Gluteal Injury

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Gluteal injury facts

  • The gluteal region of the body (the buttocks) consists of three major muscles: gluteus maximus, gluteus medius, and gluteus minimus.
  • The gluteus muscles function to move the hip and to a lesser extent help with knee movement in association with the iliotibial tract.
  • Other muscles, nerves, and bursae in the gluteal region that may cause buttock pain include the following:
    • Hip rotator muscles: Piriformis, obturator, quadratus, and gemellus muscles
    • Ischial bursa
    • Sciatic nerve
  • Most commonly, gluteal injuries are due to local trauma from falls or direct blows.
  • Treatment is often supportive with ice, elevation, and rest.

What is a gluteal injury? What are the types of gluteal injuries?

A gluteal contusion is a bruise to the muscle area. A gluteal muscle strain is a stretch or partial tear of the muscle or tendon.

Trauma, either by a fall or a direct blow to the buttock area, causes most gluteal injuries.

Overuse injuries of the hip may cause inflammation and damage to the gluteal muscles that help move the hip or to the tendons that attach the gluteal muscles to the greater trochanter of the hip.

What causes a gluteal injury?

Falls are a common cause of a gluteal or buttock contusion. In patients who are anticoagulated or on blood thinners, a large amount of bleeding can occur within and around the muscle, causing significant pain and swelling.

Gluteal muscle and tendon strains occur because of overuse injuries, usually of the hip joint. Repetitive motions like squatting and lifting at work may cause inflammation in tissues surrounding the hip.

In athletes, gluteal tendinopathies may mimic hip bursitis. Injuries may occur because of overtraining, especially with weightlifting and squats.

Inflammation of the hip, piriformis, iliotibial band, and the gluteus muscles are common running injuries.

Symptom of Gluteal Injury

Buttock Pain

Many conditions and diseases can cause pain in the buttocks, commonly known as butt pain. Causes of pain in the buttocks range from temporary annoyances, such as bursitis, bruising, piriformis syndrome, muscle strain, and shingles, to more serious diseases with long-term consequences, such as cancer, arthritis of the sacroiliac joints, and herniated disc with sciatica. All symptoms related to buttock pain must be evaluated in terms of their intensity, duration, location, and aggravating or relieving factors. For examples, whether or not the pain changes when walking, when sitting, or when at rest while lying down. Buttock pain after running can be from muscle strain. It is also important to consider the presence or absence of accompanying medical issues in order to precisely identify the cause and to help formulate the optimal treatment for pain in the buttocks.

What are signs and symptoms of a gluteal injury?

Falls or direct blows to the buttock can cause bleeding, inflammation, and swelling. This leads to pain, making it difficult to sit on the buttocks, or stand and/or walk normally because of the decreased range of motion of the hip. When the gluteal muscles are inflamed, movement of the hip joint causes pain. Because of bleeding that may be deep and not immediately apparent on the surface of the skin, inflammation may occur causing the buttock to feel swollen, warm, and become slightly red.

How do medical professionals diagnose a gluteal injury?

History is the first important step in helping the health care provider make a diagnosis.

  • Was there an injury or fall? It is important that other parts of the body be examined to look for other potential injuries.
  • Did it just happen or has the pain been persistent and ongoing? Is this an acute injury, or has it been a chronic ongoing problem?
  • Is the patient able to walk, and if so, is there a limp? Any fall or blow may be associated with fractures or broken bones of the pelvis, hip, or lower back (sacrum, lumbar spine).
  • Is the patient taking blood thinners? Gluteal injuries may have significant bleeding in these patients.
  • Is there any numbness or tingling or pain that radiates down the leg? The care provider may check for sciatic nerve inflammation and the cause of gluteal or buttock pain.
  • Has there been any issue with the ability to urinate or have a bowel movement? Acute changes in bowel or bladder function are associated with potential spinal cord injury, like cauda equina syndrome, a medical emergency.

Physical examination will focus on the low back, buttock, and hips.

  • Inspection or looking at the buttock area might reveal bruising of the skin or the buttock may appear swollen and red.
  • Palpation, or feeling the buttock, may find tenderness associated with a contusion. The overlying skin might feel warm. Swelling, redness, and warmth may be due to a gluteal contusion but also might signal a deep infection.
  • Examining the hip may find pain with tenderness over the joint line or the greater trochanter. This can be associated with gluteal tendinopathy (inflammation and damage of the gluteus tendon that attach the gluteal muscles to the greater trochanter). An injury may decrease hip range of motion. Moving the hip may cause pain in the buttock due to muscle inflammation and damage.
  • X-rays may be done to look for fractures of the hip, pelvis, and lumbar spine.
  • CT scan or MRI may be considered if the health care provider has a high index of suspicion for a hip fracture, but the plain X-rays are normal.
  • Ultrasound may be helpful to look for a large collection of blood deep in the buttock muscle or to look for an abscess if infection is a concern.
  • Blood tests are not usually done, expect for patients who take warfarin (Coumadin) as a blood thinner.

What is the treatment for a gluteal injury?

Should the gluteal injury be due to a direct blow or fall, resulting in a contusion, treatment aims to decrease the inflammation in the area.

Ice, elevation, and rest may be helpful. Most commonly, gluteus muscle injuries heal with time and no further treatment.

A rubber donut may be used to decrease the pain of sitting on a swollen buttock

Some patients with gluteal injuries have difficulty sitting on the commode and become constipated. A stool softener may be considered for a short period of time.

If the gluteal injury is due to overuse, or an abnormal gait (pattern of walking), physical therapy may be considered to prevent further injury and inflammation.

Physical therapy may also be helpful in treating tendinopathies and other inflammation of the gluteus muscles not due to trauma. Treatment modalities may include massage and ultrasound. Rehab may include exercises to strengthen muscles and maintain range of motion to prevent future injury.

In some circumstances, medical professionals may consider administering steroid injections. Using ultrasound, a long needle is guided near the injury site so that the injected steroid can work directed at the site of inflammation.

Surgery is not commonly considered but may be an option when nonsurgical treatments have failed, and torn muscles need to be repaired.

What is the prognosis and recovery time for a gluteal injury?

Most traumatic gluteus injuries resolve on their own with time and conservative therapy, but recovery time may be measured in weeks and not days.

Overuse injuries may take longer to heal, but the goal is to return the patient to their normal level of function.

Is it possible to prevent a gluteal injury?

People may sometimes avoid accidental falls. It is important to have good footwear, be aware of surroundings, especially when the weather is rainy, snowy, or icy. This is especially true for elderly patients and those who may have impaired balance. Warming up and stretching before activities may help decrease injury risk.

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Medically Reviewed on 12/4/2018
References
REFERENCE:

Teixeira, Pedro Augusto Gondim. "Gluteus Maximus and Surrounding Muscles Injuries." Muscle Injuries in Sport Athletes. Ed. B. Roger, A. Guermazi, and A. Skaf. Switzerland: Springer International Publishing AG, 2017: 335-351.