Diagnostic Approach to Hip Pain
Initial Assessment
- The American College of Sports Medicine recommends that the localization of hip pain guides the differential diagnosis, with anterior/inguinal pain suggesting intra-articular pathology, lateral pain indicating trochanteric pain syndrome, and posterior pain indicating lumbar, sacro-iliac, or deep gluteal pathology 1, 2
- The British Journal of Sports Medicine suggests that hip pain in young and middle-aged adults (20-50 years) may be due to femoroacetabular impingement (FAI), labral tears, or dysplasia 1, 2
Exclusion of Serious Pathologies
- The American Academy of Orthopaedic Surgeons recommends excluding serious conditions such as slipped capital femoral epiphysis (SCFE), stress fractures, avascular necrosis, septic arthritis, and tumors before considering benign diagnoses 2, 4
- The British Journal of Sports Medicine suggests that SCFE should be excluded in adolescents with deformity and antalgic gait 4
Clinical Examination
- The American College of Sports Medicine recommends using specific clinical tests such as the FADIR (flexion-adduction-rotation internal) test to exclude intra-articular hip pathology 1, 2, 5
- The British Journal of Sports Medicine suggests that a negative FADIR test can help exclude intra-articular hip pathology 5, 2
- The American Academy of Orthopaedic Surgeons recommends examining the lumbar spine and pelvis to exclude concurrent conditions 5, 1
Imaging
- The British Journal of Sports Medicine recommends standard radiographs (anteroposterior pelvis and lateral femoral head) as the initial imaging modality to evaluate osseous morphology and exclude fractures, arthritis, and dysplasia 5, 2, 1
- The American College of Sports Medicine suggests that advanced imaging such as MRI or arthro-MRI may be indicated to evaluate intra-articular structures (labrum, cartilage, ligamentum teres) when 3D morphological evaluation is required 5, 2, 1