Gluteal TendinopathyEdit

Gluteal tendinopathy is a common source of lateral hip pain arising from degenerative changes in the gluteal tendons where they attach to the greater trochanter of the femur. It is a leading cause of GTPS (greater trochanteric pain syndrome), a broader umbrella term for pain around the outer hip. Modern understanding emphasizes tendon degeneration and mechanical overload rather than acute inflammation, although inflammatory components can be present in flare-ups. The condition is seen across a wide age range but is particularly prevalent among middle-aged, physically active people and those with contributing biomechanical or body-weight factors.

Clinically, patients describe deep, aching discomfort on the outer aspect of the hip, often worsened by stairs, standing from a seated position, or lying on the affected side. Pain may radiate toward the thigh, and some individuals notice weakness in hip abduction or a sense of pelvic instability during gait. Because the hip replacement and spine disorders can produce overlapping symptoms, precise diagnosis relies on careful examination and imaging when needed. The term GTPS is frequently used to capture the spectrum of peritrochanteric pathology, of which gluteal tendinopathy is a major component. gluteus medius and gluteus minimus contribute to lateral hip stabilization, and their tendinous attachments can become symptomatic when subjected to chronic overload or age-related degeneration. The greater trochanter serves as the key anatomic anchor for these tendons. For background context, see hip and anatomy of the hip.

Pathophysiology

Gluteal tendinopathy reflects tendinous degeneration in the gluteal tendons, typically at the insertion on the greater trochanter. While early terminology emphasized inflammation (tendinitis), current consensus recognizes a degenerative process with scattered inflammatory cells in some cases. Contributing factors include repetitive or excessive loading, poor hip abductor strength, and altered gait or pelvic mechanics that place abnormal stress on the tendons. Biomechanical contributors may include leg length differences, knee or foot alignment issues, and laxity or stiffness in the lumbopelvic region. Obesity and sedentary behavior can exacerbate loading patterns, and prior injuries or overuse are common antecedents. The condition may coexist with other lateral hip pathologies, such as partial tears of the gluteal tendons or bursitis around the greater trochanter.

Key terms to understand include tendinopathy as a spectrum of tendon pathology, and the concept of GTPS as a broader clinical syndrome. Imaging modalities such as MRI and ultrasound help identify tendon degeneration, focal tears, or bursitis and guide treatment planning. The pathophysiology informs a conservative, progressive approach to rehabilitation that prioritizes tendon healing through controlled loading. See also gluteus medius and gluteus minimus for anatomy and function related to this condition.

Clinical features

Deep, localized pain over the lateral hip, often near the greater trochanter.
Pain with single-leg stance, stairs, squatting, or side-lying on the affected side.
Reduced hip abductor strength or a subjective sense of pelvic stability during gait.
Point tenderness over the greater trochanter region on examination.
Positive provocative tests that stress the gluteal tendons, such as resisted hip abduction or hip-extension maneuvers.

Differential diagnosis includes trochanteric bursitis, other causes of lateral hip pain, lumbar spine disorders, and hip joint pathology. Distinguishing GTPS from intra-articular hip disease is important because management strategies differ.

Diagnosis

Diagnosis is chiefly clinical, supported by imaging when necessary. A careful history plus targeted physical examination helps distinguish gluteal tendinopathy from other causes of hip pain. Imaging steps include:

Ultrasound: Dynamic assessment of tendon structure and thickness, with evaluation for tendinous tears or bursal involvement.
Magnetic resonance imaging (MRI): Provides detailed visualization of tendon degeneration, tearing patterns in the gluteal tendons, and surrounding structures.
Laboratory tests: Usually not required unless another inflammatory or systemic condition is suspected.

Imaging findings may show tendon thickening, focal signal change within the gluteal tendons, or partial-thickness tears. The choice of imaging depends on clinical suspicion, availability, and prior imaging results. See magnetic resonance imaging and ultrasound for broader diagnostic tools.

Management

Management emphasizes a stepped, evidence-based approach that starts with conservative treatment and reserves more invasive options for refractory cases.

Conservative management

Load management: Avoiding activities that provoke symptoms initially, then gradually reintroducing loading with a structured, progressive program.
Targeted rehabilitation: A physical therapy program focusing on strengthening of the hip abductors (gluteus medius and minimus), core stabilization, and pelvis control during gait. Emphasis on gradual progression and adherence to the program.
Activity modification: Weight management and gait retraining where relevant to minimize abnormal tendon loading.
Pain relief: Short courses of nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for symptom relief, though they do not cure the underlying pathology.
Education on prognosis: Most patients improve with structured rehabilitation over weeks to months, but some require longer treatment.

Injections and medications

Corticosteroid injections: Can provide short-term relief for GTPS associated with inflammatory components, but evidence indicates limited long-term benefit and potential tendon weakening with repeated use. Generally used selectively and with awareness of risks.
Platelet-rich plasma (PRP) and other biologics: The evidence is mixed and evolving; some studies report modest short-term improvements, while others show minimal or no benefit. These are considered in select cases after conservative measures have failed.
Shockwave therapy: Some centers offer extracorporeal shockwave therapy with variable results; overall the evidence is not definitive, and it is typically not a first-line therapy.

Surgical management

Surgery is reserved for patients with persistent symptoms despite optimized conservative care for an extended period (often 6–12 months or longer) and in whom tendon integrity or disconnects are present. Surgical options include:

Endoscopic or open gluteal tendon tenotomy or debridement to remove degenerative tissue and promote healing.
Tendon repair or reconstruction for partial or full-thickness tears of the gluteus medius or minimus.
Tendon augmentation or grafting in complex cases where primary repair is not feasible.

Postoperative rehabilitation focuses on protecting the repair while gradually restoring strength and function, with a return-to-activity timeline individualized to the extent of the pathology and the chosen surgical approach. See gluteus medius tear and gluteus minimus tear for related surgical discussions.

Prognosis

Most individuals respond to structured conservative therapy, with gradual improvement in pain and function over weeks to months. Prognosis depends on factors such as the extent of tendinopathy, presence of tendon tears, adherence to rehabilitation, body weight, and activity demands. In cases requiring surgery, outcomes can be favorable with appropriate repair and rehabilitation, though recovery may be prolonged compared with purely conservative management.