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There are a number of possible causes for pain arising form the hip joint. Additionally many adjacent structures may produce symptoms misinterpreted as "hip pain".

True hip pain is usually felt in the groin, radiating to the thigh and to the outer side of the upper leg. This may be a dull ache after exercise, indicating inflammation or a sharp stabbing pain on specific movements due to a mechanical problem in the joint. Pain from osteoarthritis of the hip often has an insidious onset, gradually progressing to become more troublesome.

Pain around the hip joint

Causes of pain originating within the hip joint include:
Causes of pain from adjacent tissues include:
The Teaching Zone has a whole section covering many causes of hip pain.

If pain develops on both sides then central (e.g. spinal stenosis - trapping the nerves to the legs) or systemic cause (e.g. Polymyalgia rheumatica , Inflammatory arthritis, AVN) should be considered.

Diagnostic Tests

There are some conditions that cause a reproducible pattern of symptoms and signs; in these cases the diagnosis can be made without any special tests. e.g. Trochanteric Bursitis, Pubic Symphysitis, Gilmore's Groin.

Osteoarthritis is the commonest cause of significant hip pain and in the majority of cases a firm diagnosis can be made with a simple x-ray. When this condition develops at an early age it is quite commonly mis-diagnosed as muscle strain. I would suggest that anyone with recurrent or prolonged "muscle strain" (say > 8 weeks) should have an x-ray.

Inflammatory arthritis, such as Rheumatoid arthritis, may present in a number of different ways. Simple x-rays and screening blood tests may help with diagnosis. When the symptoms or family history suggest the possibility of an inflammatory condition early referral to a specialist Rheumatologist is advised.

If it is not possible to reach a confident diagnosis after interview, examination and simple x-rays then further special test are required. The structures of the hip joint can be viewed using MRI with or without intra-articular contrast. Increased biological activity in the hip or adjacent bones may be assessed using an isotope bone scan. Both of these imaging techniques may be used to look for causes of referred pain, say from the knee or spine.

Causes of neurogenic hip pain may be visible on MRI, but in some cases a diagnostic injection is required to confirm which nerve/root is irritated. Using similar logic it is sometimes necessary to undertake diagnostic injections around the hip to identify the source of pain from muscles or tendons.

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