Gluteal Tendinopathy

Gluteal Tendinopathy and subsequent tearing may be a degenerative process similar to that in the shoulder, as the gluteal tendons at the greater trochanter have been called the rotator cuff of the hip.

Gluteal Tendinopathy has been reported to occur most frequently during the fourth to sixth decades of life and it’s four times more common in women than in men, possibly because of the wider female pelvis.

Studies have shown the presence of gluteal tears in nearly 20% of patients with femoral neck fracture and in those who are electing to have total hip arthroplasty.

See Also: Rotator Cuff of the Shoulder

Related Anatomy

Gluteus Medius

The gluteus medius is critical for balancing the pelvis in the frontal plane during one leg stance, which accounts for approximately 60% of the gait cycle. In addition to its role as a stabilizer, the gluteus medius also functions as a decelerator of hip adduction. Because of its shape, the gluteus medius is known as the deltoid of the hip.

The muscle can be divided into two functional parts: an anterior portion and a posterior portion. The anterior portion works to flex, abduct, and internally rotate the hip. The posterior portion extends and externally rotates the hip. On the deep surface of this muscle is located the superior gluteal nerve and the superior and inferior gluteal vessels

Gluteus Minimus

The gluteus minimus, the major internal rotator of the femur, is a relatively thin muscle situated between the gluteus medius muscle and the external surface of the ilium. It receives support from the TFL, semitendinosus, semimembranosus, and gluteus medius. The gluteus minimus also abducts the thigh, as well as helping the gluteus medius with pelvic support.

Gluteal Tendinopathy Causes

The exact cause of gluteal tendinopathy is unknown but is thought to be from direct mechanical trauma or through progressive degeneration. Researchers have hypothesized that progressive degeneration initially begins as a tendonitis. Tendonitis can then lead to tendon thickening and progress to partial and then complete tearing of both the gluteus medius and minimus.

Excessive tensioning of the iliotibial band over the greater trochanter may further contribute to these ruptures.

Symptoms & Signs

Patients often complain of a dull ache with tenderness to palpation over the greater trochanter. They may also complain of a grinding sensation along with pain when lying on the affected side and with single-leg stance activities such as climbing stairs.

On evaluation they often demonstrate hip abductor weakness. Patients may demonstrate this weakness by presenting with a Trendelenburg gait, leaning over the involved lower extremity during the stance phase and causing passive abduction of the hip to decrease load to the gluteals. Patients may also have pain during passive and resisted external rotation with the hip flexed to 90 degrees and with single-leg stance for more than 30 seconds.

Patients diagnosed with trochanteric bursitis that does not respond to conservative care should be further evaluated for gluteal tendon pathology because clinical presentation may initially appear to be trochanteric bursitis.

Imaging Evaluation

Plain radiographs are usually negative but may sometimes show calcification at the tendon insertion.

MRI is useful to determine the severity of damage to the gluteal tendon along with fatty deposition of the gluteal muscles and calcification of the tendon insertion.

Gluteal Tendinopathy Treatment

As with rotator cuff pathology of the shoulder, management of gluteal tendinopathy depends on severity.

Initial intervention is similar to that of trochanteric bursitis and should include the use of NSAIDs, rest, ice, and other modalities for inflammation control such as ultrasound. As patients become less symptomatic, they can begin progressive strengthening of the hip abductors.

Strengthening programs should include all motions of the hip along with exercises to strengthen the abdominals, lower back, and other trunk musculature.

If conservative management fails, endoscopic repair of the gluteal tendon may be beneficial.

References & More

1. Clinical Orthopaedic rehabilitation: an evidence-based approach – 3rd Edition
2. Lequesne M, Mathieu P, Vuillemin-Bodaghi V, Bard H, Djian P. Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. Arthritis Rheum. 2008 Feb 15;59(2):241-6. doi: 10.1002/art.23354. PMID: 18240186.
3. Freitas A, Rosa TM, Macedo Neto SL, Bandeira VC, Souto DRM, Barin FR. FABREX: A NEW CLINICAL TEST FOR DIAGNOSIS GLUTEAL TENDINOPATHY. Acta Ortop Bras. 2022 Apr 15;30(2):e241045. doi: 10.1590/1413-785220223002241045. PMID: 35765571; PMCID: PMC9210511.
4. Reliability of a Novel Scoring System for MRI Assessment of Severity in Gluteal Tendinopathy The Melbourne Hip MRI Score – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/MRI-scans-of-a-patient-with-gluteal-tendinopathy-and-an-MHIP-score-of-8-GT-14-3-FA-14-0_fig3_351063518 [accessed 11 Jan, 2023]