Version May 2024
| Condition | Common & important examples | History & mechanism | Physical examination | Diagnostic testing |
| Acute or acute-on-chronic conditions | ||||
| Muscle & tendon injuries | Adductor strain | Often acute strain that occurs w intense, repetitive, side to side movement (eg, skating), sprinting, or sudden forced hip abduction; Causes proximal groin/inguinal pain | Focal groin/inguinal tenderness at muscle origin; pain w resisted hip adduction | US; MRI (typically unnecessary) |
| Quadriceps strain (rectus femoris most common) | Often acute strain that occurs w rapid change of direction while sprinting or when landing from jump; Causes proximal anterior thigh pain | Focal tenderness at site of injury; Hip flexion activities (eg, climbing stairs) & resisted hip flexion cause pain | US; MRI (typically unnecessary) | |
| Hamstring strain | Often acute strain that occurs with sprinting or hill running; Causes proximal posterior thigh pain | Focal tenderness at MT junction and/or tendon insertion onto ischial tuberosity; Pain with resisted knee flexion & hip extension | US; MRI (typically unnecessary) | |
| External snapping hip | Patient c/o palpable or audible "snap" in area of greater trochanter w particular hip movements; may or may not be painful | Some combination of hip flexion, abduction, and/or external rotation reproduces symptoms | Dynamic US may reveal tendon motion w particular hip movements | |
| Trochanteric pain syndrome (formerly trochanteric "bursitis") | Lateral hip pain at & around greater trochanter; pain often increases w running or climbing stairs or inclines; caused by insertional tendinopathy | Focal tenderness at greater trochanter; Resisted hip abduction, hip internal rotation, or FABER test may elicit pain | US often reveals tendon abnormalities | |
| Labral tear | Groin pain exacerbated by sport, often jumping or sprinting involving aggressive hip flexion, or develops towards end of long runs; Groin pain may occur w sitting, transition to standing, descending stairs, or putting on shoes while seated | Pain increases w repeated hip flexion, resisted hip flexion, and FADIR test | MRA may be necessary for Dx & to distinguish from femoracetabular impingement | |
| Stress fracture | Femoral neck stress fracture | May start w vague groin pain that worsens & localizes over time; acute increase in pain w weight-bearing activity; relatively common w running, dance, and jumping sports; more common in women | Pain may increase when hip placed at extremes of motion; Hopping test often positive | Plain radiographs diagnostic if reveal fracture but may be normal; MRI preferred study |
| Proximal femoral shaft stress fracture | Often starts w vague anterior thigh pain that worsens and localizes to proximal thigh over time; acute increase in pain w weight-bearing activity; more common in runners & women | Hopping and fulcrum tests often positive | Plain radiographs diagnostic if reveal fracture but may be normal; MRI preferred study | |
| Sacral stress fracture | Persistent pain in region of SI joint; more common in women involved in running or jumping sports | Tenderness w palpation of bony prominences of sacrum - pain is diffuse and NOT only at the SI joint; NO pain with resisted strength testing of gluteal muscles | Plain radiographs often unrevealing; MRI preferred study | |
| Pubic ramus stress fracture | Pain in region of pubic ramus; occurs in distance runners; more common in women | Focal tenderness at pubic ramus; pain increases when pelvis is rocked or compressed | Plain radiographs may reveal pathologic changes, but MRI preferred study | |
| Subacute & chronic conditions | ||||
| Neuropathies | Piriformis syndrome (sciatic nerve entrapment) | Causes gradual onset of buttock pain that increases w sitting; May cause paresthesias but classic sciatica is uncommon; occurs in some runners | Standard tests for lumbar radiculopathy are negative; neurologic testing normal; resisted hip abduction & external rotation may increase pain; forced hip adduction, flexion, & internal rotation may increase pain | MRI may be performed to rule out alternative diagnoses |
| Pudendal nerve entrapment | Symptoms include ipsilateral perineal pain, which often increases with sitting, and penile or labial numbness; Relatively common among cyclists | Sensory deficits often absent | None | |
| Ilioinguinal nerve entrapment | Symptoms consist of groin pain radiating to the genitalia; Can occur in hockey players (often associated w external oblique aponeurosis tear) & bodybuilders | Tenderness may be present about 2-3 cm below the anterior superior iliac spine | MRI may be performed primarily to assess other possible diagnoses | |
| Femoral nerve entrapment | Causes paresthesias over anterior and anteromedial thigh; Associated w activities involving repeated forceful hip flexion, jumping sports, and gymnastics | May cause sensory deficits over anterior or anteromedial thigh; May cause quadriceps weakness | US may show entrapment at inguinal region | |
| Osteitis pubis (symphysis pubis stress injury) | Causes gradual onset of unilateral or bilateral groin pain; typically no acute injury; pain may radiate to low abdomen or hip or thigh; more common in males playing sports involving rapid acceleration & deceleration, kicking, & pivoting | Tenderness at symphysis pubis; Passive stretch of hip adductors and resisted hip adduction (performed at several positions) increase pain | Plain radiographs often reveal suggestive changes; MRI is definitive study | |
| Femoroacetabular impingement | Presentation often insidious & diagnosis difficult; Mild groin pain may be present for months before abruptly worsening; buttock pain may develop but is less common; pain increases w transition from sitting to standing | Hip internal rotation often decreased but external rotation is near normal; FADIR test often reproduces pain; extreme hip flexion & FABER test may reproduce pain; EABER test may reproduce pain | Plain radiographs (special views needed) demonstrate type of hip deformity | |
| Athletic pubalgia ("sports hernia") | Pain in vicinity of common attachment of rectus abdominis & inguinal ligament and origin of adductor longus on superior pubic ramus; Athletes describe groin or low abdominal pain w exertion or when trying to play their sport; Pain often develops insidiously but may be acute; pain is diffuse & may be burning; more common in men involved in hockey or field sports involving rapid change in direction | Tenderness at insertion of conjoint tendon, over deep inguinal ring, at external inguinal ring, and/or origin of adductor longus tendon | MRI can reveal suggestive findings, but may be misleading; US may reveal suggestive findings but is technically challenging | |
| Osteoarthritis of hip | Causes chronic, progressive hip pain punctuated by acute flares; pain increases w activity but diminishes w rest; joint stiffness common; generally occurs in patients over 40 years | Hip motion is diminished and mobility testing causes pain | Plain radiographs reveal diminished joint space, sclerosis, & other characteristic changes | |
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