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Hip pain diagnosis

Most cases of hip pain are reliably diagnosed by an experienced clinician

There are many common causes of hip pain. Most cases of hip pain are reliably diagnosed by an experienced clinician, undertaking a history of the condition and completing a physical examination.

Good examples of useful, clinical diagnostic tests include analysing the hip’s range of motion, which when stiff and painful will often be a sign of hip osteoarthritis or hip impingement syndromes.

X-rays may be useful in determining the extent of any degenerative changes to the hips joint/s. However, using specialist angles hip surgeons often find X-rays a useful method of evaluating the shape, contour and angles of the hip joints in younger patients.

These specialist X-rays may provide information as to whether there are any developmental defects to the hip/s or whether there is any obvious bone related cause for hip impingement symptoms.

CT scans, which provide a very detailed 3D perspective on the bone anatomy, may be requested in certain cases to provide additional detail for planning certain forms of hip surgery. 

MRI scans may be used for this additional detail and are also requested in cases where a hip cartilage (labral) tear is suspected or where the hip pain is suspected to be caused by soft tissue outside of the joint itself. 

Ultrasound technology has increased significantly in recent years and in the diagnosis of muscle and tendon pathology, such as that often found in greater trochanteric pain, will normally be used instead of MRI scans.

In fully mobile hips, using resisted tests may be useful to place different muscles and tendons under load and observe pain, as well as palpating for areas of tenderness over the soft tissue structures.

You may be experiencing general pain in hip area, right side hip pain or left side hip pain, or only have hip pain at night. You may also feel pain and stiffness in the ball and socket joint of your hip.

Depending on the findings from the history and examination, further diagnostic tests may be requested depending on the suspected diagnoses, or to plan whether and what form of surgery may be offered.

In the majority of circumstances, hip pain or aching hips is due to degenerative hip joint disease (osteoarthritis) or other soft tissue problems.

Very occasionally, there may be an underlying medical problem causing the hip pain.

This is an extremely rare occurrence and an examination by a doctor or physiotherapist can establish normal, mechanical hip pain over any more serious pathology. Immune system problems, known as autoimmune diseases, may also give rise to joint inflammation.

Often these inflammatory responses are felt throughout the body but the hip joint/s may be affected by conditions such as psoriatic arthritis and rheumatoid arthritis. A process known as osteonecrosis may affect the ball part of the hip joint (femoral head) which leads to loss of bone mass due to a lack of blood supply.

This condition normally affects individuals who have suffered a trauma or who have risk factors (such as metabolic problems) or who have been on courses of particular medications. In very rare circumstances, a similar condition known as transient osteoporosis of the hip may occur during pregnancy.

This condition, leading to rapid bone loss in the femoral head, requires careful monitoring and a period of offloading the joint by using crutches.

Therefore, when women are unable to weight bear due to hip pain or instability, they are advised to offload their weight and seek an urgent healthcare consultation.

Rarely, certain types of tumours (known as sarcomas) can arise around the pelvis or the top of the thigh-bone (femur) and in some circumstances spread of forms of cancer may occur near the pelvis or hip.

It’s important to appreciate that everybody's perception and tolerance of pain is different, and people may feel pain in different areas. Some people might not complain of much pain despite having very stiff hips and quite a bit of disability as a result of damage to the joint. A good rule of thumb is to see a doctor if your symptoms are impacting on your quality of your life or your ability to carry out your normal everyday tasks.

When you visit a doctor for help with hip pain, they will want to learn as much as possible about your symptoms. They may ask you questions like:

  • How long have you had the hip pain?
  • Was there an obvious cause, such as a hip fracture?
  • Has the pain stayed the same, or has it been getting progressively worse over time?
  • Where exactly is the joint pain?
  • Do any specific movements, positions or activities make the pain worse?
  • Have you tried any treatments for your hip pain? If so, have they helped?

There are some specific clinical tests a doctor may arrange as part of their assessment.

As well as a physical examination of your hip and back, they may also arrange for you to have an X-ray, MRI scan or CT scan of the pelvis, depending on the most likely cause of your pain. (These additional diagnostic tests will not always be needed; you will always be assessed on an individual basis by your consultant, based on your specific symptoms.)

As with many medical conditions, proper assessment by an experienced doctor is the most reliable way of finding out what is causing your hip pain and then getting the optimal treatment for it.

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