Treatment of gluteal tendinopathy: a systematic review and stage-adjusted treatment recommendation

Review written by Dr Alison Grimaldi info

Key Points

  1. While severity of pathology is certainly a consideration, particularly for surgical interventions, decisions on management of gluteal tendinopathy cannot be made on the basis of pathology alone.
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BACKGROUND & OBJECTIVE

Gluteus medius and/or minimus tendinopathy has been shown to be the primary pathology underlying lateral hip pain or greater trochanteric pain syndrome. Tendon structure may deteriorate through a degenerative process described in grades of pathology:

  • Grade 1 - Initially no or minimal changes within the gluteal tendons that may be accompanied by bursal change
  • Grade 2 - Clear tendinopathy
  • Grade 3 - Partial thickness tears
  • Grade 4 - Full thickness tendon tears with some degree of discontinuity of one or both tendons (1). Note that a full thickness tear may only involve a limited area of an otherwise largely intact tendon (full thickness tear ≠ complete rupture).

Previous systematic reviews have already examined the effectiveness of treatments available for gluteal tendinopathy, including education and exercise, injections (corticosteroids, platelet-rich plasma (PRP)), autologous tenocytes with or without needle tenotomy/tendon fenestration, shockwave therapy, therapeutic ultrasound, and surgical procedures such as bursectomy, iliotibial band release and endoscopic or open tendon repair (with or without tendon augmentation).

This review was approached in a different manner, where the authors reviewed the evidence for treatment options for each grade of gluteal tendinopathy, aiming to provide stage-adjusted treatment recommendations for gluteal tendinopathy.

Gluteus medius and/or minimus tendinopathy has been shown to be the primary pathology underlying lateral hip pain or greater trochanteric pain syndrome.
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There is high-level evidence that an education and exercise approach is efficacious in the management of patients with gluteal tendinopathy.

METHODS

A systematic review of studies that examined treatment outcomes for participants with imaging-confirmed gluteal tendinopathy was performed. The search returned 27 studies, including 6 randomized clinical trials (RCTs), and 21 case-controlled studies or case series.

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