What is GLUTEAL TENDINOPATHY?
A host of causes can contribute to hip pain and gluteal tendinopathy
On the side of the hip, there are muscles and tendons that attach to the bone called the greater trochanter which is a boney protuberance on the thigh bone (femur). On the side of the hip there are many muscles which attach to tendons that attach to the greater trochanter. The most commonly injured tendons include the gluteus minimus and gluteus medius. Above the tendons between the gluteus maximus and the gluteus minimus/medius there is a bursa that lubricates the tendons and can get inflamed which is the trochanteric bursa.
Although most people get diagnosed as bursitis, trochanteric bursitis, or greater trochanter pain syndrome, most of the time it is not the bursa being inflamed and it is the tendons being injured that can cause pain on the side of your hip. A combination of over use and micro-damage from a host of causes can contribute to gluteal tendinopathy.
How do I know if I have gluteal tendinopathy (trochanteric bursitis, greater trochanter pain syndrome, or bursitis)?
Symptoms begin with pain focused on the side of the hip. The pain can be worse lying on one side. A physician might press on the tendons which are tender and test the strength of the tendons which can have pain and weakness.
A diagnostic ultrasound or MRI can be used to properly evaluate the tendons to know if there is an injury. Ultrasound can be done in the clinic and can be useful to determine if it is the hip joint or the gluteus tendons.
What are treatment options for gluteal tendinopathy and partial thickness tears?
When gluteal tendinopathy initially happen, most of the time they are chronic injuries that happen over time. The first step in managing gluteal tendinopathy and partial tears is physical therapy to strengthen the gluteal muscles to help the tendon heal.
If physical therapy does not improve your pain or ability to perform activities, the next step is to consider injection. There are cortisone injections and orthobiologic injections. Cortisone can be injected in the trochanteric bursa which coats the tendons and decreases inflammation. This reduces pain and enables you to complete the strengthening exercises in physical therapy which is the sustainable treatment to preventing future gluteal tendon injuries.
Other injections to consider are orthobiologics. Orthobiologics include Platelet Rich Plasma (PRP). Please speak with your physician to see if you are a candidate with these procedures. They can help with reducing pain and increasing function. PRP has been shown in several studies to be effective in gluteal tendinopathy. Below is a link for one great study to read about gluteal tendinopathy.
If injections do not provide relief, the next procedure to consider is tendon repair. This is where they stitch the tendon back together.
Hip Research | Gluteus Tendonitis