What is gluteal tendinopathy (GT), and why is it often difficult to diagnose?

Gluteal tendinopathy (GT) is a condition that affects the tendons around the hip and is a common cause of lateral hip pain. Diagnosing GT can be challenging because its symptoms can overlap with other conditions, such as lumbar spine issues or hip osteoarthritis. This overlap can lead to misdiagnosis and inappropriate treatment. This is further complicated by the limitations of traditional clinical tests.

What are the limitations of the FADER, FABER, ADD, and ADDR tests in diagnosing gluteal tendinopathy?

The study evaluated several clinical tests, including FADER (Flexion, Adduction, External Rotation), FABER (Flexion, Abduction, External Rotation), ADD (Adduction in Sidelying), and ADDR (Resisted Adduction in Sidelying). The findings revealed that these tests have limitations in accurately diagnosing GT when compared to MRI results. For example, the study found that palpation of the greater trochanter was sensitive but not specific, meaning it often produced false positives. Resisted abduction in adduction (ADDR) was found to be the most specific but less sensitive, meaning it missed some cases of GT.

How can healthcare providers improve the diagnosis and treatment of hip pain related to gluteal tendinopathy?

Healthcare providers can improve the diagnosis and treatment of hip pain by adopting a more nuanced approach. Relying solely on traditional clinical tests is insufficient and may lead to misdiagnosis. The study suggests integrating MRI findings with clinical assessments. This comprehensive approach ensures that individuals receive the most appropriate and effective care. Seeking a thorough evaluation including advanced imaging techniques is essential for persistent lateral hip pain to ensure proper diagnosis and recovery.

Why is it important to re-evaluate the diagnostic approaches for gluteal tendinopathy?

It is important to re-evaluate diagnostic approaches for gluteal tendinopathy because relying on traditional clinical tests can lead to inaccurate diagnoses and ineffective treatment. Many patients are misdiagnosed, resulting in unnecessary interventions. More accurate diagnostic tools are needed to improve patient outcomes. The study highlights that integrating MRI findings can significantly enhance diagnostic accuracy, ensuring that individuals receive appropriate and effective care for their hip pain. This approach helps avoid unnecessary spinal investigations and surgical procedures.

Illustration symbolizing the connection between hip health and overall well-being, particularly emphasizing the diagnostic challenges of hip pain.

Decoding Hip Pain: Are Your Clinical Tests Missing the Mark?

Q: What role does MRI play in the diagnosis of gluteal tendinopathy?

MRI findings are crucial in the diagnosis of gluteal tendinopathy. The study compared the results of the clinical tests with MRI findings to assess their accuracy and reliability. Integrating MRI with clinical assessments can significantly improve diagnostic precision. MRI provides a more detailed view of the gluteal tendons, helping to confirm the presence and extent of GT, which is often missed when relying solely on traditional clinical tests.

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"New research reveals the limitations of common clinical tests in diagnosing gluteal tendinopathy, urging a re-evaluation of diagnostic approaches for more accurate patient care."

Hip pain, particularly lateral hip pain, is a common complaint that can significantly impact daily life. Gluteal tendinopathy (GT), a condition affecting the tendons around the hip, is increasingly recognized as a frequent source of this pain. However, diagnosing GT accurately can be challenging. Often, its symptoms mimic or coexist with other conditions, such as lumbar spine issues or hip osteoarthritis, leading to misdiagnosis and inappropriate treatment.

Traditionally, healthcare providers rely on a combination of physical examinations and clinical tests to identify the root cause of hip pain. Yet, recent research suggests that these conventional methods may not be as reliable as previously thought. Many patients with GT are misdiagnosed, resulting in unnecessary spinal investigations and surgical procedures, highlighting the urgent need for more accurate diagnostic tools.

A study published in the British Journal of Sports Medicine sheds light on the limitations of common clinical tests in diagnosing gluteal tendinopathy. The study evaluates the diagnostic utility of several physical tests against MRI findings, offering valuable insights into which tests are most effective—and which may be leading us astray. This article delves into the findings, exploring the implications for clinicians and individuals experiencing persistent hip pain.

The Trouble with Traditional Tests: Why Clinical Exams Fall Short

Illustration symbolizing the connection between hip health and overall well-being, particularly emphasizing the diagnostic challenges of hip pain.

The study, led by Alison Grimaldi and her team, involved sixty participants reporting lateral hip pain. Each participant underwent a series of clinical tests commonly used to diagnose GT. These tests included:

Following the clinical examinations, all participants received an MRI evaluation of their gluteal tendons and hip. The MRI results were then compared to the clinical diagnoses to determine the accuracy and reliability of each test. This comparison revealed some concerning discrepancies.

FADER (Flexion, Adduction, External Rotation): Passive hip flexion to 90° with adduction to the end of range and external rotation.
FADER-R (FADER with Resistance): The FADER test performed with static resisted hip internal rotation.
FABER (Flexion, Abduction, External Rotation): Hip flexion, abduction, and external rotation.
ADD (Adduction in Sidelying): Passive end-of-range hip adduction while lying on the side.
ADDR (Resisted Adduction in Sidelying): Adduction in sidelying with static resisted abduction at the end of range.
Palpation: Physical examination involving palpation of the greater trochanter to identify tenderness.

The results indicated that while palpation of the greater trochanter (the bony prominence on the side of the hip) was the most sensitive test for GT diagnosed via MRI, it was also the least specific. This means that while palpation was good at identifying potential cases of GT, it often produced false positives, indicating GT when it wasn't actually present. In contrast, resisted abduction in adduction (ADDR) was the most specific test, accurately identifying individuals who did have GT, but it had lower sensitivity, meaning it missed some cases.

Rethinking the Approach: Towards More Accurate Diagnoses

The study underscores the need for a more nuanced approach to diagnosing gluteal tendinopathy. Relying solely on traditional clinical tests may lead to misdiagnosis and ineffective treatment strategies. Integrating MRI findings with clinical assessments can significantly improve diagnostic accuracy, ensuring that individuals receive the most appropriate and effective care for their hip pain. For those experiencing persistent lateral hip pain, seeking a comprehensive evaluation that includes advanced imaging techniques may be the key to unlocking lasting relief and recovery.