Gluteal Tears and Bursitis in Sydney

What are gluteal tears and bursitis?

Gluteal tears and bursitis are common causes of pain on the outside of the hip. These conditions affect the tendons and soft tissues surrounding the greater trochanter, the prominent bony area at the upper end of the thigh bone. Symptoms may develop gradually through tendon degeneration and repeated loading or occur more suddenly following a fall or other injury.

The gluteus medius and gluteus minimus tendons attach the muscles of the buttock to the greater trochanter. They help stabilise the pelvis during walking, climbing stairs and standing on one leg. When these tendons become overloaded, painful or torn, appropriately prescribed physiotherapy for hip conditions is often an important part of treatment.

A trochanteric bursa is a small, fluid-filled sac that helps reduce friction between the tendons and nearby tissues. Irritation of this structure is commonly called hip bursitis or trochanteric bursitis. Bursal irritation may occur by itself, but it frequently develops alongside gluteal tendinopathy or a gluteal tendon tear.

These related conditions are often grouped under the term greater trochanteric pain syndrome, or GTPS. A careful assessment is important because lateral hip pain can also be caused by hip osteoarthritis, referred pain from the lower back and other conditions affecting the hip and pelvis.

What conditions can cause lateral hip pain?

Pain around the outer hip may involve the gluteal tendons, the trochanteric bursa or several structures at the same time. Identifying the main source of symptoms helps guide treatment and avoids assuming that all lateral hip pain is simply bursitis.

Gluteal tendinopathy

Gluteal tendinopathy occurs when the gluteus medius or gluteus minimus tendon becomes painful and less able to tolerate normal loads. It may develop gradually due to age-related tendon change, repetitive loading, a sudden increase in activity or altered movement patterns.

People with gluteal tendinopathy often experience tenderness over the outer hip, pain when lying on the affected side and discomfort during walking, stair climbing or prolonged standing. Symptoms may fluctuate according to activity and can become persistent if the tendon continues to be overloaded.

Partial gluteal tendon tear

A partial gluteal tendon tear affects some, but not all, of the tendon fibres. Partial tears may develop as part of chronic tendinopathy or follow an injury. The severity of symptoms does not always correspond directly with the size of the tear seen on imaging.

Some partial tears can be managed without surgery, particularly when strength and function remain reasonable. Treatment decisions depend on examination findings, symptom severity, weakness, imaging results and the response to structured rehabilitation.

Full-thickness gluteal tendon tear

A full-thickness gluteal tendon tear occurs when the tendon separates through its entire depth. The tendon may remain close to its attachment or retract away from the greater trochanter. Larger tears can cause substantial hip-abductor weakness, limping and difficulty maintaining pelvic stability while walking.

Not every full-thickness tear requires surgery. A specialist will consider the person's symptoms, functional limitations, tendon quality, muscle condition, general health and previous treatment before recommending an appropriate management plan.

Hip bursitis

Hip bursitis refers to irritation of one or more bursae around the outer hip. The trochanteric bursa is most commonly discussed because it lies close to the greater trochanter and the gluteal tendons.

Bursal irritation can cause localised tenderness and pain when pressure is applied to the side of the hip. However, bursitis often occurs with underlying tendon disease, which is why treatment may need to address more than the bursa alone.

Greater trochanteric pain syndrome

Greater trochanteric pain syndrome is a broad term used for pain arising from tissues around the greater trochanter. It may include gluteal tendinopathy, partial or complete tendon tears and irritation of the trochanteric bursa.

Using this broader term reflects the fact that patients may have overlapping tendon and bursal abnormalities rather than a single isolated condition.

What is the difference between bursitis, tendinopathy and a tendon tear?

Symptoms of gluteal tears and bursitis

Symptoms vary according to the tissue involved, the severity of the condition and the activities that place pressure or load through the outer hip.

Pain on the outside of the hip

The most common symptom is pain or tenderness over the side of the hip, near the greater trochanter. The discomfort may remain localised or spread into the buttock or outer thigh. Pain felt mainly in the groin may suggest that the hip joint itself is contributing to the symptoms.

Night pain and difficulty sleeping

Direct pressure on the affected side can irritate the gluteal tendons and bursa. This may make it uncomfortable to sleep on that side. Some people also experience pain when lying on the opposite side if the upper leg falls across the body and compresses the painful tendon.

Pain when walking or climbing stairs

Walking, climbing stairs, walking uphill and standing on one leg require the hip-abductor muscles to stabilise the pelvis. These activities may become painful when the gluteal tendons are irritated, weakened or torn.

