Gluteal Tendinopathy and Greater Trochanteric Pain Syndrome: Review of Current Concepts in Diagnosis and Management
DOI:
https://doi.org/10.63403/re.v33i1.422Keywords:
Greater trochanteric pain syndrome, Gluteal tendinopathy, PRP, Shockwave therapy, MRI, Hip abductor repair, Endoscopic surgeryAbstract
Greater trochanteric pain syndrome (LTPS) is a common, though frequently underestimated, cause of chronic lateral hip pain. Traditionally linked to trochanteric bursitis, advances in functional anatomy and imaging have repositioned gluteal tendinopathy as the central pathological axis, with or without secondary bursal inflammation. In this context, we present a comprehensive, evidence-based review of pathophysiological mechanisms, clinical and imaging assessment strategies, and available therapeutic options, with particular emphasis on gluteal tendon involvement.
A narrative review was conducted according to the STROBE guidelines. The literature search included publications from 2018 to 2025 in the PubMed, Embase, Scopus, and Web of Science databases. Clinical studies, systematic reviews, and expert consensus statements focused on LTPS or gluteal tendinopathy were selected. The synthesis was organized around five thematic axes: biomechanics, clinical presentation, diagnostic imaging, non-surgical interventions, and surgical approaches.
Gluteal tendinopathy is currently recognized as the main determinant of temporomandibular joint dysfunction (TMD), with a typical presentation of lateral hip pain that is exacerbated by weight-bearing activities. Diagnosis is based on clinical evaluation and imaging studies, especially magnetic resonance imaging (MRI). Conservative treatment achieves effective results in most cases. Those refractory to conservative treatment with confirmed tendon ruptures may benefit from surgical repair, with the endoscopic technique standing out for its good results and lower morbidity. Despite encouraging data, a lack of high-quality comparative studies persists. Consequently, TMD should be understood as the result of the interaction between tendon degeneration, biomechanical alterations, and neuromuscular imbalance. A stepwise, patient-centered approach that integrates early detection, individualized treatment, and appropriate surgical selection appears to offer the best clinical outcomes.
Level of Evidence: V. Narrative Review
Downloads
References
Grimaldi A, Ganderton C, Nasser A. Gluteal tendinopathy masterclass: refuting the myths and engaging with the evidence. Musculoskelet Sci Pract. 2025;76:103253. doi: https://doi.org/10.1016/j.msksp.2025.103253. DOI: https://doi.org/10.1016/j.msksp.2025.103253
Merrill CA, Fleisig GS, Arceo C, Jebeles NA, Emblom BA. Endoscopic gluteus medius repair. Arthrosc Tech. 2022;11(10):e1787-e1791. doi: https://doi.org/10.1016/j.eats.2022.06.015. DOI: https://doi.org/10.1016/j.eats.2022.06.015
Meghpara MB, Yelton MJ, Glein RM, et al. Isolated endoscopic gluteus medius repair can achieve successful clinical outcomes at minimum 2-year follow-up. Arthrosc Sports Med Rehabil. 2021;3(6):e1697-e1704. doi: https://doi.org/10.1016/j.asmr.2021.07.026. DOI: https://doi.org/10.1016/j.asmr.2021.07.026
Ladurner A, Fitzpatrick J, O’Donnell JM. Treatment of gluteal tendinopathy: a systematic review and stage-adjusted treatment recommendation. Orthop J Sports Med. 2021;9(7). doi: https://doi.org/10.1177/23259671211016850. DOI: https://doi.org/10.1177/23259671211016850
Guemara R, Nissen MJ. The greater trochanteric pain syndrome: clinical presentation, diagnosis, and management. Curr Treatm Opt Rheumatol. 2023;9(3):192–203. doi: https://doi.org/10.1007/s40674-023-00209-9. DOI: https://doi.org/10.1007/s40674-023-00209-9
Wang SQ, Guo NY, Liu W, Huang HJ, Xu BB, Wang JQ. Effect of conservative treatment on greater trochanteric pain syndrome: a systematic review and network meta-analysis of randomized controlled trials. J Orthop Surg Res. 2025;20(1):126. doi: https://doi.org/10.1186/s13018-025-05477-w. DOI: https://doi.org/10.1186/s13018-025-05477-w
Bicket L, Cook J, Knott I, Fearon A. The natural history of greater trochanteric pain syndrome: an 11-year follow-up study. BMC Musculoskelet Disord. 2021;22(1):1048. doi: https://doi.org/10.1186/s12891-021-04935-w. DOI: https://doi.org/10.1186/s12891-021-04935-w
Giai Via R, Elzeiny A, Bufalo M, Massè A, Giachino M. Endoscopic management of greater trochanteric pain syndrome (GTPS): a comprehensive systematic review. Eur J Orthop Surg Traumatol. 2024;34(6):3385–3394. doi: https://doi.org/10.1007/s00590-024-04019-0. DOI: https://doi.org/10.1007/s00590-024-04019-0
