Di erential Diagnosis - Hip Pain
Red Flags, Tests & Clinical Reasoning
Hip pain is a common, yet often complex clinical presentation. It may originate from local
musculoskeletal structures or be referred from the spine, pelvis, or abdomen. Classifying pain by
region—anterior, lateral, or posterior—can help narrow the di erential. A structured regional
approach supports accurate diagnosis and timely management, reducing the risk of missed or
delayed treatment.
Di erentials by Region
Anterior Hip Pain
Diagnosis Structure Presentation
OA Joint Age 50+, Morning sti ness <1hr, Reduced internal
rotation, Radiates to thigh/buttock/knee, Worse at
night, rest or strenuous activity, Locking, grinding,
instability, crepitus
FAI (cam + pincer) Bone/ Active young/middle-aged, Aggravated by exion,
Labrum acceleration sports, squatting, climbing stairs, Groin
pain (sometimes lateral), sharp on turning/twisting/
squatting, Limited IR and exion, Radiate to thigh,
buttock, back
Labral tear Labrum Associated with FAI, DDH, OA, major trauma, Often
asymptomatic, Pain on weight-bearing, exion, internal
rotation, Clicking, locking, giving way
Femoral neck stress # Bone Overuse injury, repetitive load, Common in young
athletes, Gradual onset pain, aggravated by weight
bearing + internal rotation, Point tenderness, oedema,
antalgic gait
Avascular necrosis of Bone Age 50+, Asymptomatic until late stages, Associated
femoral head with alcohol + steroid use, sickle cell, SLE, diabetes
Mellitus, Groin, thigh, buttocks pain
Iliopsoas bursitis Bursa Acute trauma, overuse injuries, RA, Non-speci c
anterior pain, Radiate to knee, leg, lower back,
Aggravated by activity, Snapping sensation at the front
of hip
Groin strain Muscle/ Intense groin pain + pain in inner thigh, Common in
Tendon athletes
Lateral Hip Pain
Diagnosis Structure Presentation
GTPS (gluteal Tendon/ Most commonly associated with gluteus medius
tendinopathy) Bursa tendinopathy, Trochanteric bursitis is typically
secondary to tendon pathology, Age 40-60s, females,
Lateral hip pain aggravated by prolonged sitting and
sleeping on a ected hip, Tender greater trochanter ,
Trendelenburg gait
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, ITB syndrome Fascia Often associated with lateral knee pain (burning /
shooting), Pain on lateral hip, greater trochanter area,
Common in cyclists and runners (repeated exion /
extension)
Lateral femoral Nerve Localised parasthesia and numbness on anterolateral
cutaneous nerve thigh, Age 30-40s, Increased intra-abdominal pressure
neuralgia (Meralgia eg obesity, pregnancy, ascities, tight clothing,
Parastheica) Aggravated by prolonged standing / walking, Relieved
sitting (less tension on LFCN)
Posterior Hip Pain
Diagnosis Structure Presentation
Piriformis syndrome Nerve Persistent, radiating low back pain, Buttock pain,
Numbness + parasthesia, Pain with sitting, squatting,
standing
Ischiofemoral Bone Chronic pain in groin / buttock, Radiate to thigh / knee,
impingement Snapping, crepitus, locking of joint , F>M
SIJ dysfunction Joint Associated with micro/acute trauma in athletes,
Pregnancy, sedentary life, obesity, Localised buttock
pain, Sharp stabbing shooting pain down posterior
things (not past the knee), Local tenderness near PSIS,
Pain sitting down, lying of ipsilateral side, climbing
stairs
Proximal hamstring Tendon Long distance runners, sprinting, hurdles, football,
tendinopathy hockey, Deep localised pain at ischial tuberosity,
Aggravated by running, lunging, squatting, sitting
Sacroiliitis Joint Ipsilateral / bilateral buttock / midline-low lumbar pain,
Aggravated by prolonged standing, stair climbing,
running, weightbearing on one side, Associated with
OA, AS, Reactive arthritis, Psoriatic arthritis, Pregnancy
VINDICATE
V Vascular Avascular necrosis
I Infection, Septic arthritis, Osteomyelitis, Pelvic abscess
In ammation
N Neoplasm Bone metastases eg prostate, breast, Primary bone tumour,
Myeloma
D Degenerative OA, FAI, Labral tear, Tendinopathy
I Iatrogenic, Idiopathic Post-surgical pain, Prosthesis complications, Steroid induced
AVN
C Congenital Developmental dysplasia of the hip (DDH), Perthes disease
(paediatric)
A Autoimmune RA, Ankylosing spondylitis, Psoriatic arthritis
T Trauma Fracture, Dislocation, Soft tissue injury
E Endocrine, Metabolic Osteoporosis, Paget’s disease, Osteomalacia, Diabetes related
joint pain
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Red Flags, Tests & Clinical Reasoning
Hip pain is a common, yet often complex clinical presentation. It may originate from local
musculoskeletal structures or be referred from the spine, pelvis, or abdomen. Classifying pain by
region—anterior, lateral, or posterior—can help narrow the di erential. A structured regional
approach supports accurate diagnosis and timely management, reducing the risk of missed or
delayed treatment.
