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Gluteus medius tendon

The gluteus medius tendon is the distal fibrous continuation of the gluteus medius muscle, a powerful hip abductor and stabilizer. It inserts onto the greater trochanter of the femur and works in concert with the gluteus minimus tendon. Together, they play a critical role in maintaining pelvic stability during gait and single-leg stance.

The tendon is clinically significant as it is a common site of tendinopathy, partial or full-thickness tears, and calcific deposits, often contributing to greater trochanteric pain syndrome (GTPS). Accurate anatomical and imaging knowledge of this tendon is essential for musculoskeletal radiologists, orthopedic surgeons, and sports medicine specialists.

Synonyms

  • Hip abductor tendon

  • Gluteus medius insertion

  • Greater trochanteric tendon of gluteus medius

Origin and Insertion

  • Origin (muscle): Arises from the outer surface of the ilium, between the anterior and posterior gluteal lines

  • Course: The fibers converge into a strong tendon that passes laterally and inferiorly, approaching the greater trochanter

  • Insertion: Inserts onto the lateral and posterosuperior facets of the greater trochanter of the femur

Nerve Supply

  • Superior gluteal nerve (L4–S1)

Arterial Supply

  • Superior gluteal artery

  • Trochanteric branches of the femoral artery

Venous Drainage

  • Venous return via superior gluteal vein and femoral vein tributaries

Function

  • Abduction of the thigh at the hip joint

  • Stabilization of the pelvis during walking, running, and single-leg stance

  • Anterior fibers assist in internal rotation of the thigh

  • Posterior fibers assist in external rotation of the thigh

  • Provides dynamic support of the hip joint capsule

Clinical Significance

  • Gluteus medius tendinopathy: Common in middle-aged and elderly patients, especially women

  • Partial and full-thickness tears: Often cause lateral hip pain and weakness, mimicking lumbar radiculopathy

  • Greater trochanteric pain syndrome (GTPS): Includes tendinopathy, bursitis, and tears

  • Calcific tendinitis: Deposition of calcium hydroxyapatite crystals in the tendon

  • Surgical repair may be required in full-thickness tendon tears

MRI Appearance

T1-weighted images:

  • Tendon appears as a low-signal linear structure inserting onto the greater trochanter

  • Chronic degeneration may show focal intermediate signal or thickening

T2-weighted images:

  • Normal tendon is dark (low signal)

  • Tendinopathy: focal hyperintense signal within or around tendon fibers

  • Partial tear: focal bright signal disrupting tendon

  • Full-thickness tear: tendon discontinuity with fluid-filled gap

STIR (Short Tau Inversion Recovery):

  • Normal tendon remains dark

  • Tendinopathy and tears show bright hyperintense signal, highlighting inflammation or fluid

  • Associated trochanteric bursitis also appears as bright signal

Proton Density Fat-Saturated (PD FS):

  • Normal tendon: dark signal

  • Pathology (tendinopathy, tear, calcific focus): bright hyperintense changes within tendon or adjacent bursa

T1 Fat-Sat Post-Contrast:

  • Normal tendon shows minimal or no enhancement

  • Tendinopathy: mild diffuse or focal enhancement

  • Tears: rim or interstitial enhancement, surrounding inflamed tissue enhances strongly

CT Appearance

Non-Contrast CT:

  • Tendon not clearly visible due to low soft tissue contrast

  • Calcific tendinitis appears as dense calcifications at the greater trochanter insertion

  • Adjacent muscle atrophy may be seen in chronic disease

Post-Contrast CT:

  • Normal tendon does not enhance significantly

  • Surrounding inflammatory changes or bursitis show contrast enhancement

  • Tears may appear as soft tissue defects with fluid density adjacent to the greater trochanter

MRI image

Gluteus medius tendon MRI axial anatomy image-img-00000-00000

MRI image

Gluteus medius tendon MRI axial anatomy image-img-00000-00000_00001

CT image

Gluteus medius tendon mri axial image