Weakness and limping

More substantial tendon disease can reduce hip-abductor strength. This may cause a limp, a feeling that the hip is giving way or difficulty keeping the pelvis level while standing on the affected leg.

Pain during everyday activities

Symptoms may occur when getting out of a chair, standing for prolonged periods, carrying weight on one side or returning to activity after sitting. Running, gym exercises, hiking and sports involving repeated single-leg loading may also aggravate the condition.

What causes gluteal tears and bursitis?

There is not always one identifiable cause. These conditions may result from gradual tendon change, repeated loading, a sudden injury or a combination of factors.

Gradual tendon degeneration

Gluteal tendons can gradually change in structure and lose some of their capacity to tolerate load. This does not necessarily cause symptoms, but it may increase susceptibility to tendinopathy or tearing.

Sudden injury

A fall onto the side of the hip, an awkward movement or a sudden forceful contraction can injure the gluteal tendons. Acute tears may cause immediate pain, weakness and difficulty walking.

Changes in activity

A rapid increase in walking, running, hill training, gym exercise or other physical activity can overload a tendon that has not adapted to the new demand. Symptoms may also develop after returning to exercise following a period of reduced activity.

Compression of the outer hip

Positions that repeatedly compress the tissues over the greater trochanter may aggravate symptoms. Examples include prolonged side lying, crossing the legs or standing with most of the body weight shifted onto one hip.

Other contributing factors

Hip osteoarthritis, lower-back conditions, altered walking patterns and reduced muscle strength may contribute to lateral hip symptoms in some people. Gluteal tendon problems can also occur after hip surgery, although this is not the cause in every case.

Physical examination

The examination may assess tenderness around the greater trochanter, hip movement, muscle strength, walking pattern and the ability to stand on one leg. Specific tests can place controlled load through the gluteal tendons to determine whether they reproduce the symptoms.

A Trendelenburg test may be used to assess hip-abductor function and pelvic control. However, no single physical test confirms every case, so findings are interpreted together.

X-rays

X-rays do not show the gluteal tendons or bursa clearly, but they can identify hip osteoarthritis and other bony conditions that may cause or contribute to hip pain.

Ultrasound

Diagnostic ultrasound can assess the gluteal tendons and bursa. It may identify tendon thickening, partial or full-thickness tears and bursal fluid. Ultrasound can also be used to guide an injection when this is clinically appropriate.

MRI

MRI provides detailed images of the gluteal tendons, muscles and surrounding soft tissues. It can help assess the location and extent of a tendon tear, tendon retraction, muscle atrophy and fatty change.

Imaging findings must be considered alongside the patient's symptoms and examination. Tendon or bursal changes can sometimes appear on scans without being the main cause of pain.

Other causes of hip pain

Lateral hip pain can occasionally arise from hip osteoarthritis, lumbar spine conditions, nerve irritation, stress injury or other disorders. Patients can review information about other hip and orthopaedic conditions when considering possible causes of their symptoms.

Treatment options for gluteal tears and bursitis

Treatment depends on the underlying diagnosis, symptom severity, hip strength, functional limitations, imaging findings where relevant and the patient's health and goals. Most cases of gluteal tendinopathy, hip bursitis and many partial tendon tears are initially treated without surgery.

Activity and load modification

Temporarily reducing or modifying painful activities can allow symptoms to settle while maintaining as much safe activity as possible. Complete rest is not always necessary and can contribute to a further loss of strength.

Management may involve adjusting walking distances, reducing hills or stairs, avoiding sudden increases in exercise and limiting positions that place prolonged compression through the outer hip.

Physiotherapy and strengthening

Physiotherapy commonly focuses on understanding tendon load, reducing aggravating compression and progressively improving the capacity of the hip-abductor muscles. Treatment may also address pelvic control, walking mechanics and a gradual return to work, exercise or sport.

Rehabilitation usually needs to be progressed according to symptoms and function. Exercises appropriate at one stage may be too demanding at another, so individual guidance can be helpful.

Exercise physiology

Once symptoms are more stable, exercise physiology for ongoing rehabilitation may support progressive conditioning, general strength and a safe return to higher-level activity.

Pain relief and medication

Simple pain-relieving or anti-inflammatory medication may be considered where medically appropriate. Patients should discuss medication suitability with their general practitioner, pharmacist or treating clinician, particularly if they have other medical conditions or take regular medicines.

Image-guided injections

A corticosteroid injection may be considered in selected cases to help reduce pain associated with bursal irritation. Relief can be temporary, and an injection does not repair a damaged tendon.