He Y, Lin Y, He X, Li C, Lu Q, He J. The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis. BMC Musculoskelet Disord. 2023;24(1):423. doi: https://doi.org/10.1186/s12891-023-06443-5. DOI: https://doi.org/10.1186/s12891-023-06443-5
Pianka MA, Serino J, DeFroda SF, Bodendorfer BM. Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology. SAGE Open Med. 2021;9:20503121211022582. doi: https://doi.org/10.1177/20503121211022582 DOI: https://doi.org/10.1177/20503121211022582
Aicale R, Tarantino D, Maffulli N. Basic science of tendons. En: Gobbi A, Espregueira-Mendes J, Lane JG, Karahan M (eds). Bio-orthopaedics: a new approach. Berlin, Heidelberg: Springer; 2017. pp. 249–273. doi: https://doi.org/10.1007/978-3-662-54181-4_21. DOI: https://doi.org/10.1007/978-3-662-54181-4_21
Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res. 2018;13(1):309. doi: https://doi.org/10.1186/s13018-018-1017-5. DOI: https://doi.org/10.1186/s13018-018-1017-5
Tarantino D, Palermi S, Sirico F, Corrado B. Achilles tendon rupture: mechanisms of Injury, principles of rehabilitation and return to play. J Funct Morphol Kinesiol. 2020;5(4):95. doi: https://doi.org/10.3390/jfmk5040095. DOI: https://doi.org/10.3390/jfmk5040095
Tarantino D, Palermi S, Sirico F, Balato G, D’Addona A, Corrado B. Achilles tendon pathologies: how to choose the best treatment. J Hum Sport Exerc. 2020;15(4):S1300–S1321. DOI: https://doi.org/10.14198/jhse.2020.15.Proc4.29
Tarantino D, Aicale R, Maffulli N. Achilles tendinopathy. En: Bhandari M (eds). Evidence-Based orthopedics. New Jersey, Hoboken; John Wiley & Sons; 2021. pp. 849–852. doi: https://doi.org/10.1002/9781119413936.ch145. DOI: https://doi.org/10.1002/9781119413936.ch145
Loiacono C, Palermi S, Massa B, et al. Tendinopathy: pathophysiology, therapeutic options, and role of nutraceutics. A narrative literature review. Medicina (Kaunas). 2019;55(8):447. doi: https://doi.org/10.3390/medicina55080447. DOI: https://doi.org/10.3390/medicina55080447
Aicale R, Tarantino D, Maffulli N. Non-insertional achilles tendinopathy: state of the art. En: Canata GL, d’Hooghe P, Hunt KJ, Kerkhoffs GMMJ, Longo UG (eds). Sports injuries of the foot and ankle. Berlin, Heidelberg: Springer; 2019. pp. 359–367. doi: https://doi.org/10.1007/978-3-662-58704-1_32. DOI: https://doi.org/10.1007/978-3-662-58704-1_32
Bisaccia DR, Aicale R, Tarantino D, Peretti GM, Maffulli N. Biological and chemical changes in fluoroquinolone-associated tendinopathies: a systematic review. Br Med Bull. 2019;130(1):39–49. doi: https://doi.org/10.1093/bmb/ldz006. DOI: https://doi.org/10.1093/bmb/ldz006
Tarantino D, Mottola R, Resta G, et al. Achilles tendinopathy pathogenesis and management: a narrative review. Int J Environ Res Public Health. 2023;20(17):6681. doi: https://doi.org/10.3390/ijerph2017668110.3390/ijerph20176681. DOI: https://doi.org/10.3390/ijerph20176681
de Sire A, Lippi L, Mezian K, et al. Ultrasound-guided platelet-rich-plasma injections for reducing sacroiliac joint pain: a paradigmatic case report and literature review. J Back Musculoskelet Rehabil. 2022;35(5):977-982. doi: https://doi.org/10.3233/BMR-210310. DOI: https://doi.org/10.3233/BMR-210310
Pellegrino R, Di Iorio A, Filoni S, et al. Radial or focal extracorporeal shock wave therapy in lateral elbow tendinopathy: a real-life retrospective study. Int J Environ Res Public Health. 2023;20(5):4371. doi: https://doi.org/10.3390/ijerph20054371. DOI: https://doi.org/10.3390/ijerph20054371
Maffulli N, Aicale R, Tarantino D. Tendinopathy of the achilles tendon. En: Allegra F, Cortese F, Lijoi F (eds). Ankle joint arthroscopy: a step-by-step guide. Berlin, Heidelberg: Springer; 2020. pp. 227–237. doi: https://doi.org/10.1007/978-3-030-29231-7_31. DOI: https://doi.org/10.1007/978-3-030-29231-7_31
Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22(4):675-692. doi: https://doi.org/10.1016/s0278-5919(03)00004-8. DOI: https://doi.org/10.1016/S0278-5919(03)00004-8
Maffulli N, Aicale R, Tarantino D. Autograft reconstruction for chronic achilles tendon disorders. Tech Foot Ankle Surg. 2017;16(3):117. doi: https://doi.org/10.1097/BTF.0000000000000154. DOI: https://doi.org/10.1097/BTF.0000000000000154
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Pablo V. Cornejo Alban, Galo F. Echeverría Bolaños, Ana F. Rivero Tlaque, Carlos P. Peñaherrera Carrillo, Francisco Endara Urresta, Alejandro X. Barros Castro, Paúl S. Vaca Pérez, Diego P. Michilena Chávez
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This work is published under a Creative Commons Attribution–NonCommercial–ShareAlike 4.0 International License (CC BY-NC-SA 4.0). The authors retain the copyright.
