MSK · Hip

Outer Hip Pain — Bursitis or Gluteal Tendinopathy?

Pain on the outside of the hip is usually blamed on bursitis. Most of the time the tendons are the real problem — which matters, because the two are managed differently.

Person climbing outdoor steps with a hand resting on the outer hip

The picture is familiar: a deep ache on the bony point of the hip, worse lying on that side at night, worse on stairs, worse standing on one leg to put trousers on. For years this was labelled trochanteric bursitis — an inflamed fluid sac. Imaging has shifted that view. In most cases the gluteal tendons that attach there are the primary problem, with any bursal swelling secondary.

The distinction is not academic. Tendon problems respond to progressive loading and time; treating it as pure inflammation with rest alone tends to disappoint.

Telling Them Apart

What the pattern suggests

What you notice Commonly
Tender to press on the bony point, sore lying on that side, worse on stairs and single-leg standing Gluteal tendinopathy, often with secondary bursitis
Pain in the groin, worse rotating the hip, stiffness putting on shoes The hip joint itself — not the outer structures
Buttock pain radiating down the back of the leg Referred from the lower back or nerve-related
Sudden pain after a fall, unable to weight bear Needs urgent assessment for fracture

When hip pain needs urgent care

Inability to bear weight after a fall, a leg that looks shortened or turned out, or a hot swollen hip with fever needs same-day assessment — A&E or NHS 111. Ultrasound does not show hip fractures; that is an X-ray question.

Honestly

What the scan can settle

The gluteal tendons and the bursae sit close to the surface over the bony point of the hip, which is good ultrasound territory. A scan shows tendon thickening and tears, distinguishes tendon change from a genuinely distended bursa, and puts a size on any fluid collection.

What it does not do is assess the hip joint itself. The joint is deep, and the cartilage, labrum and bone are not properly seen by ultrasound — groin pain, stiffness and suspected arthritis are X-ray and MRI questions, arranged through your GP. If your pain is in the groin rather than on the outer hip, an ultrasound is probably the wrong test and we would rather say so before you book.

At IUS London

How the appointment runs

  1. 1
    BookingNo referral, no preparation. Wear something that allows access to the outer hip. The appointment is 30 minutes.
  2. 2
    The scanMostly lying on your side. We examine the gluteal tendon attachments and the bursae, and compare with the other side where that helps.
  3. 3
    ResultsExplained on screen as we scan, written report usually within two hours — written so a physiotherapist can build a loading programme around it.
  4. 4
    RoutingIf the picture points to the joint rather than the tendons, the report says so and names the test that would answer it.
FAQs

Your questions answered

Is trochanteric bursitis the right diagnosis?
Often it is the incomplete one. Imaging tends to show gluteal tendon change as the primary problem, with bursal swelling secondary where it is present at all. The umbrella term now used is greater trochanteric pain syndrome, which better reflects what is going on.
Why does it hurt so much at night?
Lying on the affected side compresses the tendons against the bone, and lying on the other side with the top leg dropping forward stretches them. A pillow between the knees often helps.
Will an ultrasound show hip arthritis?
No. The joint is deep and its cartilage and bone are not assessed by ultrasound. Groin pain and stiffness suggesting arthritis need an X-ray via your GP.
Do I need a scan before physiotherapy?
Not always — many people improve with a loading programme without imaging. A scan earns its place when the diagnosis is uncertain, when a tear is suspected, or when a good rehab programme has not shifted it.
Can a gluteal tendon tear?
Yes, and ultrasound sees partial and full-thickness tears well. It changes what a rehab programme should look like and occasionally prompts a surgical opinion.
Should I rest completely?
Usually not. Complete rest tends to leave tendons less capable rather than better. Avoiding the specific provoking positions while building strength progressively is the general direction — a physiotherapist should set the detail.
Related

Where to go from here

KneeKnee Pain After Exercise

What ultrasound answers about a painful knee — and what it cannot.

Read the guide →AchillesAchilles Pain

Tendinopathy or rupture — and how the two are told apart.

Read the guide →ScansOther MSK Scans

Calf, hamstring, groin and other soft tissue areas.

See scans →

Tendon or bursa — know which

Gluteal tendon attachments and bursae assessed properly in a 30-minute appointment, explained on screen as we scan, with a written report usually within two hours for your physiotherapist or GP.

From £169
Hip ultrasound scan

Hip scan

5a Lucerne Mews
Kensington, London W8 4ED
3 mins from Notting Hill Gate

This article is general information about outer hip pain, not individual medical advice. Inability to bear weight after a fall, a shortened or turned-out leg, or a hot swollen hip with fever needs urgent assessment — see NHS guidance on hip pain. Ultrasound does not assess the hip joint, its cartilage or bone; we do not offer X-ray, MRI or injections.

Written and clinically reviewed by the HCPC-registered sonographers who perform this scan at IUS London — a CQC-registered diagnostic ultrasound clinic (Provider ID 1-2775844974). Your own findings are explained to you at the scan and set out in your report.

Author: Yianni Kiromitis, Senior Sonographer, HCPC RA38415 — over 20 years’ experience in NHS and private ultrasound
Medically reviewed: 9 August 2026