Gluteal Tendinopathy
Lateral hip pain has historically been attributed to trochanteric bursitis, but more recently, the diagnosis of gluteal tendinopathy is believed to be a more common cause
Demographics
Pathoanatomy
gluteal tendinopathy refers to a tendinopathy of the gluteus medius or gluteus minimus tendons1.
Glute med tendinopathy has been paralleled to supraspinatus tendon pathology since both structures commonly develop deep tears and both experience relatively low tensile loads, but high compressive loads against their respective bony insertions1.
What causes this compression?
Iliotibial band tensioning in a position of hip ADDuction was found to create more compressive forces at the greater trochanter than passive hip adduction alone1.
Functionally, this occurs if the iliotibial band tensioners are over-active and the hip abductors are underactive1. This culminates in the gluteus medius fighting a losing battle against hip adduction1.
- Increased fatty atrophy of gluteus muscle(s)1
Presentation
Movement Patterns
Patients who have gluteal tendinopathy due to compression often default to positions of hip ADDuction with excessive IT Band tension1. This presents as excessive hip ADDuction during:
- Bilateral Squatting
- Bilateral lunging
- Climbing and descending stairs
- Single leg stance
- Single leg squatting
- single leg hopping
Patients who have less severe pathologies may need to be loaded greater than just bodyweight to make these dysfunctional patterns apparent1.
Diagnosis
Clinical Tests for Ruling in
Imaging
X-Ray, MRI, ultrasound (US), and scintigraphic imaging can all useful in ruling-in or out gluteal tendinopathy, but it should be noted that signs of soft tissue pathology often occur in non-symptomatic hips1.