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Evaluation of the adult with hip pain

Author
Peter Fricker, MBBS, FACSP
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Hip pain is a common symptom with a number of possible causes [1]. In a survey of 6596 adults ages 60 years and older, 14.3 percent reported significant hip pain on most days over the past six weeks [2].

Trochanteric and gluteus medius bursitis, osteoarthritis, and fractures of the femur are the most common conditions affecting the hip. The character and location of the pain, the movement and positions that reproduce the pain, and the affect on ambulation can be used to distinguish the conditions affecting soft tissues from disorders affecting the hip joint and adjacent bones.

This review will provide a general approach to the evaluation of patients with hip pain. More in-depth discussions of the diagnosis and treatment of specific disorders of the hip are found separately. The diagnostic approach to hip pain in children is discussed elsewhere. (See "Approach to hip pain in childhood".)

ANATOMY

The hip joint is formed by the rounded head of the femur and its articulation with the acetabulum. The latter is formed by the union of the ilium, ischium, and pubis. The hip joint is a ball-and-socket joint that is relatively fixed to the body by the pelvic girdle. Because of this relative immobility, a primary abnormality of the hip or pelvis can cause symptoms in the lumbar spine or knee, and a primary abnormality in the lumbar spine or knee may cause a secondary abnormality in the hip [3].

The femoral neck is approximately 8 to 10 cm in length. Two bony prominences project from the femoral neck: the greater trochanter laterally and the lesser trochanter medially. The greater trochanter is the site of attachment for the abductor muscles (gluteus medius and gluteus minimus) and the external rotators of the hip. The main hip extensors are gluteus maximus and the hamstrings; the former attaches to the proximal femur, just distal to the greater trochanter. The lesser trochanter is the attachment site for the major hip flexor, the iliopsoas muscle.

                                         

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Literature review current through: Jun 2017. | This topic last updated: Jun 24, 2016.
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References
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