What is Left Gluteal Tendinopathy?
Left gluteal tendinopathy is a degenerative condition of the gluteus medius and/or gluteus minimus tendons on the left hip, characterized by chronic tendon breakdown rather than acute inflammation, causing lateral hip pain that is aggravated by loading and compression of these tendons. 1
Pathophysiology and Key Characteristics
- The condition represents degenerative tendinopathy (tendinosis) rather than acute inflammation (tendinitis), involving collagen fiber disorganization, hypercellularity, and neovascular proliferation within the tendon substance 2, 3
- The gluteus medius and minimus tendons function as the "rotator cuff of the hip", and their degeneration results from a combination of excessive compression and high tensile loads 2, 1
- Age-related degenerative changes at the hip abductor tendon insertions and surrounding bursae are the primary drivers, exacerbated by abnormal hip biomechanics 4
Epidemiology and Risk Factors
- Gluteal tendinopathy is the most prevalent lower limb tendinopathy, affecting 1 in 4 women older than 50 years 4
- The condition predominantly occurs in mid-life (fifth and sixth decades), with a female-to-male ratio of 7:1 5
- It affects both athletes and sedentary individuals regardless of activity level 4, 1
Clinical Presentation
- Patients experience lateral hip pain that is load-related and worsens with activities involving hip adduction (crossing legs, side-lying, climbing stairs) 1, 3
- Pain typically has an insidious onset and may progress from activity-related to rest pain in chronic cases 2
- The condition significantly interferes with sleep (particularly side-lying) and common weight-bearing tasks, making it a debilitating musculoskeletal problem 1
- Physical examination reveals well-localized tenderness over the greater trochanter that reproduces the patient's symptoms 2
Diagnostic Considerations
- MRI is the mainstay for evaluating gluteal tendinopathy, with sensitivity of 93% and specificity of 92% for detecting gluteus medius/minimus tendon tears, though more recent studies show more modest accuracy (sensitivity 33-100%, specificity 92-100%) 2
- Plain radiographs should be obtained first to rule out other causes of hip pain 6
- Ultrasound can detect trochanteric bursitis and evaluate gluteal tendons, though it may be difficult to distinguish from gluteus medius tendinosis 6
- Trochanteric bursitis and gluteal tendinopathy frequently coexist, making differentiation challenging 6
Important Clinical Pearls
- The term "tendinitis" is a misnomer for this chronic condition—the correct terminology is "tendinopathy" or "tendinosis" because the pathology is degenerative rather than inflammatory 2, 3
- This distinction is critical because it fundamentally changes treatment approach: anti-inflammatory treatments (rest, corticosteroids) are no longer considered first-line management 3
- Chronic degenerative tendon changes often exist without causing pain, and imaging abnormalities do not reliably predict symptoms 7