The patient can also indicate the site of symptoms. The Trendelenberg gait reflects the integrity of the hip abductor muscles on the side of the standing leg. An antalgic gait (short stance phase relative to swing phase) reflects pain on weight bearing and may indicate a painful joint.

Inspection of the patient’s standing posture and gait will reveal any obvious asymmetry in the musculature or alignment.

Clinical examination has been shown to have a high sensitivity (98%) in localising intra-articular hip pathology but is poor in exactly defining its nature. The aim of a focused hip examination is to confirm the hip as the source of symptoms and to exclude alternative diagnoses such as referred pain rather than make a definitive diagnosis. osteitis pubis, incipient inguinal hernia, adductor tendinopathies) have been the focus of a previous review article 5 and are not addressed here. 4 Other conditions that present predominantly with groin pain (eg. 3 Patients with FAI most commonly report groin (88%), lateral hip (67%) and anterior thigh (35%) pain but may also complain of buttock (29%), knee (27%) and lower back (23%) pain. For example, pain and tenderness over the greater trochanter, buttock or lateral thigh can suggest trochanteric bursitis, a tear of the gluteus medius muscle or a snapping hip. History helps to localise the hip as the source of pain rather than make a specific diagnosis as there is significant overlap in symptoms originating from different structures in and around the hip. Symptoms suggestive of hip pathology include localised symptoms (such as catching sensations), symptoms related to activity or when going up and down stairs, or symptoms related to prolonged sitting or standing. Patients typically present when their hip pain impairs activities such as work, exercise or sport. ITB = iliotibial band, LFCN = lateral femoral cutaneous nerve, FAI = femoroacetabular impingement OA = osteoarthritis, AVN = avascular necrosis, DDH = developmental dysplasia of the hip.

Differential diagnosis of hip pain in young adults Extra-articular

Normal hip xray with pain and weakness