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Observational Study
. 2025 Jun 19;145(1):347.
doi: 10.1007/s00402-025-05964-z.

An examination of imaging findings in patients with clinically diagnosed gluteal tendinopathy: a secondary analysis of a randomised clinical trial

Alison Grimaldi  1 , Anthony Nasser  2 , Rebecca Mellor  3   4 , Bill Vicenzino  3
Affiliations
Observational Study

An examination of imaging findings in patients with clinically diagnosed gluteal tendinopathy: a secondary analysis of a randomised clinical trial

Alison Grimaldi et al. Arch Orthop Trauma Surg. .

Abstract

Objectives: To report tendon pathology present on imaging and relationships to pain, function and disability in participants with gluteal tendinopathy (GT) who participated in a multi-centre randomised clinical trial.

Materials and methods: Imaging findings were examined in 204 participants with GT. Magnetic Resonance Images (MRI) and x-ray were evaluated against pre-determined criteria by experienced radiologists, blind to clinical findings, who reported on location of tendon pathology, presence and severity of tendon tears and location and presence of calcification. Severity of changes seen on MRI were scored and analyses for relationships to pain, function and disability were performed.

Results: Information on location and severity of tendon pathology was available for 202 (99%) of the 204 LEAP trial participants. Tendon pathology was commonly present in both the gluteus medius (GMed) and gluteus minimus (GMin) tendons (130/202; 64%), with tears in one or both tendons in 85 (42%) participants. Of 99 tears across both tendons, 77 (78%) were partial-thickness and 22 (22%) were full-thickness in nature. The anterior aspect of the GMed tendon and the posterior aspect of the GMin tendon were most afflicted. Calcifications at the lateral ilium or greater trochanter were evident on x-ray in 73 (36%) participants. Pain, function and disability were not associated with the severity of changes on MRI.

Conclusion: In a clinical trial of people with GT, a substantial number of participants had multiple tendons affected, as well as concomitant tendon tears and calcification. MRI detected changes were not associated with levels of pain, function or disability.

Keywords: Buttocks; GTPS; Gluteal tendinopathy; Gluteal tendon tears; Hip; Trochanteric bursitis.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
An example of tendon pathology in a participant of the LEAP trial demonstrated on axial and coronal plane T2-weighted MRI. Tears of the gluteus medius and minimus on the background of severe tendinopathy was reported
Fig. 2
Fig. 2
Tendon calcifications evident on radiographs. Superior/Blue arrows: Gluteus medius origin at iliac crest. Dotted/ Pink arrow: Gluteal tendons at the superolateral aspect of the greater trochanter. Inferior/Orange arrows: Calcifications extending inferiorly from the greater trochanter
Fig. 3
Fig. 3
Axial cross-section of a T1 weighted MRI at the level of the greater trochanter, demonstrating the anterior and lateral facets of the greater trochanter, and the overlying iliotibial band and muscular tensioners - tensor fascia lata and gluteus maximus. GMED: Gluteus Medius; GMin: Gluteus Minimus
See this image and copyright information in PMC

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