Gluteal Tendinopathy

Procedure

Patient stands on the affected leg with hip and knee extended, arms folded across chest, for up to 30 seconds. Observe for pelvic drop or Trendelenburg sign on the contralateral side.

Positive Finding

Reproduction of the patient's lateral hip pain during 30 seconds of single-leg stance. Pelvic drop may be observed but is a separate finding (Trendelenburg sign) and is not what makes this test useful for gluteal tendinopathy.

Sensitivity / Specificity

Interpretation

This is the single most useful physical test for gluteal tendinopathy. In Grimaldi et al. (2017), pain reproduced during a sustained 30-second single-leg stance carried a positive likelihood ratio of 12.2 against MRI-confirmed gluteal tendinopathy — a result strong enough to substantially raise the probability of the diagnosis on its own. The key point is that the test works because it loads the tendon actively; tests relying on passive positioning perform considerably worse. Hold the position for the full 30 seconds, because pain often takes time to build. Note that pelvic drop and pain are different findings: pelvic drop indicates abductor weakness and is the Trendelenburg sign, whereas it is the reproduction of familiar lateral hip pain that supports tendinopathy. From one small study of 17 patients with long-standing lateral hip pain, all with gluteal tendon changes or bursitis on MRI (Lequesne 2008). Only sensitivity is shown: the comparison group had no hip pain, which makes specificity look better than it is in clinic. A larger study of 65 people with lateral hip pain (Grimaldi 2017) found that pain within 30 seconds of standing on one leg made gluteal tendinopathy on MRI very likely; that figure is not shown until the full paper is checked.

Procedure

Patient stands on affected leg and performs a controlled squat to approximately 60° knee flexion, maintaining arms outstretched for balance. Observe lower extremity mechanics and patient symptoms.

Positive Finding

Dynamic knee valgus, visible pelvic drop, or reproduction of gluteal/lateral hip pain; patient unable to perform the movement with control.

Interpretation

Assesses hip abductor and external rotator function under load. Poor control or reproduced lateral hip pain is consistent with gluteal tendinopathy but is not diagnostic of it, since the same pattern appears in patellofemoral pain, hip osteoarthritis and general deconditioning. Treat it as a movement-quality observation that guides rehabilitation rather than as a diagnostic test. The previously cited source was a real paper on a different topic and does not report diagnostic accuracy for this test.

Procedure

Patient lies on unaffected side with hips flexed 45° and knees extended. Patient abducts the affected leg against gravity (or clinician resistance). Note pain and weakness.

Positive Finding

Pain in the gluteal/lateral hip region, or reduced strength compared with the contralateral side.

Interpretation

Isolates gluteus medius function. Pain or weakness supports a gluteal tendinopathy picture and is useful for tracking progress over a rehabilitation programme, but no diagnostic accuracy has been established for this test. The previously cited source was a real paper on a different topic and does not report diagnostic accuracy for this test.

Procedure

Patient supine, hip flexed 90° and knee flexed 90°. Clinician passively internally rotates the femur, noting end-feel and any reproduction of gluteal pain.

Positive Finding

Reduced internal rotation compared with the unaffected side, or pain in the gluteal/posterior hip region at end-range.

Interpretation

Reduced hip internal rotation is associated with femoroacetabular impingement and altered hip mechanics, which may contribute to gluteal tendon loading. This is a contributing-factor assessment, not a test for gluteal tendinopathy — a restriction here does not confirm the diagnosis, and full rotation does not exclude it. The previously cited reference combined the title, journal details and author list of three unrelated papers, none of which concerns this condition.

Procedure

Patient side-lying on unaffected side. Clinician palpates the gluteal insertion region (lateral greater trochanter and adjacent gluteal muscle attachments) using firm, direct pressure.

Positive Finding

Reproduction of patient's characteristic gluteal pain, point tenderness, or patient recognition of symptom familiar pain

Sensitivity / Specificity

Interpretation

Palpation over the greater trochanter is a sensitive test with the best negative likelihood ratio of the clinical tests examined by Grimaldi et al. (2017) — which means its real value lies in a NEGATIVE result. A non-tender greater trochanter argues meaningfully against gluteal tendinopathy. A tender one is much weaker evidence, because specificity is poor and the trochanter is tender in a range of other lateral hip conditions and in some asymptomatic people. Use it to rule out rather than to confirm, and corroborate a positive with an active loading test such as the 30-second single-leg stance. From one study of 65 people with lateral hip pain, with MRI as the reference (Grimaldi 2017). Specificity is not shown: the number of people without tendinopathy is not given in the abstract. No tenderness over the greater trochanter made gluteal tendinopathy on MRI unlikely.

Procedure

Patient supine with contralateral knee pulled to chest. Affected leg hangs over table edge. Observe hip extension angle and external rotation. Note any gluteal pain with hip extension.

Positive Finding

Restricted hip extension on the hanging leg, or gluteal/lateral hip pain with passive hip extension and external rotation.

Interpretation

Identifies hip flexor tightness that can alter hip mechanics and increase load through the gluteal tendons. This is a contributing-factor assessment that informs treatment planning; it has no established diagnostic accuracy for gluteal tendinopathy. The previously cited source was a textbook rather than primary research, and the accuracy figures it was said to support could not be traced to any study.