Hip Pain: Causes and Differential Diagnosis

Investigate axial spondyloarthropathy and seronegative spondyloarthropathies, focusing on spine and Si joints involvement, HLA-B27 positivity, and enthesitis. Learn early diagnosis, differential features, CPR, and the gender differences impacting patient journeys.

Assess statin associated muscle symptoms (SAMS), including myalgia, myopathy, and rhabdomyolysis risk, with nocebo considerations, differential diagnoses, and management via statin cessation or dose adjustment.

Examine lumbar radiculopathy, differentiate it from posterior hip pain, and review key tests like the straight leg raise and slump test, plus emerging clinical prediction rules for diagnosis.

Identify thoracolumbar involvement as a potential source of posterior hip pain, including Maine syndrome and superior cluneal nerve impingement, with referral patterns to groin, abdomen, and buttock.

Identify sacroiliac dysfunction through SI joint-related pain patterns worsened by sit-to-stand and single-leg stance. Apply Laslett's five SI joint tests, noting limited rule-in accuracy and 92% rule-out with negative results.

Identify deep gluteal syndrome as a non-disc, extra pelvic entrapment of the sciatic nerve within the deep gluteal space, involving piriformis, gemelli, and obturator internus.

Soft tissue issues, including muscles, tendons, and fascia, can cause posterior buttock pain from overloading or rest loading; pain eases with warming up but recurs after cooling.

Explore posterior hip joint pain due to pathology, osteonecrosis, and chondrolabral disease, with instability linked to anterior impingement and hypermobility. Manage with rest, NSAIDs, injections, and targeted physical therapy.

Explore anterior and lateral hip pathology, revisit hip osteoarthritis and knee referral patterns, and examine labral tears, femoroacetabular impingement, hip laxity, inguinal ligament disruption, and cutaneous nerve impingement.

FAI, a motion-related hip disorder with cam and pincer morphologies, risks hip osteoarthritis; diagnosis combines symptoms, clinical signs, and imaging, with treatment spanning conservative care, rehabilitation, and surgery.

Explore anterior groin disorders such as inguinal ligament disruption, inguinal hernia, and anterior nerve impingement, outlining hallmark signs, differential diagnoses, and first-line physical therapy strategies.

Introduce gtps, the greater trochanter pain syndrome, as the primary cause of lateral hip pain, potentially involving bursitis, inflamed tendons, or surrounding muscles with moderate to severe pain on palpation.

The clinical presentation of greater trochanter pain syndrome affects midlife athletes, especially females, with higher BMI. It features lateral hip pain with tenderness, provoked by weight-bearing tasks and single-leg stance.

Review external snapping hip and lateral femoral cutaneous or iliohypogastric neuropathies; diagnose with neurodynamic testing using hip extension and adduction, plus trunk movements.

Learn to use outcome measures and functional assessment tools to diagnose and treat greater trochanter pain syndrome, including Who's Hip survey, Womac, and I heart 33.

Evaluate greater trochanter pain syndrome using a full battery of objective tests, including palpation, resisted hip movements, and passive adduction, to differentiate gluteal tendinopathy and confirm diagnosis.

Educate patients on load management for lateral hip pain. Monitor activity, sleep position, and avoid adduction stretches and clamshells when gtps is present.

Corticosteroid injections offer short-term relief but may raise recurrence and hinder tendon loading. If conservative treatment fails and MRI suggests a tear, open or endoscopic surgery can improve outcomes.