septic arthritis, fracture, slipped upper femoral epiphysis (SUFE), dislocation). Special tests are indicated where intra-articular hip pathology is suspected after exclusion of acute conditions that require emergency department referral (eg. Passive ROM assesses the integrity of the joint and surrounding soft tissues, a reduction in which suggests FAI or labral/chondral injury in this patient group. Further assessment of specific muscle groups should be made where weakness or pain is identified. MoveĪctive range of movement (ROM) will test muscle integrity. Buttock tenderness to palpation suggests muscular pathology (such as gluteus medius tear) and tenderness over the psoas tendon (located lateral to the femoral nerve just below the inguinal ligament) is suggestive of psoas tendonitis. Pain reproduced by palpation over the greater trochanter is suggestive of trochanteric bursitis or a snapping hip (iliotibial band irritation over the greater trochanter). Palpation may reproduce symptoms over anatomical landmarks suggestive of extra-articular pain. Clinical signs often performed by patients with FAI syndrome A) trochanteric C-sign, B) triangulation sign, C) deep pointer sign Feel It is important to note that these signs are commonly reported anecdotally rather than being evidence-based and their sensitivity for detecting intra-articular hip pathology is not known.įigure 1. Cupping of the greater trochanter in the trochanteric C-sign 7 ( Figure 1A), pointing with two fingers towards the hip joint in the triangulation sign ( Figure 1B) or pointing deep within the groin crease in the deep pointer sign ( Figure 1C. The patient may have one of the clinical signs suggestive of intra-articular hip pathology ( Figure 1). The patient can also indicate the site of symptoms. The Trendelenberg gait reflects the integrity of the hip abductor muscles on the side of the standing leg. An antalgic gait (short stance phase relative to swing phase) reflects pain on weight bearing and may indicate a painful joint. Inspection of the patient’s standing posture and gait will reveal any obvious asymmetry in the musculature or alignment. Clinical examination has been shown to have a high sensitivity (98%) in localising intra-articular hip pathology but is poor in exactly defining its nature. The aim of a focused hip examination is to confirm the hip as the source of symptoms and to exclude alternative diagnoses such as referred pain rather than make a definitive diagnosis.

osteitis pubis, incipient inguinal hernia, adductor tendinopathies) have been the focus of a previous review article 5 and are not addressed here. 4 Other conditions that present predominantly with groin pain (eg. 3 Patients with FAI most commonly report groin (88%), lateral hip (67%) and anterior thigh (35%) pain but may also complain of buttock (29%), knee (27%) and lower back (23%) pain.

For example, pain and tenderness over the greater trochanter, buttock or lateral thigh can suggest trochanteric bursitis, a tear of the gluteus medius muscle or a snapping hip. History helps to localise the hip as the source of pain rather than make a specific diagnosis as there is significant overlap in symptoms originating from different structures in and around the hip. Symptoms suggestive of hip pathology include localised symptoms (such as catching sensations), symptoms related to activity or when going up and down stairs, or symptoms related to prolonged sitting or standing. Patients typically present when their hip pain impairs activities such as work, exercise or sport. ITB = iliotibial band, LFCN = lateral femoral cutaneous nerve, FAI = femoroacetabular impingement OA = osteoarthritis, AVN = avascular necrosis, DDH = developmental dysplasia of the hip. Differential diagnosis of hip pain in young adults Extra-articular

Normal male hip xray