Can trochanteric bursitis affect leg strength?

Can Trochanteric Bursitis Affect Leg Strength?

Trochanteric bursitis itself does not directly cause leg weakness, but the underlying pathology—gluteus medius and minimus tendinopathy or tears—frequently causes hip abductor weakness that can significantly impair leg function. 1

Understanding the True Pathology

The term "trochanteric bursitis" is actually a misnomer in most cases. Evidence suggests that the majority of cases attributed to trochanteric bursitis actually result from pathology of the gluteus medius or minimus muscles and their tendons rather than true bursal inflammation. 2 This distinction is critical because:

• The gluteus medius and minimus are primary hip abductors, and when damaged, they cause measurable weakness in leg strength and function 1
• These conditions frequently coexist, making differentiation difficult even on imaging 1, 3
• MRI can assess the gluteus minimus and medius muscles for tears, tendinopathy, and fatty atrophy—all of which directly impact strength 1, 3

Clinical Presentation and Functional Impact

When gluteal tendinopathy or tears accompany what appears to be trochanteric bursitis:

• Patients experience pain radiating to the posterolateral thigh, which can limit functional leg use 4
• Bilateral cases show significantly slower functional performance, including increased 20-meter walk time and chair stand time, indicating measurable functional impairment 5
• The condition is associated with reduced mobility and physical performance, though this may be more related to pain avoidance than pure strength loss 5

Diagnostic Approach to Identify Strength-Affecting Pathology

Radiographs should be obtained first to rule out other causes of hip pain such as arthritis or bone tumors 1, 3

For suspected soft tissue pathology:

• Ultrasound effectively detects trochanteric bursitis and can evaluate gluteal tendons, though distinguishing between bursitis and tendinosis may be difficult 1, 3
• MRI provides comprehensive assessment of peritrochanteric structures including muscle quality, tendon integrity, and fatty atrophy—all indicators of potential weakness 1, 3
• Surgical repair is indicated when MRI and clinical findings show tendon disruption with weakness after 3-6 months of failed conservative treatment 1

Associated Conditions That Compound Weakness

Greater trochanteric pain syndrome shows strong associations with conditions that alter lower-limb biomechanics:

• Ipsilateral knee osteoarthritis increases odds of trochanteric bursitis 3.47-fold, and contralateral knee OA increases odds 1.74-fold 5
• Low back pain is associated with a 2.79-fold increased odds of trochanteric bursitis 5
• Iliotibial band tenderness increases odds 1.72-fold 5

These associations suggest that altered biomechanics and compensatory movement patterns may contribute to both the development of the condition and functional limitations.

Clinical Pitfall

The key pitfall is assuming pure bursal inflammation when underlying gluteal tendon pathology is present—this leads to underestimating functional impairment and delaying appropriate strengthening interventions. 1, 2 When patients report difficulty with activities requiring hip abduction (climbing stairs, standing on one leg, walking), this suggests tendon pathology rather than simple bursitis and warrants advanced imaging to guide treatment. 1