Young, athletic patient acute injury (vs. Young, athletic patient gradual onset pain with hip range of motion history of slipped capital femoral epiphysis or developmental dysplasia Pain over the hip bony prominence, anterior superior iliac spine, anterior inferior iliac spine, or pubic symphysis pain with hip flexion strength testingįemoroacetabular impingement 2, 5, 7, 8 Overuse activities, acute strain or injury with hip flexion activities Pain associated with urinary or bowel symptoms, cyclic pain associated with menses 30įor patients with greater trochanteric pain syndrome not responding to conservative therapy, ultrasonography or magnetic resonance imaging should be considered to evaluate for gluteus medius tendon tears. 5, 11, 12, 21 – 23Įxpert opinion and reviews of prospective and randomized trialsįor intra-articular pain, ultrasound-guided anesthetic injection of the hip may be diagnostic, and corticosteroid injection may be therapeutic. 4, 21įor patients with anterior hip pain and history suggestive of a labral tear, stress fracture of the femoral neck, or early avascular necrosis, magnetic resonance imaging should be performed for accurate diagnosis. If imaging is performed in the evaluation of a patient with undifferentiated chronic hip pain, standing anteroposterior hip and pelvic radiographs should be the first choice. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Radiography of the hip and pelvis should be the initial imaging test. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes extra-articular etiologies, such as hip flexor injuries and intra-articular etiologies. Hip pain is usually located anteriorly, laterally, or posteriorly. Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy.

Xray normal hips