Gluteal Tendinopathy (GTPS) Symptoms and Diagnosis +/- Trochanteric Bursitis: Do I have this?

 
Gluteal Tendinopathy, Physiotherapy

In this blog we’ll outline gluteal tendinopathy symptoms typically associated with this condition, which may be accompanied by trochanteric bursitis (and therefore trochanteric bursitis symptoms) (both conditions together referred to as GTPS) and how it is diagnosed.

If you are not sure what these conditions are and what the differences are between these different names, click here to read our blog on this topic.

What are the usual gluteal tendinopathy symptoms (or trochanteric bursitis symptoms)?

The main gluteal tendinopathy symptoms (or trochanteric bursitis symptoms) are pain and tenderness over the bony prominence at the side of the hip, called the greater trochanter. If you stand upright with your arms hanging by your side, the greater trochanters are at about the level of your wrists. The greater trochanters are part of the femur (thigh bone) and serve as an anchor point for some of the gluteal (buttock) muscles. Pain may also spread down the outer surface of the thigh towards the knee. The red area on the model below highlights the common area of pain experienced with gluteal tendinopathy and bursitis.

area at the side of the hip where gluteal tendinopathy symptoms or trochanteric bursitis symptoms are felt

location of gluteal tendinopathy symptoms +/- trochanteric bursitis symptoms felt at the side of the hip

Pain is often worst at night particularly when lying on the side (lying on either side may be painful) and can disturb sleep considerably. The pain can have a significant impact on activity due to discomfort when walking, particularly walking up hills, slopes or stairs. Sitting in low chairs, particularly with the legs crossed can also aggravate the pain. Getting up from a chair after sitting can be quite uncomfortable and there might be a limp for the first few steps.

Lateral hip pain is usually experienced when:

  • Lying on your side at night
  • Walking uphills and stairs
  • Standing on 1 leg eg to dress
  • Sitting in low chairs with crossed legs
  • Getting up from chairs and during the first steps

Gluteal Tendinopathy (or Trochanteric Bursitis) Diagnosis

Clinical Assessment

Following a thorough interview and establishing that you have these gluteal tendinoapthy symptoms, there are a number of special tests that a health professional can perform in order to make a gluteal tendinopathy diagnosis (+/- trochanteric bursitis, GTPS). A couple of the tests that researchers have found most useful in diagnosing this condition1, you can perform at home yourself.

1. Sustained Single Leg Stance Test (Watch the video below)
Stand side on to a wall, with your sore hip furthest from the wall
Place 1 finger, from the nearside hand, on the wall at about shoulder height – this is just to help with balance
Now lift the nearside foot up behind you, just clearing the foot from the ground
Stand here for up to 30seconds
If you develop pain over the side of the hip within this 30 seconds, you may have gluteal tendinopathy.
(If you experience pain more quickly than 30seconds, don’t keep holding there, the test is positive)

Note: A positive test result significantly improves the chances that you have this problem. Some people will however test negative on this test and still have the problem, so this test is most useful for indicating a diagnosis of gluteal tendinopathy (+/- bursitis, GTPS) when it is positive1.

Single Leg stand test for gluteal Tendinopathy diagnosis +/- trochanteric bursitis
Single Leg stand test for gluteal Tendinopathy diagnosis +/- trochanteric bursitis

2. Palpation over the greater trochanter
If you are tender over the greater trochanter when you press with your fingers, you may have gluteal tendinopathy diagnosis (+/- bursitis, GTPS).

Note: Many people without gluteal tendinopathy are also tender over this bone, so this test cannot be used alone to diagnose the condition. Research has found that if there is no tenderness when pressing on this bony point, it is much less likely that there is a problem with the gluteal tendons1. So, this test is most useful for indicating that a gluteal tendinopathy diagnosis (+/- bursitis, GTPS) is unlikely when there is no tenderness.

There are a number of other useful diagnostic tests that need to be performed by a health professional. Organise to see a Hip Pain Professional as soon as possible – early gluteal tendinopathy diagnosis means early recovery and less chance of long-term problems.

Imaging for Gluteal Tendinopathy Diagnosis (or trochanteric bursitis diagnosis)

Ultrasound and MRI (Magnetic Resonance Imaging) scans may also be used in the diagnosis of gluteal tendinopathy and trochanteric bursitis. It is important to be aware that changes seen on a scan do not always accurately identify what is causing the problem.

In one large study, 50% of people without pain over the side of their hip had gluteal tendinopathy on their MRI scans2. This is not surprising, similar phenomena have been shown in other tendons all over the body. This means that even if your scan reports changes in the tendons or bursae, this may be a red herring! What this means is that tissue changes on imaging may NOT be related to the pain you are experiencing.

Intervention should never be planned on imaging findings alone. Tests such as those mentioned above must also be positive. A physical assessment by a health professional is required to determine the relevance of any scan results to ensure the planned treatment is appropriate and most likely to have a positive outcome. See a Hip Pain Professional  for a thorough assessment, to ensure you don’t waste valuable time and resources treating the wrong condition.

  1. Grimaldi A, Mellor R, Nicolson P, Hodges P, Bennell K, Vicenzino B. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. British Journal of Sports Medicine. 2017 Mar;51(6):519-524. doi: 10.1136/bjsports-2016-096175. Epub 2016 Sep 15.
  2. Blankenbaker DG, Ullrick SR, Davis KW, et al. Correlation of MRI findings with clinical findings of trochanteric pain syndrome. Skeletal Radiology 2008; 37:903–9.

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