Ultrasonographic and magnetic resonance images of gluteus maximus tear

Article information

J Yeungnam Med Sci. 2021;.yujm.2020.00501
Publication date (electronic) : 2021 July 2
doi : https://doi.org/10.12701/yujm.2020.00501
1Department of Physical Medicine and Rehabilitation, Yeungnam University Hospital, Daegu, Korea
2Department of Radiology, College of Medicine, Kyungpook National University, Daegu, Korea
3Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
Corresponding author: Min Cheol Chang, MD, Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-4682, Fax: +82-53-4231-8694, E-mail: wheel633@gmail.com
Received 2021 March 1; Revised 2021 April 01; Accepted 2021 May 05.

A 58-year-old woman visited a university hospital because of dull pain (numeric rating scale [NRS] = 8) in the left lateral gluteal region that she had been experiencing for 8 days. The pain had started while she was hiking. On physical examination, the pain was observed to be aggravated upon extension, abduction, and external rotation of the left hip. Deep palpation revealed tenderness along the left lateral gluteal region.

For the evaluation of gluteal muscles with US, a 12-MHz linear probe was placed at the level of the lateral facet of the greater trochanter of the left femur. The axial ultrasound (US) image showed a retracted left gluteus maximus muscle and an anechoic defect around its insertion site in the iliotibial band (Fig. 1). On magnetic resonance imaging (MRI), a partial tear in the left gluteus maximus was observed at its insertion site in the left iliotibial band, suggesting grade 2 muscle strain (Fig. 2) [1]. At the area adjacent to the site of the tear, fluid infiltration due to edema and hemorrhage were also noted. Therefore, a partial left gluteal muscle tear was diagnosed. The patient was treated with physical therapy at the involved region and oral analgesics. She reported relief from the pain (NRS: 2) after 1 month of treatment.

Fig. 1.

Axial ultrasound image of the torn left gluteal muscles. Gmax: gluteus maximus, Gmed: gluteus medius.

Fig. 2.

Axial (upper line) T2- and T1-weighted gadolinium-enhanced magnetic resonance (MR) images at the level of the lateral facet of the greater trochanter of the left femur. A partial tear of the left gluteus maximus muscle at its insertion site in the left iliotibial band is observed on the images (arrows). Fluid infiltration around the site of the tear, suggesting edema or hemorrhage, is also observed. Coronal (lower line) T2- and fat-suppressed T2-weighted MR images at the level of the lateral facet of the greater trochanter of the left femur. There is a partial tear at the myotendinous junction of the left gluteus maximus and iliotibial band (arrows) with intramuscular feathery fluid infiltration in the left gluteus maximus suggesting grade 2 muscle strain.

The gluteus maximus is the largest muscle in the gluteal region and plays an important role in maintaining balance during standing, walking, or running by controlling the hip joint and thigh [2]. Clinically, gluteal strain can be confused with several differential diagnoses, including hamstring strain, sciatic nerve lesion, gluteal tendinopathy, bony fracture in the pelvis, lumbar radiculopathy, lumbar facet pathology, and sacroiliac joint pathology. Therefore, a detailed evaluation is necessary for accurate diagnosis.

Although clinical examination forms the basis of a diagnosis of muscle strain, imaging evaluation is necessary to confirm the clinical diagnosis [3]. US and MRI are useful tools for determining the location and extent of the lesion and assessing possible compression of the surrounding structures [3]. US has merits in that it offers real-time images of soft tissues with great convenience. MRI is better in detecting pathologic changes in soft tissue and bone and is useful for evaluating the pathology of deep muscles. The combined use of these two diagnostic tools facilitates an accurate diagnosis.

Based on the mechanism of injury, muscle injuries are classified into extrinsic and intrinsic injuries [3]. In the case reported herein, the gluteus maximus tear was not caused by extrinsic injury, and there were no contusions or penetration. Intrinsic injury is caused by contraction or elongation of the muscle, usually resulting in destruction of muscle fibers at the myotendinous junction [3]. In this patient, the gluteal muscle tear seems to have occurred by intrinsic injury at the myotendinous junction between the gluteus maximus and the iliotibial band. US or MRI findings of gluteus maximus muscle tears have rarely been reported in the literature. Therefore, this report would be helpful for clinicians in diagnosing gluteus maximus muscle tear.

Notes

Ethical statesments

This study was approved by the Institutional Review Board (IRB) of the Yeungnam University Hospital (IRB No: 2021-01-021). Written informed consent was obtained for publication of this article.

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Author contributions

Conceptualization, Visualization, Methodology: All authors; Data curation, Formal analysis, Investigation, Supervision, Validation: MCC; Writing-original draft: All authors; Writing-review & edit: All authors.

References

1. Guermazi A, Roemer FW, Robinson P, Tol JL, Regatte RR, Crema MD. Imaging of muscle injuries in sports medicine: sports imaging series. Radiology 2017;285:1063.
2. Selkowitz DM, Beneck GJ, Powers CM. Comparison of electromyographic activity of the superior and inferior portions of the gluteus maximus muscle during common therapeutic exercises. J Orthop Sports Phys Ther 2016;46:794–9.
3. Draghi F, Zacchino M, Canepari M, Nucci P, Alessandrino F. Muscle injuries: ultrasound evaluation in the acute phase. J Ultrasound 2013;16:209–14.

Article information Continued

Fig. 1.

Axial ultrasound image of the torn left gluteal muscles. Gmax: gluteus maximus, Gmed: gluteus medius.

Fig. 2.

Axial (upper line) T2- and T1-weighted gadolinium-enhanced magnetic resonance (MR) images at the level of the lateral facet of the greater trochanter of the left femur. A partial tear of the left gluteus maximus muscle at its insertion site in the left iliotibial band is observed on the images (arrows). Fluid infiltration around the site of the tear, suggesting edema or hemorrhage, is also observed. Coronal (lower line) T2- and fat-suppressed T2-weighted MR images at the level of the lateral facet of the greater trochanter of the left femur. There is a partial tear at the myotendinous junction of the left gluteus maximus and iliotibial band (arrows) with intramuscular feathery fluid infiltration in the left gluteus maximus suggesting grade 2 muscle strain.