Gluteal Tendon Tears

What is a gluteal tendon tear?

The gluteus medius and gluteus minimus are the muscles on the side of the buttock that hold your pelvis level as you walk and stand on one leg. Their tendons attach to the bony point on the outside of your hip, called the greater trochanter. Like the rotator cuff in the shoulder, these tendons can become irritated (tendinopathy), partly torn, or fully torn from the bone. For this reason gluteal tears are sometimes called the “rotator cuff of the hip.”

What does it feel like?

The main symptom is pain on the outside of the hip, often spreading down the thigh. It is typically worst lying on that side at night, climbing stairs, standing on one leg, and after long walks. Some people have a limp or a tilting of the pelvis when they walk, and weakness lifting the leg out to the side. The condition is more common in women and in people in midlife and beyond.

Is it bursitis, a pinched nerve or arthritis?

It can look like any of them, and several can coexist. An inflamed bursa is a frequent finding alongside a tendon problem, but treating the bursa alone often doesn't fix things. Hip arthritis tends to cause groin pain, and a pinched nerve in the back often causes pain below the knee. An exam and an MRI or ultrasound help sort these apart.

Do I need surgery?

Usually not at first. In a randomized trial of 204 adults with gluteal tendinopathy, education plus a progressive exercise program gave better pain relief and overall improvement than simply waiting and seeing, and at eight weeks it also did better than a single cortisone injection. By one year, exercise and injection had similar results.¹ Treatment focuses on:

• Learning which positions and habits irritate the tendon, such as lying on the sore side, crossing the legs, standing with the hip pushed out, and sitting low
• A progressive strengthening program for the hip abductors
• Pacing activity rather than stopping altogether
• Weight management when it applies
• A cortisone or PRP injection in selected cases, used as a bridge to exercise rather than a fix

Most people improve over several months without an operation.

When is surgery considered?

Surgery is considered when there is a significant tear or tendon detachment on MRI, when pain and weakness persist after a committed course of therapy, or when the tear has led to a limp or a positive Trendelenburg sign. The repair reattaches the tendon to the greater trochanter with anchors and strong sutures. Small tears are often repaired through small incisions, while retracted or degenerated tendons may need reinforcement. Dr. Stepanyan will explain how each option applies to your tear.

Should I get a second opinion?

It is reasonable if you have had “trochanteric bursitis” treated several times without lasting relief or if an MRI shows a tear and surgery has been suggested. Request a visit and bring your imaging.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees patients in Glendale, East LA and Santa Fe Springs.

What does recovery look like?

If surgery is needed, these are typical stages after a gluteal tendon repair. Your own plan may differ.

1. Weeks 0–6

   Protect the repair

   You use crutches and limit how much weight you place on the leg, avoid actively lifting the leg outward, and use a brace or positioning aids as directed. Gentle motion exercises start early.

2. Weeks 6–12

   Progress weight bearing

   Weight bearing increases and crutches are weaned. Therapy begins to restore a normal walking pattern.

3. Months 3–6

   Build strength

   Strengthening of the hip abductors begins in earnest. Most daily activity is comfortable by about three months.

4. 6–12 months

   Return to activity

   Strength and endurance keep improving. Dr. Stepanyan clears you for higher-impact activity once your strength is close to the other side.

Healing of a tendon to bone is slow, and gains in strength can continue for a year or more. Follow the plan written for you if it differs from this overview.

Sources

1. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. PubMed