (black arrows), and depressed groove at
muscle-tendon junction. More anteverted axis of right femoral neck
(double-headed arrows) suggests mild external rotation of right
femur. Healthy left gluteus maximus muscle extends to lateral aspect of
greater trochanter and inserts on iliotibial tract (white arrow).
Gmax = gluteus maximum muscle.
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Fig. 3A —20-year-old man with bilateral gluteal contracture. Spin-echo
T1-weighted oblique coronal image (TR/TE, 400/16) of right buttock discloses
thick fibrotic cord (black arrow) and surrounding atrophic gluteus
maximus muscle (arrowhead).
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Fig. 3B —20-year-old man with bilateral gluteal contracture.
Fat-saturated fast spin-echo proton density-weighted oblique coronal image
(2,000/48) anterior to A shows marked thickening, shortening, and
straightening of gluteus maximus muscle tendon and iliotibial tract (black
arrow).
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Fig. 3C —20-year-old man with bilateral gluteal contracture. Spin-echo
T1-weighted axial image (600/11) of both buttocks discloses atrophic and
medial retraction of gluteus maximus muscles (arrowheads), fibrotic
cords (white arrows), and thickening and retraction of distal tendons
and iliotibial tracts (black arrows).
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Fig. 3D —20-year-old man with bilateral gluteal contracture. Spin-echo
T1-weighted axial image (600/11) inferior in relation to C discloses
atrophic and medial retraction of gluteus maximus muscles, thickening and
retraction of distal tendons and iliotibial tracts (black arrow)
posterior to proximal femurs, and resultant depressed grooves at muscle-tendon
junctions. Exaggerated anteverted axis of femoral neck (double-headed
arrow) suggests external rotation of proximal femur.
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Fig. 3E —20-year-old man with bilateral gluteal contracture. Spin-echo
T1-weighted sagittal image (500/16) discloses thick fibrotic cord (white
arrow) and surrounding muscle atrophy (arrowheads).
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Fig. 4A —23-year-old woman suffering from bilateral gluteal
contracture that is more severe on left side. Patient related history of
repeated injections in both buttocks since adolescence. Spin-echo T1-weighted
axial image (TR/TE, 566/16) discloses atrophic and medial retraction of left
gluteus maximus muscle (arrowhead), thickening and retraction of
fibrotic cord and distal tendon (white arrow), and displacement of
iliotibial tract (black arrow).
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Fig. 4B —23-year-old woman suffering from bilateral gluteal
contracture that is more severe on left side. Patient related history of
repeated injections in both buttocks since adolescence. Spin-echo T1-weighted
axial image (566/16) inferior in relation to A discloses atrophic left
gluteus maximus muscle (arrowhead), thickening and retraction of
distal tendon and iliotibial tract (black arrows) posterior to left
femur. Angle formed by lines of connecting ischia (black line) and
axis of femoral necks (double-headed arrows) measures 9° on right
side and 36° on left side. Exaggerated anteverted axis of left femoral
neck suggests external rotation of left proximal femur.
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Copyright © 2006 by the American Roentgen Ray Society.
