The gluteal tendons attach the buttock muscles to the outer hip and can tear, causing pain and weakness on the outside of the hip. Because the symptoms overlap with gluteal tendinopathy and trochanteric bursitis, a gluteal tendon tear is often missed. So how do we diagnose a tear in the tendon of the hip, and how is it treated?
The gluteal tendons attach the buttock muscles to the outer hip and can tear, causing pain and weakness on the outside of the hip. Because the symptoms overlap with gluteal tendinopathy and trochanteric bursitis, a gluteal tendon tear is often missed. So how do we diagnose a gluteal tendon tear and how is it treated?
What is a gluteal tendon tear?
The gluteus medius and gluteus minimus muscles run down the outer hip and narrow into tendons that attach to the knob of bone on the outer femur — the greater trochanter. On top of these tendons sits the trochanteric bursa. Together, the gluteal muscles are the hip abductors: they move the leg outward and, crucially, keep the pelvis level when you walk.
A gluteal tendon tear, also called a hip abductor tear, is a tear of the abductor tendons where they attach to the bone. Tears range across a spectrum — from a small partial-thickness tear, to a full-thickness tear, to a complete tear that pulls away and retracts from the bone. They’re so similar to rotator cuff tears in the shoulder that they’ve been nicknamed the “rotator cuff tears of the hip”.
What causes a gluteal tendon tear?
Most hip abductor tears are degenerative — the tendon gradually weakens with age and wear, then tears, often without a single injury. This is why they’re most common in middle-aged and older women. Less commonly, a tear follows a specific injury, such as a fall onto the hip.
A gluteus medius tear often develops on a background of long-standing gluteal tendinopathy — so many people have had outer-hip pain for a while before the tear is identified.
Symptoms of a gluteal tendon tear
The symptoms of hip abductor tear are similar to gluteal tendinopathy or greater trochanteric pain syndrome — but usually worse. Typical features include:
- Pain on the outside of the hip, worse with walking, climbing stairs, and lying on that side
- Weakness — a key feature; people describe the leg feeling like it’s dragging, or being unable to support their body weight
- A limp, sometimes with the pelvis dropping on the opposite side (a Trendelenburg gait)
The weakness is what tends to set a tear apart from simple tendinopathy — it reflects loss of the abductor tendons’ pull.
How is a gluteal tendon tear diagnosed?
We diagnose a gluteus medius tear from the description of outer-hip pain, combined with the examination and imaging.
On examination, there’s usually tenderness over the greater trochanter and — importantly — weakness of hip abduction (moving the leg outward against resistance). This weakness is the clue that points towards a tear rather than tendinopathy alone. However, this is not always the case.
Imaging then confirms it and grades the tear:
- Ultrasound — shows the tendon well and can demonstrate a tear in real time, comparing the two sides.
- MRI — grades the tear (partial vs full-thickness vs retracted) and, crucially, shows the muscle — how much wasting (atrophy) and fatty change has occurred, which strongly affects the outcome of any repair.
One important caveat: gluteal tendon changes are common on scans even in people without pain, so the imaging must always be read alongside the clinical picture rather than in isolation.
How is a gluteal tendon tear treated?
Treatment depends on the size of the tear, the degree of weakness, and the extent of muscle atrophy.
Conservative treatment (first-line for most tears)
Most partial tears are managed without surgery, and rehabilitation is the foundation:
- Load management — reducing the activities that aggravate the tendon, and avoiding positions that compress it (such as crossing the legs or lying on the side)
- Progressive strengthening — a physiotherapy programme targeting the hip abductors and surrounding muscles, which is the single most effective treatment
- Shockwave therapy — helpful for the associated tendinopathy
- Injections — cortisone has only a limited role here (it can ease pain from associated bursitis in the short term, but it doesn’t heal the tendon, and repeated use may weaken it further), so we’re cautious with it. A PRP (platelet-rich plasma) injection is sometimes used to support the tendon, under ultrasound guidance.
Surgery (for larger tears that fail conservative treatment)
Where a significant tear hasn’t responded to rehabilitation, surgical repair reattaches the torn tendon to the greater trochanter — the “rotator cuff repair of the hip”. It can be done open or endoscopically (keyhole), often with a double-row technique for a stronger repair. Outcomes are generally good for pain and strength — but they depend heavily on how much the muscle has wasted beforehand: a badly atrophied, fatty muscle doesn’t recover well even after a technically good repair, which is another reason not to leave a significant tear too long.
A recent study found reasonably good outcomes for repair of partial and full-thickness tears, although results are better if there is no fatty atrophy of the muscle.
Frequently asked questions about a gluteal tendon tear
What’s the difference between a gluteal tendon tear and bursitis?
They cause similar outer-hip pain and often occur together, but a tear also causes weakness — difficulty with hip abduction, a dragging leg, or a limp — whereas bursitis and tendinopathy are mainly painful without that weakness. Imaging (ultrasound or MRI) distinguishes them, which matters because the treatment and outlook differ.
Can a gluteal tendon tear heal without surgery?
Many partial tears are managed successfully without surgery, with a progressive hip-abductor strengthening programme as the mainstay. Larger, full-thickness tears that cause significant weakness and don’t respond to rehabilitation may need surgical repair.
Why are gluteal tendon tears called the “rotator cuff tears of the hip”?
Because they’re remarkably similar to rotator cuff tears in the shoulder — the same kind of degenerative tendon tearing away from the bone, similar symptoms, similar imaging, and similar surgical repair techniques. The nickname captures how the two problems mirror each other.
Is cortisone a good treatment for a gluteus medius tear?
Only in a limited way. A cortisone injection can ease pain from the associated bursitis in the short term. Still, it doesn’t heal the tendon, and repeated cortisone around a torn tendon may weaken it further. For that reason, we use it sparingly and lean towards rehabilitation, and sometimes PRP, instead.
How long does a gluteal tendon tear take to recover?
A partial tear, managed with rehabilitation, typically improves over several months as strength rebuilds. A surgically repaired tear takes longer, with a graded rehabilitation programme over many months to protect the repair — and the final result depends partly on how healthy the muscle was to begin with.
Final word from Sport Doctor London about gluteal tendon tears
A gluteus medius tear is a common but often-missed cause of outer-hip pain and weakness — frequently mistaken for bursitis. The weakness is the clue, and ultrasound and MRI confirm the diagnosis. Most partial tears respond to a progressive strengthening programme, with surgery reserved for larger tears that fail rehabilitation. Because the outcome of repair depends on the health of the muscle, a significant tear is best not left too long.
If you have persistent outer-hip pain or weakness, Dr Masci can assess you in London, including ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
in the USA are PRP injections paid for by Medicare
Hi Jackie, My brother works as a PM+R consultant and says that PRP is generally not covered by insurance, including medicare or Medicaid.
LM