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Gluteal tendinopathy is recognized as the primary cause of lateral hip pain, and is typically a degenerative process and can involve the gluteus medius or gluteus minimus (Mulligan et al; Reid; Robinson et al; Torres et al).
Over time gluteal tendinosis can progress to a partial-thickness tear or full thickness tear with atrophy of the muscle belly (Kingzett-Taylor et al; Kong et al).
Patients typically report pain over the lateral hip that worsens with walking, going up stairs or lying on the affected side.
Pain may be felt over the outside of the leg down the thigh or into the buttocks and low back.
Diagnosis is based on detailed history, physical examination, and imaging. Both ultrasound and magnetic resonance imaging (MRI) have been shown to be able to identify and differentiate between tendinosis and partial-thickness tear (Docking et al; Westacott et al).
Different treatment regimens have been described for the management of gluteal tendinopathy, including non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, shockwave therapy and injections.
Shockwave therapy may be used as an adjunctive therapy for Greater Trochanteric Pain syndrome associated with gluteal tendinopathy. Shockwave therapy initiates the body’s natural healing process with the aim of reduction in pain and increase in function.
Corticosteroid injections are a common treatment for lateral hip pain with good short-term outcomes, but do not provide long-term benefit.
PRP therapy concentrates the growth factors in your own blood, which can decrease inflammation, improve function and control joint pain. A recent study has shown improved outcomes using PRP in the treatment of grade 1 and 2 gluteal tendinopathy (Ladurner et al, 2021).
Ultrasound Guided Needle Tenotomy (TENEX), is a minimally invasive procedure that can help eliminate chronic tendon pain by precisely targeting and removing damaged tissue without the need for conventional surgery.
Surgical management is typically reserved for non-responsive cases. There are a number of surgical approaches that may be used to repair or debride the affected tendon or related structures.
Docking SI, Cook J, Chen S, et al. Identification and differentiation of gluteus medius tendon pathology using ultrasound and magnetic resonance imaging. Musculoskelet Sci Pract. 2019;41:1-5.
Kingzett-Taylor A, Tirman PFJ, Feller J, et al. Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. AJR Am J Roentgenol. 1999;173(4):1123-1126. https://pubmed.ncbi.nlm.nih.go...
Kong A, Vliet A, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol. 2007;17(7): 1772-1783. https://pubmed.ncbi.nlm.nih.go...
Ladurner A, Fitzpatrick J, O'Donnell JM. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation. Orthop J Sports Med. 2021 Jul 29;9(7):23259671211016850.
Mulligan EP, Middleton EF, Brunette M. Evaluation and management of greater trochanter pain syndrome. Phys Ther Sport. 2015;16(3): 205-214.
Reid D. The management of greater trochanteric pain syndrome: a systematic literature review. J Orthop. 2016;13(1):15-28.
Robinson NA, Spratford W, Welvaert M, Gaida J, Fearon AM. Does Dynamic Tape change the walking biomechanics of women with greater trochanteric pain syndrome? A blinded randomised controlled crossover trial. Gait Posture. 2019;70:275-283.
Westacott DJ, Minns JI, Foguet P. The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears: a systematic review. Hip Int. 2011;21(6):637-645.