History & exam
Key factors
- presence of risk factors
- acute pain related to trauma
- hx of sports-related or overuse injury
- positive anterior impingement test
- pain on adduction against resistance (neutral hip flexion)
- pain on palpation of adductor tendons
- pain on palpation of iliopsoas
Other diagnostic factors
- snapping/clicking hip
- positive Trendelenburg's test
- positive apprehension test
- positive modified Thomas' test
- pain on palpation of inguinal canal
- pain on palpation of conjoined tendon at pubic tubercle
- decreased strength and increased pain with hip flexion against resistance (90˚)
- pain on passive range-of-motion testing of the hip joint
- night pain/rest pain
History & exam details
Diagnostic tests
1st tests to order
- plain x-rays (AP pelvis and AP and lateral hip)
Tests to consider
- ultrasound of the hip
- MRI of the hip
- MRI arthrogram of the hip
- CT of the hip
- isotope bone scan of the hip
- intra-articular injection corticosteroid ± local anaesthetic agent
Diagnostic tests details
Treatment details
Acute
x-ray findings consistent with congenital or anatomical deformity
- referral to orthopaedic surgeon
femoral neck stress fracture
-
superior femoral neck stress fracture (tension-side fracture)
- immediate internal fixation
-
inferior femoral neck stress fracture (compression-side fracture)
- cessation of high-impact activities and protected weight-bearing for 6 to 8 weeks
traumatic or overuse injury: initial presentation
- conservative management
- non-steroidal anti-inflammatory drugs (NSAIDs)
Ongoing
traumatic or overuse injury: not responding to initial management
- advanced imaging studies ± orthopaedic referral
-
long-standing adductor-related groin pain
- functional physiotherapy and strengthening
- adductor longus tenotomy
-
osteitis pubis
- physiotherapy
-
inguinal-related groin pain
- functional physiotherapy and strengthening
- surgical exploration and repair
-
iliopsoas-related groin pain
- strengthening exercises + pelvic muscle coordination programme
Treatment details
last updated:=최종 업데이트: 9월 17, 2012
