DipMSK Revision Guide · Chapter 9 of 18

Hip Region Conditions

Hip OA, greater trochanteric pain syndrome, FAI, athletic groin and buttock pain.

Syllabus: Hip Region Conditions

Written by Dr David Palethorpe, MBBS, BSc (Hons), MRCGP · NHS GP PartnerReviewed 14 September 202619 min readChapter 9 of 18

Before you start

Try this first

A 55-year-old has activity-related groin pain. Which hip movement do you test first, and what are you looking for?

Internal rotation in flexion. Loss of internal rotation reproducing groin pain is the most useful single hip sign, and it precedes loss of flexion. If it is full and painless, look elsewhere.

2 more warm-up questions in the full chapter.

What this chapter covers

  • 9.1Hip osteoarthritis — a clinical diagnosisA clinical diagnosis over 45, and the examinable sign is restricted, painful internal rotation. If internal rotation is…Preview below
  • 9.2Greater trochanteric pain syndrome — gluteal tendinopathy, not bursitisMembers
  • 9.3FAI syndrome and athletic groin pain — the Doha vocabularyMembers
  • 9.4Buttock pain and the differentials the syllabus namesMembers
  • 9.5The hip diagnoses you cannot miss — fracture, avascular necrosis, sepsisMembers
  • —Referral, by timeframeRed flags below

Hip osteoarthritis — a clinical diagnosis

Core Lens — the takeaway

A clinical diagnosis over 45, and the examinable sign is restricted, painful internal rotation. If internal rotation is full and painless, look elsewhere.

Recognise

  • Groin pain that is activity-related and eases with rest, often with a deep ache in the buttock or anterior thigh.
  • NICE NG226 diagnoses osteoarthritis clinically without imaging over 45 with activity-related joint pain and either no morning stiffness or stiffness lasting no longer than 30 minutes.
  • About 11 in every 100 people over 45 in England have hip osteoarthritis, per the NHS England decision support tool.

The rest of this chapter is in the DipMSK guide

4 more topics, every section opened up, the recall questions and the guidance summaries — written and reviewed by practising UK doctors.

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Referral, by timeframe

Same day · Emergency
  • Suspected hip fracture, suspected septic arthritis, or inability to weight-bear after a fall
  • Suspected cauda equina syndrome, or a febrile patient with severe buttock or hip pain
  • Suspected testicular torsion, incarcerated hernia, or an acute hot hip with fever
  • An adolescent with groin or knee pain, an antalgic gait and an externally rotated leg — same-day orthopaedics

Also in the full chapter: Cancer pathway · Urgent · Routine.

← Chapter 8Neck Pain +/- Radiculopathy

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