Which of your hips has the most profound sciatica?
WILLIAM SHAKESPEARE (1564–1616), MEASURE FOR MEASURE
Pain in the hip, buttock, groin and upper thigh tends to be interrelated. Patients often present complaining of pain in the ‘hip’ but point to the buttock or lower back as the site of their pain. Most pain in the buttock has a lumbosacral origin. Pain originating from disorders of the lumbosacral spine (commonly) and the knee (uncommonly) can be referred to the hip region, while pain from the hip joint (L3 innervation) may be referred commonly to the thigh and the knee. Disorders of the abdomen, retroperitoneal region and pelvis may cause hip and groin pain, sometimes mediated by irritation of the psoas muscle.
Key facts and checkpoints
Hip troubles have a significant age relationship (see FIG. 65.1).
Children can suffer from a variety of serious disorders of the hip—such as developmental dysplasia of the hip (DDH), Perthes disease, tuberculosis, septic arthritis, slipped capital femoral epiphysis (SCFE) and inflammatory arthritis—all of which demand early recognition and management.
SCFE typically presents in the obese adolescent (10–15 years) with knee pain and a slight limp.
Every newborn infant should be tested for DDH, which can usually be treated successfully when diagnosed early.
Limp has an inseparable relationship with painful hip and buttock conditions, especially those of the hip.
The spine is the most likely cause of pain in the buttock in adults.
Disorders of the hip joint commonly refer pain to the knee and thigh.
If a woman, especially one with many children, presents with bilateral buttock or hip pain, consider dysfunction of the sacroiliac joints (SIJs) as the cause.
If a middle-aged or elderly woman presents with hip pain, always consider the underdiagnosed conditions of trochanteric bursitis or gluteus medius tendonitis (greater trochanteric pain syndrome).
Typical ages of presentation of hip disorders
A summary of the diagnostic strategy model is presented in TABLE 65.1.
Table 65.1Hip and buttock pain: diagnostic strategy model ||Download (.pdf) Table 65.1 Hip and buttock pain: diagnostic strategy model
Traumatic muscular strains
Referred pain from spine
Osteoarthritis of hip
Greater trochanteric pain syndrome
Serious disorders not to be missed
slipped femoral epiphysis
transient synovitis (irritable hip)
juvenile chronic arthritis
Pitfalls (often missed)
Tear of hamstring
Avascular necrosis femoral head
Torn acetabular labrum
Sacroiliac joint disorders
Inguinal or femoral hernia
Bursitis or tendonitis: