Non-Surgical Options For Hip Tendon Tears In Taichung City, Nantun Dist.

No. Some hip tendon tears cause no pain nor any other signs or symptoms, particularly Grade 1 injuries, in which the tendon is slightly stretched and only a few fibers are torn.

Yes, most hip tendon tears can be identified with an MRI. They provide good definition for large muscles, labrum and tendon tears, and areas of inflammation.

Generally, a physician or orthopedic surgeon will initially recommend rest, ice, anti-inflammatory medication for pain relief, massage, stretching, and strengthening through physical therapy. If the problem persists, corticosteroid injections or hip tendon repair surgery are often recommended.1

Hip tendon repair surgery can involve sewing together tears, cutting the tendon to try to get it to heal, or lengthening a tight tendon. While this approach may lead to relief of the pain and other symptoms, shortening or lengthening of the tendon often leads to other problems, including:

• Severe and permanent injury to the ligaments, muscles, and fascia around the joint
• Chronic pain
• Damage to chromosomes caused by debris from hip replacement metal
• Cobalt and chromium toxicity
• Tissue irritation that may cause pseudotumors (a growth caused by irritation from the hip replacement device)
• Allergic reaction to hip replacement materials
• Hip instability

Moreover, the underlying biomechanical problem that led to the initial tendon injury (hip impingement, tendonitis, tendonosis, arthritis, labral tears, avascular necrosis, etc.) has not been resolved, despite a lengthy recovery. To make matters worse, tendons can have a poor blood supply and therefore may not heal well after surgery, making reinjury more likely.2

Tendons are tough cords made of straight, parallel fibers of collagen that attach muscles to bones. There are two tendons that attach at the outer aspect of the hip at the head of the femur: the gluteus minimus and gluteus medius. 

Both of these abduct the hip to move the leg outward, while the gluteus minimus also works as the primary internal rotator of the hip (i.e., it twists your thigh inward). Other hip tendons often subject to tears are the iliotibial (IT) band and hamstring tendon. 

Three of the most common causes of damage to the hip tendons:

Tendonitis occurs as a result of acute inflammation, often due to overuse or repetitive motion. There’s usually no permanent damage to the underlying tissues. 

Tendinosis, on the other hand, occurs when there is chronic damage and degradation to the tendon to such a degree that it becomes hard, thick, scarred, and rubbery. It generally results in pain and loss of joint flexibility and function and can involve several tendons surrounding the hip joint. 

Tendon tears, which are typically classified according to severity:5

• Grade 1 (Mild): The muscle and/or tendon has been slightly overstretched, but there is no pain or instability.
• Grade 2 (Moderate): The muscle and/or tendon has been torn slightly, and there may be moderate tenderness, swelling, pain, and bruising as well as some instability and loss of function.
• Grade 3 (Severe): The muscle and/or tendon is completely ruptured (torn), with severe swelling, pain, and bruising. The patient may be unable to bear weight and have moderate to severe instability and loss of function.