Part of Greater trochanteric pain syndrome
Does gluteal tendinopathy show on MRI, and do you need a scan?
Warning signs, and when to get help
Does gluteal tendinopathy show on MRI?
Yes, clearly, and in detail. An MRI of the hip can show increased signal and thickening inside the gluteus medius and gluteus minimus tendons where they attach to the bony point at the top of the thigh bone. It can show tears running through part or all of a tendon's thickness, fluid in the bursa that sits under those tendons, and muscle that has been partly replaced by fat.
We know how much detail because one trial put it on record. Entry to the LEAP trial required signal change inside those tendons on MRI, so every one of its 204 adults with clinically diagnosed gluteal tendinopathy arrived with a scan. There were 167 women among them and the mean age was 54.8 years, and a later analysis went back through the images (Grimaldi and colleagues, 2025).
In that group, both tendons were affected in 130 of 202 people with usable data, one tendon only in the rest, and one or both tendons were torn in 85 of the 202. Of the 99 tears identified across both tendons, 78% went through part of the tendon's thickness and 22% through all of it. Calcification showed on the x-rays of 73 of the 202.
Read those figures for what they are. Every one of those people had been selected into a trial partly because their scan was abnormal, so the numbers describe that group and not everybody with pain on the outside of their hip. There was also nobody pain free to compare them with, because every hip scanned was a painful one, which is why the next section has to bring in a different study. What they do establish is that a scan picks this condition up, and that findings a reader would find alarming are ordinary inside a population being treated without surgery.
The greater trochanteric pain syndrome program is the treatment, and it is the same treatment whether or not you have had a scan.
Why does a scan often change nothing?
The findings do not track the symptoms, in either direction, and the clearest demonstration of that comes from those same LEAP scans.
The researchers scored each MRI for how much tendon pathology it showed, on a published scale, and then compared that score with what people reported: their pain, their function on tasks they had chosen themselves, and their disability score. None of those comparisons reached statistical significance. The authors conclude that the severity of the imaging findings was not associated with the pain, the function or the disability people reported (Grimaldi and colleagues, 2025). A worse-looking scan did not mean a worse-feeling hip.
The other half of the argument is older. When 40 people with pain on one side of the hip had both hips scanned, the findings that appeared in the painful hips, gluteal tendon change, bursitis, osteoarthritis and muscle wasting, also appeared in the hips that did not hurt, bursitis especially. Three radiologists read the images, the strength of their agreement with each other varied, and the physical therapy diagnosis and the radiology diagnosis rarely agreed at all (Woodley and colleagues, 2008). So a finding on the sore side is not automatically the cause of the soreness.
A third piece of evidence looks at what happens afterwards. Twenty people from an injection trial, 19 of them women with a mean age of 58, had been given platelet-rich plasma, a steroid injection or both, and were scanned again an average of just over four years later. Only 9 of the 20 showed any structural improvement on the scoring system used, and the group changes did not reach statistical significance. The authors describe the work as small and hypothesis-generating (Carney and Fitzpatrick, 2023). Structure and symptoms move on different timetables, which is one more reason a repeat scan is unlikely to tell you whether you are getting better.
Our page on the stages of hip arthritis and how fast it progresses makes the equivalent point about x-rays and the hip joint. It is the same lesson in a different tissue.
When does a scan change the plan?
There are situations where it does change what happens next, and the message here is not that imaging is pointless.
- When something does not fit. Pain in the groin with a stiff hip, pain running below the knee with pins and needles, or an examination that does not behave like a tendon problem all raise other possibilities, and imaging is one way to pursue them.
- When a serious cause has to be excluded. The warning signs at the end of this page exist for that reason, and a scan ordered to rule something out is being used properly.
- When a decision depends on the tendon's state. If surgery is being considered after other treatment has not worked, the surgeon needs to see what they would be operating on.
- When nothing has changed after a proper attempt. Several months of load management and graded strengthening done well, with no improvement, is a reason to re-open the diagnosis, and imaging may be part of that.
What a scan is not for is confirming what you already know, reassuring you that your hip is sound, or deciding whether to start exercising. The treatment is the same either way, and waiting for physio covers what to get on with in the meantime.
The decision itself belongs to the clinician who examined you. This page is education and it will not tell you to request a scan or to decline one.
What do the words in the report mean?
In general terms, and only in general terms. Nothing here is an interpretation of anybody's report.
Tendinosis, or increased signal within the tendon, describes tendon tissue that has changed in composition and appearance. It is the imaging face of tendinopathy, and it is not a tear.
A partial thickness tear means part of the width or depth of the tendon has given way while the rest is intact. In the LEAP population, 78% of the tears found were of this kind (Grimaldi and colleagues, 2025).
A full thickness tear means the tear runs the whole way through the tendon's depth at that point. It does not mean the tendon has come off the bone, and it does not by itself mean an operation. It accounted for 22% of the tears in that same group.