The possible benefits and limitations should be considered carefully, particularly where significant tendon degeneration or tearing is present. Repeated injections may not be appropriate for every patient.

Walking aids

A walking stick or another aid may temporarily reduce the load on a painful hip. Correct fitting and use are important, so guidance from a qualified health professional may be helpful.

When might surgery be considered?

Most people with gluteal tendinopathy or hip bursitis are initially managed without surgery. Surgery may be discussed when symptoms and functional limitations remain significant despite an appropriate period of structured treatment.

Factors that may lead to a surgical opinion include:

• persistent lateral hip pain despite well-directed rehabilitation;
• a confirmed partial or full-thickness gluteal tendon tear;
• substantial hip-abductor weakness;
• persistent limping or pelvic instability;
• difficulty walking, climbing stairs or completing daily activities;
• a traumatic tear causing a marked loss of function;
• progressive functional decline; or
• imaging findings that correlate with the symptoms and examination.

The presence of a tear on MRI does not automatically mean that surgery is required. The decision depends on the overall clinical picture rather than the scan alone.

Who may be suitable for gluteal tendon repair?

Gluteal tendon repair may be considered for selected patients with a symptomatic and repairable tendon tear. Suitability is assessed individually and may depend on:

• the location and size of the tear;
• whether the tear is partial or full thickness;
• the degree of tendon retraction;
• the quality of the remaining tendon;
• the condition of the gluteal muscles;
• the severity of weakness and functional loss;
• how long the symptoms have been present;
• the response to physiotherapy and other non-surgical treatment;
• the condition of the hip joint;
• general health and suitability for anaesthesia;
• the ability to follow a protected rehabilitation programme; and
• personal goals and activity requirements.

Age alone does not determine suitability. A surgeon will consider the person's overall health, mobility, tissue quality and expected benefit from treatment.

How is gluteal tendon repair performed?

Gluteal tendon repair aims to reattach a torn tendon to the greater trochanter. The exact procedure depends on the tendon involved, the size and location of the tear, tissue quality and the presence of associated bursal or soft-tissue abnormalities.

Before surgery

Before surgery, the surgeon reviews the patient's symptoms, physical examination, imaging and previous treatment. General health, medications, anaesthetic suitability and the practical requirements of post-operative rehabilitation are also discussed.

Patients may need to plan for crutches, assistance at home, transport and time away from work. Smoking cessation, management of medical conditions and preparation of the home environment may also be recommended.

During surgery

Gluteal tendon repair may be performed using an open incision or an endoscopic technique involving smaller incisions. The choice depends on the nature of the tear and the surgeon's assessment.

The surgeon identifies the damaged tendon, prepares the attachment area on the greater trochanter and secures the tendon back to the bone. Suture anchors may be used to hold the repair while healing takes place.

Inflamed or damaged bursal tissue may be removed when necessary. In some cases, other tight or damaged tissues around the outer hip may also be addressed. More complex chronic tears may require additional techniques if the tendon cannot be repaired directly.

After surgery

After the procedure, the repair needs protection while the tendon begins to heal to the bone. Crutches are commonly required, and weight-bearing or hip movement may be restricted according to the repair.

A brace may be recommended in some cases. Specific instructions depend on the size of the tear, the repair technique and the surgeon's rehabilitation protocol.

Benefits and goals of treatment

The goals of non-surgical or surgical treatment depend on the underlying diagnosis and the patient's functional needs. Treatment may aim to:

• reduce pain associated with the gluteal tendons or bursa;
• improve hip-abductor strength;
• support pelvic stability during walking;
• improve tolerance for stairs and everyday activities;
• reduce limping;
• restore damaged tendon attachment when repair is appropriate; and
• support a gradual return to work, exercise or sport.

No treatment can guarantee complete pain relief or a return to a particular level of activity. Outcomes vary according to the diagnosis, tissue quality, severity and duration of symptoms, general health and participation in rehabilitation.

Risks and considerations

Non-surgical care is generally low risk, although symptoms may take time to improve and some patients continue to experience pain or weakness. Exercises and activity levels may need to be adjusted if symptoms become significantly aggravated.

All surgery carries risks. Potential risks of gluteal tendon repair may include:

• infection;
• bleeding or haematoma;
• blood clots;
• nerve irritation or injury;
• stiffness;
• persistent pain or tenderness;
• ongoing weakness or limping;
• incomplete tendon healing;
• re-tear or failure of the repair;
• complications associated with anaesthesia; and
• the need for further treatment or surgery.

