Differential diagnosis of pain felt in the hip region in adults

Differential diagnoses for pain felt in the hip region in adults lists common and uncommon differential diagnoses for pain felt in the hip region in adults.

Table 1. Differential diagnoses for pain felt in the hip region in adults
[NB1]
Location that pain is felt	Differential diagnoses [NB1]
Pain felt in the groin or anterior thigh
conditions that require urgent referral and management	septic arthritis fracture—femoral neck or pelvis stress fracture—especially associated with osteoporosis avascular necrosis of the femoral head or neck (traumatic and atraumatic)
uncommon conditions (less urgent)	inflammatory arthritis such as rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis
common conditions (nonurgent)	osteoarthritis femoroacetabular impingement syndrome acetabular-labral tear
Pain felt in the hip girdle
conditions that require urgent referral and management
uncommon conditions (less urgent)	polymyalgia rheumatica
common conditions (nonurgent)	low back pain
Pain felt in the lateral thigh [NB2]
conditions that require urgent referral and management
uncommon conditions (less urgent)	lumbar (L2, L3) radiculopathy
common conditions (nonurgent)	greater trochanteric pain syndrome including gluteal tendinopathy and bursitis low back pain
Note: NB1: This table is not exhaustive. NB2: Hip-joint pathology rarely refers pain to the lateral thigh.

In people with severe groin or anterior thigh pain, but normal hip movements, consider the possibility of avascular necrosis or stress fracture. Avascular necrosis of the head of the femur is relatively uncommon in adults. The atraumatic form in adults is associated with recognised risk factors, such as the use of systemic corticosteroids or excessive alcohol consumption. The post-traumatic form is associated with fracture of the femoral head or neck.

Stress fracture may be seen in people with risk factors for osteoporosis or people (both young and old) who participate in recurrent, vigorous physical activity (eg fractures of the femoral neck, pubic rami, sacrum).

Consider polymyalgia rheumatica in people aged over 50 years who present with pain felt in the hip girdle associated with morning stiffness.

In older people with pain felt in the hip following a fall or other trauma, consider a fracture of the femoral neck. People present with an externally rotated, shortened lower limb and are unable to weightbear.