Bursal fluid, or bursitis on a report, means fluid in the small sac beneath the tendons. This is the word that generates the most unnecessary worry, partly because it is so common in hips that do not hurt (Woodley and colleagues, 2008), and partly because of what it implies. The 2022 ISHA physiotherapy agreement points out that the term bursitis implies inflammation, which has not been demonstrated, and that imaging work points to the gluteal tendons, with or without bursal change, as the main source of symptoms (Disantis and colleagues, 2023).
Fatty atrophy, or fatty infiltration, means some muscle has been replaced by fat. It usually indicates a long-standing problem rather than a new one, and it is one of the things that can make a clinician want a strength assessment rather than another scan.
Gluteal tendinopathy, greater trochanteric pain syndrome and trochanteric bursitis all turn up on reports, sometimes in the same paragraph. Why bursitis is usually the wrong word now deals with that properly.
If you are holding a report with any of these words in it, the useful next step is to take it to the clinician who examined your hip and ask what it changes. Often the answer is nothing, which is good news read correctly.
Does a tear on the scan mean surgery?
No, and the trial data is the reassurance here.
More than four in ten of the people in the LEAP population, 85 of 202, had a tear of one or both tendons on MRI, and every one of them was in a trial of non-surgical treatment. That trial found education plus exercise did better at 8 weeks than a single steroid injection or a wait and see approach, with better overall improvement than the injection at a year (Mellor and colleagues, 2018). Tears were present throughout and the loading program still worked.
Surgery for this condition is generally kept for pain that has not improved with other treatment (Grimaldi and colleagues, 2015). This page describes no operation, no technique and no outcome, because that is a surgeon's territory and the right place for the conversation is a consultation. What it will say is that a tear on a report is not an instruction.
How is outer hip pain diagnosed without a scan?
From the pattern, the examination and what has been excluded, which is how most people with this condition are diagnosed.
What a clinician is gathering: where exactly the pain sits and whether pressing there reproduces it, what lying on that side does, how the hip behaves on stairs and standing on one leg, how far the pain travels, how long it has been going on, and what else is going on in the back and the hip joint. Where outer hip pain is felt and where it travels sets out the location half, and telling outer hip pain from sciatica covers the leg pain question.
The limits of all that are published, not hidden. The 2022 ISHA physiotherapy agreement states that there is no test or cluster of tests used to identify which specific structures are involved, names the tests commonly used and says they offer little to the clinician in prescribing treatment, and notes that pressing over the bony point may help while lacking specificity (Disantis and colleagues, 2023). Grimaldi and colleagues propose a battery of compressive and tensile provocation tests rather than relying on one, and say directly that there is no consensus on which clinical test is most useful (Grimaldi and colleagues, 2015).
So the diagnosis is a working one, built from a pattern, and treatment is how it gets tested. That sounds unsatisfying and it is standard practice for tendon problems throughout the body. The ISHA agreement also asks clinicians to screen for the hip joint itself, the lower back, and other muscle and tendon problems around the hip, because overlapping conditions are common; hip impingement and hip labral tear are two of the things a younger or more active hip gets checked for, and outer hip pain lists the rest.
When to see a physio or doctor
Book a routine appointment with a doctor or physio if outer hip pain is stopping you sleeping or doing what you normally do, if it keeps coming back, or if it has not improved after 2 weeks of looking after it at home (NHS). If you have a scan report and no explanation of it, that is a reasonable thing to book an appointment for on its own.
The questions imaging cannot answer are the ones to arrive with: whether pressing the spot reproduces your pain, what the hip does at night and on stairs, and what you have already tried and for how long. If you have been doing a program properly for 6 to 8 weeks with no change, ask for the diagnosis and the plan to be reviewed, and exercises to avoid with outer hip pain is the page to check in case something in the program is working against you.
Some signs need help faster, from an emergency visit to a doctor within a few days. They are listed under the warning signs below, each with its own timing.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
Get help today
- Same day: the hip is hot and swollen, the skin around it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a child or teenager has sudden pain in the hip, thigh or knee, is limping, or cannot put weight on one leg. Get an urgent appointment with a doctor the same day. If they have a high temperature or seem very unwell, go to an emergency department. This page is for adults, and hip pain in children has different causes.
- Same day: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. See your doctor within a few days.
- Within a few days: new pain in the groin or buttock, and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
- Within 2 weeks: pain that spreads down the leg below the knee, especially with numbness or tingling in the leg or foot. The pain may be coming from your lower back rather than the hip tendons. Book an appointment with a doctor or physio.
- Within 2 weeks: the pain is mostly in the groin rather than on the outside of the hip, or the hip is stiff and hard to bend, for example when you put on socks. This points more toward the hip joint itself, such as hip osteoarthritis. Book an appointment with a doctor or physio so the cause can be checked.
Common questions
Does gluteal tendinopathy show up on an MRI?
Yes. An MRI can show increased signal and thickening inside the gluteus medius and gluteus minimus tendons where they attach to the bony point at the side of the hip, tears through part or all of a tendon, fluid in the bursa and wasting of the muscle. Entry to the LEAP trial actually required that signal change on MRI, which is how 204 people with this condition came to have detailed scans on record (Grimaldi and colleagues, 2025). Showing up and explaining the pain are two different things, which is what the rest of this page is about.
Do I need a scan for outer hip pain?
That is a decision for the clinician who has examined your hip, and this page does not push it either way. What the page can tell you is what a scan changes and what it does not. For most people the diagnosis is made from the pattern and the examination, and a scan neither confirms the source of the pain nor alters the treatment, which starts with load management and graded strengthening whatever the images show. Where a scan does earn its place is when something does not fit, when a serious cause needs ruling out, or when a decision is being made that depends on the state of the tendon.
What does my MRI report actually mean?
In general terms: tendinosis or increased signal means the tendon tissue has changed. That is the imaging appearance of tendinopathy, not a tear. A partial thickness tear means part of the tendon's width has given way, and a full thickness tear means it has separated through its whole depth, which is not the same as the tendon being detached. Bursal fluid means fluid in the sac that sits under the tendons: a common finding, and not proof of inflammation. Fatty atrophy means some muscle has been replaced by fat, and that usually points to a long-standing problem. Only the clinician who examined your hip can say what your report means for your hip, and this page will not interpret anybody's images.
Can an MRI be normal and the hip still hurt?
Yes, and the reverse is just as true, which is the single most useful thing to understand here. In the 2025 analysis of the LEAP trial scans, how severe the changes looked on MRI was not significantly associated with how much pain, loss of function or disability people reported (Grimaldi and colleagues, 2025). And when both hips of 40 people with one-sided outer hip pain were scanned, the findings that turned up in the sore hips also turned up in the pain-free ones, bursitis in particular, while the strength of agreement between the radiologists reading them varied (Woodley and colleagues, 2008).
Does a tear on the scan mean I need surgery?
Not by itself. Tears were common in the trial population that had scans on record, every one of whom had an abnormal scan as a condition of entry: one or both tendons were torn in 85 of 202 participants, and of the 99 tears found, 78% went through part of the tendon's thickness and 22% through all of it (Grimaldi and colleagues, 2025). Those 204 people were all being treated without surgery, in a trial that found education and exercise outperformed a steroid injection (Mellor and colleagues, 2018). Surgery is generally reserved for pain that has not improved with other treatment (Grimaldi and colleagues, 2015), and whether it applies to you is a conversation with a surgeon, not something a report decides.
How is gluteal tendinopathy diagnosed without a scan?
From the pattern and the examination. Where the pain sits, whether pressing the bony point reproduces it, what lying on that side does, how the hip behaves on stairs and standing on one leg, and what has been ruled out. The limits are published rather than hidden: the 2022 ISHA physiotherapy agreement states that there is no test or cluster of tests that identifies which structure is involved, and that the commonly used tests offer little help in choosing treatment, while pressing on the bony point may contribute but lacks specificity (Disantis and colleagues, 2023). Grimaldi and colleagues work from a battery of provocation tests rather than one, noting there is no consensus on which clinical test is most useful (Grimaldi and colleagues, 2015).
Is an ultrasound as good as an MRI?
This page will not answer that, because none of the sources it has read compares the two for this condition in a way that would make the answer reliable. What can be said is that both are used, that the 2022 ISHA agreement refers to MRI and ultrasound studies pointing to the gluteal tendons as the main source of symptoms (Disantis and colleagues, 2023), and that the choice between them depends on what the clinician is looking for and what is available. Ask the person requesting it what question the scan is meant to answer; that is the more useful conversation.
References
- Grimaldi A, Nasser A, Mellor R, Vicenzino B. An examination of imaging findings in patients with clinically diagnosed gluteal tendinopathy: a secondary analysis of a randomised clinical trial. Archives of Orthopaedic and Trauma Surgery. 2025;145(1):347. https://doi.org/10.1007/s00402-025-05964-z
- Woodley SJ, Nicholson HD, Livingstone V, Doyle TC, Meikle GR, Macintosh JE, Mercer SR. Lateral hip pain: findings from magnetic resonance imaging and clinical examination. Journal of Orthopaedic and Sports Physical Therapy. 2008;38(6):313-328. https://doi.org/10.2519/jospt.2008.2685
- Carney G, Fitzpatrick J. Is there structural change on MRI in gluteal tendinopathy after treatment? Single outcome measure extension of an RCT. BMC Medical Imaging. 2023;23:179. https://doi.org/10.1186/s12880-023-01150-y
- Disantis A, Andrade AJ, Baillou A, et al. The 2022 International Society for Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of greater trochanteric pain syndrome (GTPS): an international consensus statement. Journal of Hip Preservation Surgery. 2023;10(1):48-56. https://doi.org/10.1093/jhps/hnac050
- Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine. 2015;45(8):1107-1119. https://doi.org/10.1007/s40279-015-0336-5
- Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. https://doi.org/10.1136/bmj.k1662
- NHS. Hip pain in adults. Page last reviewed 20 November 2025. https://www.nhs.uk/symptoms/hip-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-17.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.