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Hip Pain Causes

Hip Pain Causes and differential diagnosis include a variety of possible causes that arise from the hip structures itself or from structures around it (referred pain).

The location of the hip pain can provide the clinician with some useful information:

  • Complaints of hip or groin pain, morning stiffness, stiffness after sitting, and hip pain with weight-bearing are suggestive of joint involvement, such as OA.
  • Periarticular pain that is not reproduced by passive motion and direct joint palpation suggests an alternate etiology such as bursitis, tendinitis, or periostitis.
  • Lateral and posterior hip (buttock) and thigh pain may be referred from the lumbar spine.
See Also: Hip Muscles Anatomy

Physical Findings in More Common Thigh and Hip Pain Causes:

ConditionDescription of Findings
Osteoarthritis of the hip Tenderness over the anterior hip capsule
Pain reproduced by passive rotation of the hip
Restricted range of motion (rotation is usually first affected)
Pain reproduced by Stinchfield’s test.
Abductor limp (more severe cases)
Functional leg length discrepancy (if abduction contracture has developed)
Meralgia paresthetica Altered sensation over the anterolateral thigh
Symptoms reproduced by pressure or percussion just medial to the anterior–superior iliac spine
Piriformis tendinitis Tenderness to deep palpation near the hook of the greater trochanter. Pain reproduced by piriformis stretch
Gluteus medius tendinitis Tenderness just proximal to the greater trochanter
Pain reproduced by resisted abduction of the hip
Trochanteric bursitis Tenderness over the lateral aspect of the greater trochanter
Popping or crepitation felt with flexion–extension of the hip (occasionally)
Tight iliotibial tract revealed by Ober test (variable)
Quadriceps strain or contusion
Tenderness and swelling of the involved area of the quadriceps
Weakness of quadriceps contraction
Restriction of knee flexion, especially when the hip is extended
Palpable divot in the quadriceps (more severe strains)
Warmth and firmness in quadriceps (impending myositis ossificans)
Hamstring strain Localized tenderness and swelling at the site of injury
Ecchymosis (frequently)
Restricted knee extension and straight-leg raising
Palpable divot in the injured hamstring (more severe injuries)
Abnormal tripod sign
femoral neck fracture

Potential Causes of Hip Pain

Type of Pain/Structure InvolvedCause
Articular cartilageChondral lesion
Childhood disorders Congenital dysplasia
Legg–Calve–Perthes disease
Slipped capital femoral epiphysis
InflammationTrochanteric bursitis
Psoas bursitis
Toxic synovitis
Infection Septic arthritis
Labral tear
Neurologic Local nerve entrapment
OveruseStress fractures of the femur
Muscle strains
Inguinal hernia
Femoral hernia
Referred Lumbar disk pathology
Lumbar spine-degenerative joint disease
Athletic pubalgia
Piriformis syndrome
Sacroiliac joint pathology
Genitourinary tract pathology
Abdominal wall pathology
Systemic Rheumatoid arthritis
Crohn’s disease
Reiter’s syndrome
Systemic lupus erythematosus
Trauma Soft tissue contusion
Fractures of the femoral head
Dislocation of the femoral head
Avulsion injury
Myositis ossificans
Vascular Avascular necrosis
See Also: 
hip osteonecrosis

Hip Pain Description & Possible Causes

Hip Pain DescriptionPossible Diagnosis
Pain that is usually worse with sitting on hard surfaces, cycling, and prolonged standingIschiogluteal bursitis
Pain with squatting, lying on the involved side, climbing stairs, and walking Subtrochanteric bursitis
A clicking or popping sound that occurs during running and dancing activitiesSnapping hip syndrome
Pain with prolonged sitting, trunk flexion, and coughing/ sneezing Lumbar disk herniation
Pain with activities that involve lumbar extension Spinal stenosis, spondylolisthesis, or facet syndrome
Pain at night unrelated to movement Malignancy
Pain with walking, which is relieved with cessation of the activity Vascular claudication
Pain that appears to be affected by the weatherArthritic condition or fibromyalgia syndrome
Progressive loss of or change in motor, bowel, bladder, or sexual function Myelopathy, conus medullaris syndrome, or cauda equinus syndrome
nerve distribution around the hip


  1. Martell JM, Reider B: Pelvis, hip and thigh. In: Reider B, ed. The Orthopaedic Physical Examination. Philadelphia, PA: WB Saunders, 1999:159–199.
  2. Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular labral tears of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther. 2006 Jul;36(7):503-15. doi: 10.2519/jospt.2006.2135. PMID: 16881467.
  3. Feinberg JH: Hip pain: Differential diagnosis. J Back Musculoskeletal Rehabil 4:154–173, 1994.
  4. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
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