Joint Pain in Young Adults: Causes and Diagnostic Approach

Systematic Approach to Diagnosis

• The British Journal of Sports Medicine recommends excluding red flags and serious pathology, including infection, tumors, stress fractures, and slipped capital femoral epiphysis, before considering common musculoskeletal causes in young adults with joint pain 1, 2, 3
• Tumors present with insidious onset, night pain, and constitutional symptoms, according to the British Journal of Sports Medicine 1, 3
• Stress fractures are associated with a history of repetitive loading, focal tenderness, and inability to bear weight, as reported by the British Journal of Sports Medicine 1, 2
• The International Hip-related Pain Research Network consensus identifies three primary categories of hip-related pain, including femoroacetabular impingement syndrome, acetabular dysplasia, and labral, chondral, or ligamentum teres pathology, according to the British Journal of Sports Medicine 1, 2, 5
• Femoroacetabular impingement syndrome is characterized by groin pain, pain with hip flexion/internal rotation, and cam or pincer morphology on imaging, as described by the British Journal of Sports Medicine 1, 2
• Acetabular dysplasia and hip instability are associated with misalignment between the femoral head and acetabulum, causing rim overload and instability symptoms, according to the British Journal of Sports Medicine 1, 2, 3
• Labral, chondral, or ligamentum teres pathology is characterized by intraarticular damage without distinct bony morphology, as reported by the British Journal of Sports Medicine 1, 5
• A negative flexion-adduction-internal rotation test helps rule out hip-related pain, but its clinical utility is limited, according to the British Journal of Sports Medicine 1
• A comprehensive approach combining symptoms, clinical signs, and imaging is essential for diagnosing hip-related pain, as recommended by the British Journal of Sports Medicine 5
• Lumbar spine pathology must be screened as a competing musculoskeletal source of pain, according to the British Journal of Sports Medicine 1, 6, 5

Diagnostic Workup

• The British Journal of Sports Medicine recommends an initial imaging approach with AP pelvis and lateral femoral head-neck view radiographs for hip pain, followed by advanced imaging (MRI) when further assessment of intraarticular structures or morphology is needed 5

Critical Clinical Pitfalls

• Hip pathology, particularly slipped capital femoral epiphysis, can present as knee pain in adolescents and young adults, and must be considered in the differential diagnosis, as noted by Praxis Medical Insights: Practical Summaries of Clinical Guidelines 4
• Incidental imaging findings in young active adults may not correlate with symptoms, and clinical correlation is mandatory to avoid unnecessary treatment, according to the British Journal of Sports Medicine 2, 3