The hip joint is a ball and socket joint. The ball is the head of the femur (thighbone) that fits in the acetabulum (the hip socket). Tendons, muscles, and ligaments hold the joint in place. Articular cartilage covers the acetabulum and the femoral head. The synovial membrane of the hip joint secretes the synovial fluid which lubricates the joint enabling smooth movement.
Hip pain may be caused due to a variety of reasons such as osteoarthritis, labral tears, impingement, fractures, etc. Hip pain may be felt in the anterior, posterior or lateral part of the hip.
Physical examination of the hip is the key component in diagnosing the cause of your hip pain or hip pathology.
Patient’s Medical History
Prior to conducting the physical examination of the hip, your doctor enquires about any injury or trauma which may have caused the hip pain, the onset of pain and the localization of pain. You must also discuss with your doctor the activities which increase or decrease the pain.
Physical Examination of the Hip
The physical examination of the hip by your doctor includes a visual inspection of your hip, palpation of the hip to diagnose tenderness or any abnormality, etc; and testing range of motion of the hip.
Inspection (Looking): Your hip will be carefully observed while standing which may reveal any deformity or leg length discrepancy. You may also be asked to stand on one leg to see if your pelvis tilts to one side which may be an indication of hip instability or muscle weakness. You will also be asked to walk to look for an abnormal gait pattern.
Palpation (Feeling): Your pelvic region will be carefully palpated for an abnormal mass or any irregularities.
Range of Motion Tests (Movement): The various range of motion tests may include:
Forward flexion of the hip: While lying on your back on the examination table, your leg will be straightened and raised as high as possible.
Abduction of the hip: While lying on your side, your straight leg will be raised as high as possible.
Internal rotation of the hip: While lying on your back with your knee bent, your thigh is rotated in the inward direction as far as possible.
External rotation of the hip: While lying on your back with your knee bent, your thigh is rotated in the outward direction as far as possible.
The eliciting of pain or abnormal movement during these tests may give your doctor an indication of the underlying hip problem.
Differential Diagnoses of Hip Pain
Anterior Hip Pain and Groin Pain: Hip labral tears, osteoarthritis, impingements, fractures, osteonecrosis, etc.
Posterior Hip Pain: Piriformis syndrome, lumbar radiculopathy, sacroiliac joint dysfunction or ischiofemoral impingement.
Lateral Hip Pain: Greater trochanteric pain syndrome.