The greater trochanter has four distinct facets for rotator cuff-like insertions of the hip abductor and external rotator tendons: the superoposterior facet (gluteus medius posterior fibres), the anterior facet (gluteus minimus and gluteus medius anterior), the lateral facet (gluteus medius principal attachment), and the medial facet (piriformis and obturator internus). Understanding the four-facet anatomy of the greater trochanter guides accurate diagnosis and treatment of gluteal tendinopathy.
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| Ossification | The greater trochanteric apophysis ossifies at 4 years and fuses at skeletal maturity. Avulsion fractures in skeletally immature athletes produce the fragment displacement characteristic of traction injuries. |
Greater trochanteric pain syndrome from gluteal tendinopathy targets the tendon-trochanter interface on the superoposterior and lateral facets. MRI and ultrasound localise the pathology to specific facets. Superoposterior tears are most common and most symptomatic. Ultrasound-guided injection under the gluteus medius tendon at the superoposterior facet provides targeted treatment.
Degenerative or traumatic tearing of the gluteus medius tendon from its trochanteric facets, causing lateral hip pain and a Trendelenburg gait.
Degeneration of the gluteus medius and minimus insertions on the trochanteric facets, the main cause of greater trochanteric pain syndrome.
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