Gluteal Tendon Tear

The gluteus medius and minimus tendons are necessary for lateral hip and pelvis stability. Lateral stability is the ability of the muscles and ligaments surrounding the hip joint to maintain hip alignment and provide support during standing, walking, and running. Tears usually occur where the gluteal tendon attaches to the thigh bone.

Gluteal tears are a common source of chronic hip pain in the older population due to aging and tendon degeneration. These tears are commonly referred to as “rotator cuff tears of the hip.” Tears can range from mild (partial tears) to severe (complete ruptures).

Gluteus medius tears affect up to 25% of middle-aged women and 10% of middle-aged men. They can also affect younger people who engage in sports that require repetitive hip movements, which cause microtrauma and inflammation that weaken and damage the tendons over time. Chronic or longstanding injuries are more common than acute injuries. These tears can often occur in combination with trochanteric bursitis, inflammation of the bursa, or fluid-filled structures overlying the gluteal tendons.

• Degenerative Changes: Age-related wear and tear causes tendon degeneration and symptoms.
• Overuse and Repetitive Stress: Common in athletes and individuals engaging in activities requiring repetitive hip movements.
• Trauma: Acute injuries due to falls or direct impacts to the hip area.
• Biomechanical Factors: Abnormalities in gait or pelvic alignment can increase stress on the gluteal tendons.
• Corticosteroid Injections: While used to reduce inflammation and treat bursitis and/or gluteal tendon tears, repeated use can weaken tendons and increase the risk of tears.

• Pain, tenderness, and swelling around the lateral hip area.
• Symptoms are aggravated by walking, climbing stairs, or lying on the affected side.
• A limp while walking is called Trendelenberg gait.
• Weakness and difficulty abducting the hip (raising the leg to the side) can lead to a limp or difficulty maintaining pelvic stability while walking.

Your UCSF Women’s Sports Medicine physician will review your medical history and inquire about your symptoms. They will thoroughly assess the hip’s range of motion, strength, and the presence of pain during specific movements. Imaging studies will be ordered. Ultrasound imaging can visualize soft tissue structures and detect tendon tears or degeneration. Magnetic Resonance Imaging (MRI) provides detailed images of the soft tissues, including the gluteal tendons, and is considered the gold standard for diagnosing tendon tears.

Initial management is typically nonoperative and includes activity modification, NSAIDs for pain, and physical therapy. Platelet-rich plasma injections and limited use of corticosteroid injections may be helpful. Failure of conservative management and continued symptoms (weakness and pain) are indications for surgical intervention.