Andrew S. Chi MD, MS, Presenter: Nothing to Disclose

Suzanne Sundborg Long MD, Abstract Co-Author: Nothing to Disclose

Adam C. Zoga MD, Abstract Co-Author: Nothing to Disclose

Paul James Read MD, Abstract Co-Author: Nothing to Disclose

Diane Marie Deely MD, Abstract Co-Author: Nothing to Disclose

William B. Morrison MD, Abstract Co-Author: Consultant, General Electric Company Consultant, AprioMed AB Patent agreement, AprioMed AB

To evaluate gluteus medius and minimus tendon pathology and muscle atrophy in older individuals.

A retrospective study of MR imaging of 184 individuals was performed to evaluate for gluteus pathology. Inclusion criteria: age≥50. Exclusion criteria: hip surgery, fracture, infection or tumor, or inadequate image quality. Both hips were evaluated for each individual. Greater trochanteric bursitis was graded as none, mild, moderate, or severe. Gluteus medius, gluteus minimus, and iliopsoas tendon pathology was graded as normal, tendinosis, low grade partial tear, high grade partial tear, or full tear. Gluteus medius, gluteus minimus, and iliopsoas muscle fatty atrophy was scored using the Goutallier scale (0=no atrophy to 4=complete atrophy). Insertion of tendon pathology and anterior/posterior location of muscle atrophy was also analyzed.

184 subjects were stratified by age as follows: n=63(50-59 y.o.), 64(60-69 y.o.), 38(70-79 y.o.), 17(80-89 y.o.), 2(90-99 y.o.). Percentage of gluteus medius tendon abnormalities were: 34.9%(50-59 y.o.), 53.9%(60-69 y.o.), 82.9%(70-79 y.o), 73.5% (80-89 y.o.), 100%(90-99 y.o.). For the gluteus medius, tendinosis accounted for 68.2% of tendon pathology in 50-59 y.o., low grade tears accounted for 42.0% in 60-69 y.o., and high grade tears accounted for 17.5% in 70-79 y.o.. Average gluteus medius atrophy scores were as follows: 0.3(50-59 y.o.), 0.6(60-69 y.o), 1.2(70-79 y.o.), 1.6(80-89 y.o.), and 3.0(90-99 y.o). Percentage of gluteus minimus tendon abnormalities were: 30.2%(50-59 y.o.), 50.0%(60-69 y.o.), 86.8%(70-79 y.o), 79.4%(80-89 y.o.), and 100%(90-99 y.o.). For the gluteus minimus, tendinosis accounted for 73.7% of tendon pathology in 50-59 y.o., low grade tears accounted for 53.1% in 60-69 y.o., and high grade tears accounted for 7.6% in 70-79 y.o.. Average gluteus minimus atrophy scores were as follows: 0.4(50-59 y.o.), 0.9(60-69 y.o), 1.7(70-79 y.o.), 2.4(80-89 y.o.), and 3.8(90-99 y.o.).

Gluteus medius and minimus tendon pathology and muscle atrophy increase with age above 50 years. There appears to be progression from tendinosis to tendon tears with advancing age with an associated progression in muscle atrophy.

Given tendon tear may prelude atrophy and atrophy is greater in fall-related hip fractures, more aggressive therapy could be useful to prevent subsequent falls in patients with gluteus tendon tears.

Chi, A, Long, S, Zoga, A, Read, P, Deely, D, Morrison, W, Prevalence and Pattern of Gluteus Tendon Pathology and Muscle Atrophy in Older Individuals.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13013716.html