Gluteus maximus tendonitis with its clinical and imaging patterns has been described in radiologic, orthopedic, and rheumatology texts and journals. Image-guided treatment, however, is not a familiar approach and has only been described in one case report in the English literature to the best of our knowledge. We present 4 patients with calcific tendonitis of the gluteus maximus who presented with excruciating pain in the posterior upper thigh with limitation of daily activities. The diagnosis was based on the characteristic radiologic appearances of calcifications in the tendon with cortical bone erosion and muscle edema. Treatment was with image-guided (fluoroscopy or computed tomography) injection of a local anesthetic and corticosteroid. All patients were pain-free on follow up.