Di erentials by Region
Anterior Hip Pain
Diagnosis Structure Presentation
OA Joint Age 50+, Morning sti ness <1hr, Reduced internal
rotation, Radiates to thigh/buttock/knee, Worse at
night, rest or strenuous activity, Locking, grinding,
instability, crepitus
FAI (cam + pincer) Bone/ Active young/middle-aged, Aggravated by exion,
Labrum acceleration sports, squatting, climbing stairs, Groin
pain (sometimes lateral), sharp on turning/twisting/
squatting, Limited IR and exion, Radiate to thigh,
buttock, back
Labral tear Labrum Associated with FAI, DDH, OA, major trauma, Often
asymptomatic, Pain on weight-bearing, exion, internal
rotation, Clicking, locking, giving way
Femoral neck stress # Bone Overuse injury, repetitive load, Common in young
athletes, Gradual onset pain, aggravated by weight
bearing + internal rotation, Point tenderness, oedema,
antalgic gait
Avascular necrosis of Bone Age 50+, Asymptomatic until late stages, Associated
femoral head with alcohol + steroid use, sickle cell, SLE, diabetes
Mellitus, Groin, thigh, buttocks pain
Iliopsoas bursitis Bursa Acute trauma, overuse injuries, RA, Non-speci c
anterior pain, Radiate to knee, leg, lower back,
Aggravated by activity, Snapping sensation at the front
of hip
Groin strain Muscle/ Intense groin pain + pain in inner thigh, Common in
Tendon athletes
Lateral Hip Pain
Diagnosis Structure Presentation
GTPS (gluteal Tendon/ Most commonly associated with gluteus medius
tendinopathy) Bursa tendinopathy, Trochanteric bursitis is typically
secondary to tendon pathology, Age 40-60s, females,
Lateral hip pain aggravated by prolonged sitting and
sleeping on a ected hip, Tender greater trochanter ,
Trendelenburg gait
ff ff ff ff fl fl fl fi ff
, ITB syndrome Fascia Often associated with lateral knee pain (burning /
shooting), Pain on lateral hip, greater trochanter area,
Common in cyclists and runners (repeated exion /
extension)
Lateral femoral Nerve Localised parasthesia and numbness on anterolateral
cutaneous nerve thigh, Age 30-40s, Increased intra-abdominal pressure
neuralgia (Meralgia eg obesity, pregnancy, ascities, tight clothing,
Parastheica) Aggravated by prolonged standing / walking, Relieved
sitting (less tension on LFCN)
Posterior Hip Pain
Diagnosis Structure Presentation
Piriformis syndrome Nerve Persistent, radiating low back pain, Buttock pain,
Numbness + parasthesia, Pain with sitting, squatting,
standing
Ischiofemoral Bone Chronic pain in groin / buttock, Radiate to thigh / knee,
impingement Snapping, crepitus, locking of joint , F>M
SIJ dysfunction Joint Associated with micro/acute trauma in athletes,
Pregnancy, sedentary life, obesity, Localised buttock
pain, Sharp stabbing shooting pain down posterior
things (not past the knee), Local tenderness near PSIS,
Pain sitting down, lying of ipsilateral side, climbing
stairs
Proximal hamstring Tendon Long distance runners, sprinting, hurdles, football,
tendinopathy hockey, Deep localised pain at ischial tuberosity,
Aggravated by running, lunging, squatting, sitting
Sacroiliitis Joint Ipsilateral / bilateral buttock / midline-low lumbar pain,
Aggravated by prolonged standing, stair climbing,
running, weightbearing on one side, Associated with
OA, AS, Reactive arthritis, Psoriatic arthritis, Pregnancy
VINDICATE
V Vascular Avascular necrosis
I Infection, Septic arthritis, Osteomyelitis, Pelvic abscess
In ammation
N Neoplasm Bone metastases eg prostate, breast, Primary bone tumour,
Myeloma
D Degenerative OA, FAI, Labral tear, Tendinopathy
I Iatrogenic, Idiopathic Post-surgical pain, Prosthesis complications, Steroid induced
AVN
C Congenital Developmental dysplasia of the hip (DDH), Perthes disease
(paediatric)
A Autoimmune RA, Ankylosing spondylitis, Psoriatic arthritis
T Trauma Fracture, Dislocation, Soft tissue injury
E Endocrine, Metabolic Osteoporosis, Paget’s disease, Osteomalacia, Diabetes related
joint pain
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