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Which of your hips has the most profound sciatica?


Pain in the hip, buttock, groin and upper thigh tends to be interrelated. The lay meaning of hip (e.g. ‘wide hips’) is more expansive than the medical term (femoroacetabular joint), so ‘hip pain’ can describe pain in the buttock or lower back. 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. 54.1).

  • 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.

  • 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, consider the underdiagnosed conditions of trochanteric bursitis or gluteus medius tendinitis (greater trochanteric pain syndrome).


Typical ages of presentation of hip disorders


A summary of the diagnostic strategy model is presented in TABLE 54.1.

Table 54.1Hip and buttock pain: diagnostic strategy model

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