Anterior Pain
Anterior hip pain (see Table 2) is the most commonly experienced hip pain and usually indicates pathology of the hip joint (i.e. degenerative arthritis), hip flexor muscle strains or tendonitis, and iliopsoas bursitis. In a study by Lamberts et al (1996), by far the most common diagnosis of patients with hip problems seen by their general practitioner was osteoarthritis. In a study of subjects older than 40 years who experienced a new episode of hip pain, 44% had evidence of osteoarthritis (level of evidence [LOE]=1b) (Birrell et al 2000).
The following list provides some of the causes of anterior hip pain:
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Iliopsoas bursitis, a less common cause of anterior hip pain, involves inflammation of the bursa between the iliopsoas muscle and the iliopectineal eminence or “pelvic brim”.
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Stress fractures typically occur in athletes as the structural demands from training exceed bone remodeling (fatigue fractures), and may also occur in the setting of osteoporosis under normal physiologic loads (insufficiency fractures).
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Labral tears have recently been recognised in younger athletic patients with unexplained hip joint pain and normal radiographic findings (Hickman et al 2001).
| Disorder | Presentation and exam findings | |
|---|---|---|
| Anterior pain | Osteoarthritis | Gradual onset anterior thigh/groin pain worsening with weight-bearing |
| Limited range of motion with pain, especially internal rotation (LOE=1b) (Birrell at al2001) | ||
| Abnormal FABER test | ||
| Hip flexor muscle strain/tendonitis | History of overuse or sports injury | |
| Pain with resisted muscle testing | ||
| Tenderness over specific muscle or tendon | ||
| Iliopsoas bursitis | Anterior pain and associated snapping sensation | |
| Tenderness with deep palpation over femoral triangle | ||
| Positive snapping hip manoeuvre | ||
| Aetiology from overuse, acute trauma, or rheumatoid arthritis | ||
| Hip fracture (proximal femur) | Fall or trauma followed by inability to walk | |
| Limb externally rotated, abducted, and shortened | ||
| Pain with any movement | ||
| Stress fracture | History of overuse or osteoporosis | |
| Pain with weight-bearing activity; antalgic gait | ||
| Limited range of motion, sensitivity 87% (LOE=4) (Shin et al 1996) | ||
| Inflammatory arthritis | Morning stiffness or associated systemic symptoms | |
| Previous history of inflammatory arthritis | ||
| Limited range of motion and pain with passive motion | ||
| Acetabularlabral tear | Activity-related sharp groin/anterior thigh pain, especially upon hip extension | |
| Deep clicking felt, sensitivity 89% (LOE=4) (McCarthy et al 1995) | ||
| Positive Thomas flexion-extension test | ||
| Avascular necrosis of femoral head | Dull ache in groin, thigh, and buttock usually with risk factors (corticosteroid exposure, alcohol abuse) | |
| Limited range of movement with pain |
Margo et al (2003)