The table below provides a brief summary of the potential causes of hip pain in adults
| Condition | Features |
|---|---|
| Osteoarthritis/ coxarthrosis | Pain exacerbated by exercise and relieved by rest Reduction in internal rotation is often the first sign Age, obesity and previous joint problems are risk factors |
| Inflammatory arthritis | Pain in the morning Systemic features Raised inflammatory markers |
| Referred lumbar spine pain | Femoral nerve compression may cause referred pain in the hip Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped |
| Greater trochanteric pain syndrome (Trochanteric bursitis) | Due to repeated movement of the fibroelastic iliotibial band Pain and tenderness over the lateral side of thigh Most common in women aged 50-70 years |
| Meralgia paraesthetica | Caused by compression of lateral cutaneous nerve of thigh Typically burning sensation over antero-lateral aspect of thigh |
| Avascular necrosis | Symptoms may be of gradual or sudden onset May follow high dose steroid therapy or previous hip fracture of dislocation |
| Pubic symphysis dysfunction | Common in pregnancy Ligament laxity increases in response to hormonal changes of pregnancy Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs. A waddling gait may be seen |
| Transient idiopathic osteoporosis | An uncommon condition sometimes seen in the third trimester of pregnancy Groin pain associated with a limited range of movement in the hip Patients may be unable to weight bear; ESR may be elevated |
Coxarthrosis or Osteoarthritis of the hip
a degenerative joint disease characterized by deterioration of cartilage with subsequent new bone formatio at the articular surface
Piriformis syndrome
The piriformis is the small muscle that crosses the greater sciatic foramen, cutting it into two spaces as the muscle passes from the edge of the sacrum to the greater trochanter. The sciatic nerve comes out of the greater sciatic foramen below the piriformis, and is subject to compression by the muscle.
In addition to causing gluteal pain that may radiate down buttocks and the leg, the syndrome may present with pain that is relieved by walking with the foot on the involved side pointing outward. This position externally rotates the hip, lessening the stretch on the piriformis and relieving the pain slightly.
Piriformis syndrome is also known as "wallet sciatica" or "fat wallet syndrome," as the condition can be caused or aggravated by sitting with a large wallet in the affected side's rear pocket. Rowing/sculling, bicycle riding and running may also set off the symptoms, which may take the form of chronic nagging ache, pain, tingling, or numbness.
Treatment is usually to teach the patient to avoid maneuvers that set off the symptoms. Some patients have been helped by corticosteroid injection near the site where the piriformis muscle crosses the sciatic nerve; this therapy is thought to work by reducing the fat around the muscle and thereby increasing the available space in the area.