Chronic tears with substantial tendon retraction, poor tissue quality, muscle atrophy or fatty change can be more difficult to repair. These factors may influence the surgical approach, rehabilitation and likely outcome.

Recovery and rehabilitation

Recovery varies substantially between patients. It depends on whether treatment is non-surgical or surgical, the severity of tendon damage, the procedure performed, general health and participation in rehabilitation.

Recovery without surgery

Non-surgical rehabilitation is generally gradual. Tendons often respond better to controlled and progressive loading than to sudden changes in exercise. Improvement may occur over weeks or months rather than within a few days.

Progress is usually assessed through changes in pain, strength, walking tolerance, sleep and the ability to complete everyday activities. Occasional symptom fluctuations do not necessarily mean that treatment has failed.

Early recovery after surgery

The early stage focuses on protecting the tendon repair, controlling pain and swelling, caring for the wound and moving safely with crutches. Patients receive specific instructions about weight-bearing and movements to avoid.

Driving is not appropriate while a patient cannot safely control the vehicle, is using medication that affects alertness or has not been cleared according to the surgeon's advice.

Physiotherapy and rehabilitation

Rehabilitation after tendon repair is usually staged. Early exercises may focus on safe movement and maintaining strength in unaffected areas. Direct loading of the repaired tendon is introduced gradually.

Later stages may include:

• restoring hip movement;
• progressive hip-abductor strengthening;
• improving pelvic control;
• normalising the walking pattern;
• building general lower-limb strength; and
• preparing for work and recreational activities.

Advancing too quickly can place unnecessary strain on the repair. Patients should follow the progression recommended by their surgeon and rehabilitation team.

Return to work

Time away from work depends on the procedure, travel requirements and physical demands of the role. People with desk-based work may return earlier than those whose work involves prolonged standing, climbing, lifting or manual activity.

Temporary modifications, reduced hours or working from home may be useful where available. Individual clearance should be obtained from the treating team.

Return to exercise and sport

Return to exercise is progressive and based on healing, strength, control and symptoms rather than a single fixed date. Walking, gym training, running and sport may each be reintroduced at different stages.

Higher-impact activities generally require adequate hip-abductor strength, a stable walking pattern and the ability to complete activity-specific tasks without significant pain or loss of control.

How does surgical treatment compare with other options?

Non-surgical care

Non-surgical care is usually the first approach for gluteal tendinopathy, bursitis and many partial tendon tears. It avoids surgical risks and may improve pain and function through progressive rehabilitation and activity modification.

Gluteal tendon repair

Tendon repair addresses structural separation of a torn tendon from the greater trochanter. It may be considered when a clinically significant tear causes persistent pain, weakness or functional limitation despite suitable non-surgical treatment.

Bursectomy

Bursectomy involves removing persistently irritated bursal tissue. It may be performed in selected cases, sometimes alongside treatment of associated tendon or soft-tissue abnormalities. Removing the bursa alone may not address symptoms if the main problem is an underlying gluteal tendon tear.

Open and endoscopic repair

Both open and endoscopic techniques can be used to repair gluteal tendons. One approach is not automatically suitable for every tear. The choice depends on the tear pattern, tendon quality, associated conditions and the surgeon's assessment.

Questions to ask your surgeon

• What is the most likely cause of my lateral hip pain?
• Do my symptoms come from the tendon, the bursa or another condition?
• Do I need an X-ray, ultrasound or MRI?
• Does the scan finding match my examination and symptoms?
• Is my tendon partially or completely torn?
• Can I reasonably try non-surgical treatment first?
• What should my physiotherapy programme include?
• Would an injection be appropriate in my situation?
• Why might surgery be considered?
• Is the tendon likely to be repairable?
• Would an open or endoscopic approach be used?
• What are the main risks in my particular case?
• How long might I need crutches or assistance at home?
• When might I return to driving and work?
• What rehabilitation will be required?
• What outcome is realistic for my symptoms and activity goals?

Assessment for gluteal tears and bursitis in Sydney

Gluteal tears and bursitis can cause similar symptoms, but they do not always require the same treatment. Assessment may be useful when lateral hip pain interferes with sleep, walking, work or exercise, when weakness or limping is developing, or when symptoms are not improving with appropriate rehabilitation.

A qualified health professional can assess the likely source of pain, determine whether imaging is required and discuss suitable non-surgical and surgical options. Surgery is generally reserved for selected patients with clinically significant tendon tears or persistent functional limitations rather than being recommended for every case of outer hip pain.

Book an assessment with MTP Health in Sydney to discuss your lateral hip symptoms and the treatment options that may be appropriate for your circumstances.

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