What to do about gluteus contracture

  Gluteal contracture syndrome is a clinical syndrome caused by degeneration and contracture of the gluteal muscle and its fascial fibers from various causes, resulting in a characteristic gait and signs of functional limitation of the hip joint. Most scholars agree that the disease is associated with repeated hip injections, and the formation of localized hard masses after myoinjection is a manifestation of myofibrositis. Penicillin containing 2% benzyl alcohol diluted into the muscle has the greatest reaction as degenerative necrosis, which leads to fibrosis.  Patients with hip contracture have limited internal rotation and retraction of the hip joint. When sitting, the legs cannot come together, the hips are separated in frog position, and it is difficult to rest one thigh on the other thigh (cross-leg test). In the lighter cases, the knees are separated when squatting, and then come together after squatting (circle test). In severe cases, the knees cannot come together and the heels do not touch the ground, showing a frog-like pattern.  Physical examination may reveal skin depression in the upper part of the hip, and the depression is more obvious when the hip is inwardly retracted, and the hip may feel constricted, and hip flexion is limited in the neutral position of the lower limb. Ober’s sign is positive.  The treatment is mainly surgical, mainly the release of the hip contracture band. The degree of release should be about 10° of internal retraction and internal rotation each, and the hip joint should be flexed from extension to more than 120°. The operation can be finished if there is no bounce in the hip flexion test when the hip is in the extreme inversion and internal rotation position.