Revitalizing the Golf Swing: Treating a Gluteus Medius Muscle Tear and Tendinosis with Platelet-Poor and Platelet-Rich Plasma

Case Diagnosis: Gluteus medius partial muscle tear and tendinosis

Case Description or Program Description: A 73-year-old active male presents to PM&R clinic with one month of left hip pain that began acutely with a popping sensation while golfing. He was initially able to walk, but the pain worsened, prompting his primary care physician to order imaging five days later. Left hip magnetic resonance imaging (MRI) demonstrated gluteus medius partial muscle tearing and insertional tendinosis. Exam in PM&R clinic revealed greater trochanter and lateral gluteal musculature tenderness with a palpable lump. Ultrasound confirmed the MRI findings and showed a resolving hematoma. Injections of platelet-poor plasma (PPP) to the gluteal muscle tear and platelet-rich plasma (PRP) to the tendinosis were planned.

Setting: Outpatient Clinic

Assessment/Results: Two months post-injury, 10 mL of PPP was directed into the superficial gluteus medius muscle tear under ultrasound guidance. Separately, 4 mL of PRP was injected into the trochanteric bursa and gluteus medius tendon/sheath. A four-phase rehabilitation program was initiated. Two weeks post-injection, his daily pain was completely resolved. At six weeks (3.5 months post-injury), ultrasound revealed healing left gluteus medius muscle and tendon, and the patient reported 100% pain relief with full return to pre-injury function.

Discussion (relevance): Platelet-poor plasma (PPP) is a PRP “byproduct” with below baseline platelet levels compared to whole blood. Previously used as a sham treatment, laboratory research suggests that PPP may be more useful in muscle injury regeneration due to its ability to induce myoblast differentiation. Recent clinical studies indicate an earlier return to full activity following treatment of acute muscle injuries with PPP compared to PRP.

Conclusions: This is the first reported successful treatment of a gluteus medius muscle tear with PPP. PPP to treat muscle injury and PRP to treat tendinosis followed by a rehabilitation program should be considered in active individuals with gluteal tearing and tendinosis.