Gluteus Medius – Dynamic Scanning

[David Smith]

Hi Stephen,
In your material on the trochanteric tendons of the hip, your mention having the patient separate their ankles to do dynamic testing. Do you mean that the patient rotates the ankles apart, or do the do a full abduction of the legs? Will this help in evaluation for tears or only help show the friction plane between the gluteus medius tendon and the overlying ITB and gluteus maximus?
Thanks,
Dave

[Stephen Bird]

Hi David,

With the hip leg movement: Position the patient decubitus with the legs on top of each other in gentle hip and knee flexion.

Scan the G-Med tendon in short axis at the level of the GT lateral facet.

Keep the knees together and left the uppermost ankle away from the other ankle (towards the roof)

You will see rotation of the G-med and G-min while the G-max / ITB stays stationary.

It works really nicely.

When they do this movement the muscle bellies of G-min and G-med activate and the tendon is put on stretch.

What I am looking for is:

Identifying the “friction plane” between the abductor apparatus and the ITB as this is the plane of the trochanteric bursa for injection.
Identifying that there is indeed a G-med and G-min intact as if they are torn the ITB will rub against a naked facet during the movement.
See if fluid flows into a cleft as the tendon activates.

Steve

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