From the Guidelines
Tendinosis of the gluteus medius tendon should be treated with a combination of relative rest, cryotherapy, and eccentric strengthening exercises, as these methods have been shown to promote healing and pain relief 1. The treatment of tendinosis of the gluteus medius tendon typically involves a multi-faceted approach, including:
- Relative rest and reduced activity to prevent further damage and promote healing
- Cryotherapy, such as applying ice for 15-20 minutes several times daily, to provide acute relief of pain 1
- Eccentric strengthening exercises, which have been shown to be an effective treatment for tendinopathy and may reverse degenerative changes 1
- Over-the-counter NSAIDs, such as ibuprofen or naproxen, for short-term pain relief, although they have no effect on long-term outcomes 1 Some key points to consider in the treatment of tendinosis of the gluteus medius tendon include:
- The importance of accurate diagnosis, which requires recognition of historical features, anatomy, and useful physical examination maneuvers 1
- The use of plain radiography, ultrasonography, and magnetic resonance imaging to help confirm the diagnosis if it remains unclear 1
- The potential benefits and risks of injected corticosteroids, which may provide temporary relief but should be used with caution 1
- The role of surgery, which may be considered in carefully selected patients who have failed conservative therapy, typically involving excision of abnormal tendon tissue and performance of longitudinal tenotomies 1
From the Research
Tendinosis of Gluteus Medius Tendon
- Tendinosis of the gluteus medius tendon is a common cause of lateral hip pain, affecting 10-25% of people in developed countries 2.
- The condition is characterized by degenerative changes in the tendon, rather than inflammation, and can be debilitating, interfering with sleep and common weight-bearing tasks 3.
- Risk factors for gluteal tendinopathy include excessive compression and high tensile loads within the tendon, as well as joint position, particularly excessive hip adduction 3.
Diagnosis and Assessment
- Diagnosis of gluteus medius tendinosis is typically based on history and physical examination findings, with radiography, ultrasonography, and magnetic resonance imaging used to confirm the diagnosis 4, 5.
- A battery of clinical tests utilizing a combination of provocative compressive and tensile loads is recommended for assessing gluteal tendinopathy 3.
Treatment Options
- Conservative treatment options for gluteus medius tendinosis include:
- Surgical procedures, such as bursectomy, iliotibial band release, and endoscopic or open tendon repair, may be considered for recalcitrant cases or advanced tendinopathy 6, 4.
- Platelet-rich plasma injections have shown good evidence for use in grades 1 and 2 tendinopathy, while shockwave therapy, exercise, and corticosteroids have also shown good outcomes, although the effect of corticosteroids is short-term 4.