Gluteal Tendinosis and Trochanteric Bursitis

The tendons and the bursa. Two buttock muscles on the side of the hip, gluteus medius and gluteus minimus, keep the pelvis level each time you stand on one leg. Their tendons attach to the greater trochanter, the bony point you can feel on the outside of the hip. A thin fluid-filled sac, the trochanteric bursa, lies over them, under the iliotibial band (the thick band of tissue that runs down the outside of the thigh). An ultrasound or MRI report describes the tendons, the bursa and the bone where they meet.

The words that come with it. These are the terms you are most likely to see. Their definitions are not standardised, particularly for bursitis on ultrasound, so two reports can describe the same hip a little differently.

The tendons are usually the source. Greater trochanteric pain syndrome is the umbrella name for pain at the bony point on the outside of the hip, and trochanteric bursitis is its older label. Tendinopathy of the gluteus medius and minimus is now recognised as a primary local source of this pain (Grimaldi et al., 2015). In 877 people with this pain scanned with ultrasound, about half showed gluteal tendinosis, more than a quarter a thickened iliotibial band and one in five bursitis (Long et al., 2013). A scan like this shows which tissues look changed; it cannot show on its own which one is causing the pain.

These findings are common in hips without pain on the outside. In 256 hips on pelvic MRI, tendon changes were found in half of the hips with no pain on the outside, and fluid signal around the bony point, an MRI sign used for both bursitis and tendinopathy, in 88 percent of them (Blankenbaker et al., 2008). In 2,851 hips scanned before keyhole surgery for hip impingement, 457 of the 871 hips with gluteus medius changes showed no sign of a problem on the outside of the hip when examined. Most of those were tendinosis, and symptom-free findings were about twice as likely from the age of 40 (Meghpara et al., 2020).

Tears turn up on the painless side too. Among 37 people having surgery for a gluteus medius tear who had symptoms on one side only, 27 also had a tear on the other, painless side. Ten of those 27 later developed symptoms there, all mild to moderate, and none needed surgery on that side within two years (Arvesen et al., 2022). Tears may still be more likely than tendinosis to matter: in the larger group scanned before impingement surgery, no full-thickness tear was free of symptoms (Meghpara et al., 2020).

The report tracks the pain loosely. In the pelvic MRI study, these findings were a poor predictor of who had pain on the outside of the hip, and neither the size and shape of the fluid signal nor partial-thickness tears differed between the painful hips and the others (Blankenbaker et al., 2008). Among the people with tears, the grade of a tear did not always match their symptoms or predict who would develop them (Arvesen et al., 2022).

It does not decide the treatment. What decides the plan is where the pain is, what sets it off and what the examination shows: tenderness at the bony point, pain standing on that leg, and the strength of the hip. A full-thickness tear with clear weakness or a limp is the main exception, covered below. If the report also describes the hip joint itself, such as cartilage loss, the hip osteoarthritis page covers that part, because the two can sit side by side.

Compression of the tendons against the bone, combined with a high pulling load, is thought to be the most damaging mix for these tendons, and positions that draw the thigh across the body (hip adduction) are a key factor (Grimaldi et al., 2015). The iliotibial band runs over the bony point, so when the thigh crosses the midline the band presses down on the tendons and bursa. In cadavers and during hip replacement operations, the force measured under the band at the bony point rose as the thigh was moved across the body and fell as it was moved outward (Birnbaum et al., 2004).

That matches the usual triggers. Lying on the painful side presses straight onto the bony point, and lying on the other side lets the top knee drop across the body. Crossing your legs, or standing with your weight hung on one hip, holds the thigh across the midline. Stairs, hills and standing on one leg ask the tendons for a strong pull while the band presses on them. This is why the plan starts with how you sleep, sit and stand, as well as with exercise.

The trials point to advice about positions plus gradually built-up exercise as the core of care, with injections and shockwave as add-ons whose benefit is smaller or less certain.

• Education and exercise. In the LEAP trial, 204 people aged 35 to 70 with more than three months of pain, and tendon changes confirmed by examination and MRI, had education plus exercise (14 sessions over eight weeks), one cortisone (corticosteroid) injection, or a wait-and-see approach. At eight weeks, 51 of 66 in the education and exercise group reported success, against 38 of 65 after the injection and 20 of 68 who waited. At a year, education and exercise still gave more people overall success than either, and pain was similar after exercise and the injection (Mellor et al., 2018).
• Advice about positions. In a trial of 94 women after menopause, everyone was taught how to avoid compressing the tendons, then given either 12 weeks of targeted strengthening or placebo (sham) exercises. Both groups improved over a year with no overall difference between them, although the authors thought some people may benefit more from the strengthening (Ganderton et al., 2018). Because both groups had the same advice, the trial could not show how much the advice itself helped. I include it alongside exercise, as the LEAP trial did with its education.
• Cortisone injection. In the LEAP trial an injection eased pain more than waiting at eight weeks, but fewer people reported overall success with it than with education and exercise, at eight weeks and at a year (Mellor et al., 2018). It can help when pain is stopping someone from starting the exercise.
• Shockwave. Across eight trials of 754 people, shockwave gave less pain than the comparison treatments at two to four months, more so with focused shockwave than with the radial type. The gain in function at six months was smaller than people usually notice, and seven of the eight trials were at high risk of bias, meaning design weaknesses could have inflated the results (Rhim et al., 2024). The evidence is mixed; it may help alongside exercise when the tendon has not settled.
• Tears and surgery. A 2026 review of gluteal tendon tears found only studies of surgery: 38 papers on 1,584 people, 35 of them reports on groups of patients with no comparison group (case series) and none a randomised trial. People improved in pain and quality of life a year or more after surgery, but the certainty was very low, and no study of non-surgical care for tears was found (Spencer et al., 2026). Reviews keep surgery for tendons that do not respond to other treatment (Grimaldi et al., 2015).

I start with where the pain is and what sets it off. Pain at the bony point on the outside of the hip that is worse lying on that side, on stairs, standing on one leg or with the legs crossed points to the tendons. Pain deep in the groin points to the joint itself, and the hip labral tear guide covers those findings. I ask how it started, because a fall or a sudden pop with new weakness is handled differently from pain that built up over months.

On examination I press on the bony point, see how long you can stand on that leg, test the strength of the muscles on the side of the hip, and watch whether the pelvis drops when you stand or walk on that side. I check how the hip joint moves and screen the lower back, because both can send pain to the same area. Then I read the report alongside what I found. I cannot order imaging; when further imaging would change the plan, I flag it to your family doctor and refer you.

For tendinosis, bursitis and partial tears the plan is usually the same: ease the compression first, with changes to how you sleep, sit and stand, then holds that push the leg outward without moving it, then strength built up step by step from two legs to one and back toward walking, stairs, hills or running. I usually leave out IT band stretching and foam rolling over the bony point, because both press on the same spot. Soft tissue work or dry needling to the surrounding muscles can sit alongside the exercise when it helps. The gluteal tendinopathy page sets out the exercise phases, and the hip bursitis page covers the same pain under its older name.

If the hip has not settled after a fair course, shockwave or an injection can be discussed. I do not give injections; when one makes sense, I coordinate with your family doctor or a sports medicine physician. If the report shows a full-thickness tear or a tendon pulled back from the bone, or you have a clear limp and weakness that is not improving, a surgical opinion through your family doctor is the next step. A tendon pulled off the bone by a fall or a sudden injury is worth that opinion promptly rather than after months of rehabilitation.