Does Hip Bursitis Worsen with Resisted Leg Abduction?
Yes, pain on resisted hip abduction is a classic and diagnostically useful clinical sign of trochanteric (hip) bursitis, now more accurately termed Greater Trochanteric Pain Syndrome (GTPS). This test is one of the most specific clinical maneuvers for identifying this condition.
Diagnostic Value of Resisted Hip Abduction
The resisted hip abduction test has proven diagnostic accuracy for GTPS:
When combined with palpation of the greater trochanter, resisted hip abduction forms a highly effective diagnostic cluster 1. In patients with lateral hip pain, a positive greater trochanter palpation test followed by a positive resisted hip abduction test increases the probability of GTPS from 59% to 96% 1.
The test demonstrates high specificity and high positive predictive value, though sensitivity is moderate 2. This means that when the test is positive (pain with resisted abduction), it strongly suggests GTPS, but a negative test doesn't completely rule it out.
Historical case series identified pain on resisted abduction as one of only two consistent clinical signs (along with localized tenderness at the greater trochanter) in patients with this condition 3.
Clinical Application Algorithm
When evaluating suspected hip bursitis:
- First, palpate the greater trochanter for point tenderness
- Then perform resisted hip abduction with the patient lying on their side
- If both tests are positive, the posttest probability of GTPS is 96% 1
- If both tests are negative, the posttest probability drops to 14%, effectively ruling out GTPS 1
Important Clinical Caveats
Trochanteric bursitis is often misdiagnosed - the actual pathology is frequently hip abductor tendon pathology (gluteus medius/minimus tendinopathy or tears) rather than isolated bursitis 4, 5. Recent MRI studies show that only 2% of patients with lateral hip pain have isolated trochanteric bursitis, while 69% have no bursitis at all but do have tendon pathology 4.
Differentiation between bursitis and gluteus medius tendinosis may be difficult clinically, and the two conditions often coexist 6. The resisted abduction test is positive in both conditions because it stresses the hip abductor mechanism.
The term "Greater Trochanteric Pain Syndrome" is now preferred over "trochanteric bursitis" because it more accurately reflects the spectrum of pathology, which predominantly involves the gluteal tendons rather than the bursa itself 2, 1, 5.