Die Gluteale Tendinopathie – wenn die Hüfte seitlich schmerzt

Zusammenfassung

Mit der Glutealen Tendinopathie sind Schmerzen über dem Trochanter major, die lateral ins Bein ausstrahlen können, verbunden. Sie betrifft sowohl Sportler*innen als auch Nicht-Sportler*innen. Momentan wird von einer nicht-inflammatorischen Insertionstendinopathie des Gluteus medius und minimus als Ursache ausgegangen. V.a. während funktioneller Aktivitäten, die eine Stabilisierung des Beckens in der Frontalebene erfordern, sind diese Sehnen einer Kombination aus hohen mechanischen Kompressions- und Zugkräften ausgesetzt.

Es ist wichtig, die Gluteale Tendinopathie gegenüber der Hüftarthrose und somatisch ausstrahlenden LWS-Schmerzen abzugrenzen. Eine Kombination an Tests, bestehend aus Palpation um den Trochanter major, dem Single Leg Stance Test sowie einer Hüftabduktion gegen Widerstand, zeigt eine positive Wahrscheinlichkeit von 99% und eine negative Likelihood-Ratio von 95,5%. Mittels Fragebögen können die subjektiven Einschränkungen der Patient*innen erfasst werden.

Eine angemessene und patient*innenzentrierte konservative Therapie zeigt eine hohe Erfolgsrate. Diese umfasst edukative Maßnahmen, einen langsamen Trainingsaufbau und ggf. Stoßwellentherapie. Bei 90% der Patient*innen zeigen diese konservativen Ansätze positive Effekte. Edukation spielt eine essenzielle Rolle, um die Selbstwirksamkeit und somit die Alltagsbewältigung zu steigern. Das Training sollte in Positionen mit geringer Belastung begonnen und progressiv gesteigert werden. Ein besonderes Augenmerk liegt auf der Stabilität des Beckens in der Frontalebene bei funktionellen Aktivitäten.

Abstract

Gluteal tendinopathy is associated with pain over the greater trochanter that can radiate laterally into the leg. It affects both athletes and non-athletes. Currently, a non-inflammatory insertional tendinopathy of the gluteus medius and minimus is considered the cause. Especially during functional activities that require stabilization of the pelvis in the frontal plane, these tendons are exposed to a combination of high mechanical compression and tensile forces.

It is important to differentiate gluteal tendinopathy from hip osteoarthritis and somatically radiating lower back pain. A combination of tests, consisting of palpation around the greater trochanter, the Single Leg Stance Test, and hip abduction against resistance, shows a positive likelihood ratio of 99% and a negative likelihood ratio of 95.5%. Questionnaires can be used to assess the subjective limitations of patients.

Appropriate and patient-centered conservative therapy shows a high success rate. This includes educational measures, a slow build-up of training, and possibly shock wave therapy. In 90% of patients, these conservative approaches show positive effects. Education plays an essential role in increasing self-efficacy and thus coping with daily life. Training should begin in positions with low stress and be progressively increased. Special attention is paid to the stability of the pelvis in the frontal plane during functional activities.

Schlüsselwörter

Gluteale Tendinopathie - Greater Trochanteric Pain Syndrome - Tests - Algorithmus - Therapie

Keywords

gluteal tendinopathy - greater trochanteric pain syndrome - tests - algorithm - therapy

Publication History

Article published online:
15 May 2025

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