Hip pain often presents a diagnostic problem to a referring doctor, for two reasons. Firstly, what the patient describes as “hip pain”, may involve pain in the groin, pain over the lateral thigh as well as pain in the buttock, sometimes radiating down the leg. Secondly, patients who present like this, may have problems which are orthopaedic in nature, or they may be suffering from problems such as hernias, urinary tract infections as well as other issues which are best managed by other specialists. In order to decide whether a patient with hip pain is suffering from an orthopaedic problem, a clear understanding of the common-, and more importantly the less common orthopaedic pathologies around the hip is required. A goal directed series of special investigations may then be commenced in order to pin down the diagnosis. If patients are stubbornly investigated and/or empirically treated for orthopaedic causes, based on the history of hip pain alone, sub optimal outcomes and delays in diagnosis will result.
A significant part of any initial orthopaedic examination in patients with hip pain is directed towards determining whether this is a case of local pain, which may then be originating from multiple structures around the actual hip joint, the pelvis or the proximal thigh or whether the patient is suffering from referred pain, where the pathology is situated in a different area, such as the lower back.
Causes of hip pain are best primarily split up according to the age of the patient and then secondary according to the usual location of the pain (groin/buttock/lateral thigh), which should be ascertained from the patient on direct questioning.
