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Hip Pain Causes

Last updated on: December 25, 2023

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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

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Physical Findings in More Common Thigh and Hip Pain Causes:

Condition	Description 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

Potential Causes of Hip Pain

Type of Pain/Structure Involved	Cause
Articular cartilage	Chondral lesion Osteoarthritis
Childhood disorders	Congenital dysplasia Legg–Calve–Perthes disease Slipped capital femoral epiphysis
Inflammation	Trochanteric bursitis Psoas bursitis Tendinitis Toxic synovitis
Infection	Septic arthritis Osteomyelitis
Labral tear
Neoplasm
Neurologic	Local nerve entrapment
Overuse	Stress fractures of the femur Muscle strains Inguinal hernia Femoral hernia
Referred	Lumbar disk pathology Lumbar spine-degenerative joint disease Athletic pubalgia Radiculopathy Piriformis syndrome Sacroiliac joint pathology Genitourinary tract pathology Abdominal wall pathology
Systemic	Rheumatoid arthritis Crohn’s disease Psoriasis 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 Osteonecrosis

See Also:

Hip Pain Description & Possible Causes

Hip Pain Description	Possible Diagnosis
Pain that is usually worse with sitting on hard surfaces, cycling, and prolonged standing	Ischiogluteal 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 activities	Snapping 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 weather	Arthritic condition or fibromyalgia syndrome
Progressive loss of or change in motor, bowel, bladder, or sexual function	Myelopathy, conus medullaris syndrome, or cauda equinus syndrome

References

Martell JM, Reider B: Pelvis, hip and thigh. In: Reider B, ed. The Orthopaedic Physical Examination. Philadelphia, PA: WB Saunders, 1999:159–199.
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.
Feinberg JH: Hip pain: Differential diagnosis. J Back Musculoskeletal Rehabil 4:154–173, 1994.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.