Hip and groin pain

Review anatomy, pathologic differential diagnosis, musculoskeletal differential

diagnosis, orthopaedic tests, causes of clicking hip

Pathological differential diagnoses

Metabolic
 Osteoporosis
 Paget’s
 Osteomalacia

Inflammatory
 Reiter’s disease, AS (HLA-B27)
 RA
 PMR

Degenerative/developmental
 OA
 Slipped capital femoral epiphysis
 Perthes’ disease

Neoplasm
 Spinal metastases to femur
 Osteoid osteoma
 Chondroblastoma
 Chondrosarcoma
 Ewing’s sarcoma (children)

Infective
 Psoas abscess
 TB
 Osteomyelitis
 Inguinal lymphadenopathy

Genetic/hereditary
 Sickle cell anaemia
 Haemophilia
 Congenital hip dysplasia

Head
 Fibromyalgia
 Psychogenic

Trauma
 Discussed below

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Musculoskeletal differential diagnosis

Bone
 Traumatic fracture of femoral neck, acetabulum
 Stress fracture of femoral neck
 Stress fracture of pubis
 AIIS avulsion fracture
 Haematoma of pelvic/hip bones

Muscle/tendon
 TPs
 Spasm of hamstrings, gluts, TFL, Iliopsoas,
 Hypertonicity rectus femoris, adductors
 Tear
 Hernia – direct or indirect
 Gilmore’s groin

Cartilage
 OA
 Slipped capital femoral epiphysis
 Osteitis pubis

Acetabular labrum
 Tears

Ligament/capsule
 Sprain/strain
 Rupture
 Dislocation
 Compression

Bursa
 Trochanteric bursitis
 Iliopsoas bursitis

Nerve
 Sciatic nerve
 Ilioinguinal nerve entrapment
 Lateral cutaneous nerve entrapment (meralgia paresthetica)
 Obturator nerve entrapment
 Femoral nerve entrapment

Referral
 Lumbar spine, SIJ, sacrum, knee
 GUT – UTIs, testicular cancer, gynaecological conditions
 GIT – Appendicitis

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Tests

Patrick FABER test

Quadrant test
Ober’s test
Thomas flexion test
Iliopsoas muscle test
Trendelenburg’s test

Causes of clicking hip

 TFL or tendon of gluteus maximus over greater

trochanter
 Psoas tendon over hip joint
 Iliofemoral ligament over femoral head or hip
capsule
 Hip joint subluxation
 Loose body

The above is not a complete list of DDs/ tests

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