Hip Pain Diagnosis

Diagnosing hip pain involves:

• A focused examination of the hip, nearby joints, and supporting structures
• Performing a thorough neurologic, orthopedic, and vascular examination to check sensation, strength, reflexes, and pulse
• Conducting specific diagnostic tests to evaluate the health of the joint components, such as the labrum

Based on the results of the above evaluations, blood tests and/or imaging tests may be ordered to check for inflammatory, bone, and soft tissue problems.

Physical Evaluation

The initial evaluation involves collecting the medical history and performing a physical examination to evaluate the hip joint.

• Patient history: Specific questions are asked about:
  • Nature of the symptoms, including when they started and what movements cause pain
  • Location of the pain
  • Information on any past injuries and surgeries

A detailed history also helps rule out other sources of the pain, which may be referred to the hip joint.

• Physical examination: In a physical exam, the doctor evaluates:
  • The hip joint’s strength and range of motion
  • Symptoms such as swelling and redness near the hip
  • Differences in leg length
  • Walking pattern (gait)

A pelvic floor and rectal examination may sometimes be necessary depending on the patient’s history and other physical examination findings.

Hip Pain Tests

Specific clinical tests are used to check for hip joint range of motion and understand the potential cause of hip pain.

Hip pain tests are performed in a clinic or doctor’s office and include:

• Tests to check differences in leg length
• Galeazzi test
  • The patient lies on his or her back with both knees bent and feet flat on the examination table.
  • The examiner checks the level or height of the bent knees.
  • A difference in leg length is indicated by one knee appearing higher than the other or projecting farther forward compared to the other.
• Tests to check for tight or short muscles and soft tissues
  • Noble compression test
    • The patient lies on his or her back with both legs outstretched.
    • The examiner lifts the patient’s leg and moves the knee back and forth several times while applying firm pressure on the outer side of the knee.
    • A feeling of snapping, rubbing, joint sounds, or localized pain in the outer side of the knee suggests tightness in the iliotibial band (IT band syndrome).
    • Pain in the back of the thigh indicates hamstring tightness.
  • Ober test
    • This test checks for IT band tightness. 
      Read about the Ober test on our IT Band Syndrome Diagnosis page.
  • Thomas test
    • The patient sits on an examination table with both legs outstretched.
    • The examiner helps the patient bend one knee and bring it toward his or her chest.
    • With the knee held in the bent position, the patient is asked to lie down on the examination table while the opposite leg continues to remain flat.
    • Lifting of the opposite leg from the table may indicate a tight iliopsoas muscle in the front of the hip.
• Tests to check for problems related to the hip joint’s structures, such as the labrum
  • Twist test
  • Hip impingement test
  • FABER test

MRI

A magnetic resonance imaging (MRI) scan is the gold standard and most preferred imaging test to identify or confirm potential causes of hip pain.¹Mak MS, Teh J. Magnetic resonance imaging of the hip: anatomy and pathology. Pol J Radiol. 2020;85:e489-e508. Published 2020 Sep 4. doi:10.5114/pjr.2020.99414 It provides high-contrast images of the hip from different angles and is not associated with the risk of radiation exposure.

A hip MRI provides a detailed visual of almost all components of the hip joint and surrounding structures.

MRA

A magnetic resonance arthrography (MRA) scan is similar to an MRI. It uses an injected contrast fluid, which provides doctors with a better image for diagnosing cartilaginous problems, such as labral tears and other damage to hip joint cartilage.

X-ray

Front-and-back view and side-view x-rays are useful in identifying or ruling out bony conditions affecting the hip, such as late signs of hip impingement, fractures, dislocation, normal variants, and degenerative changes. X-rays use ionizing radiation to create images.

X-rays do not reveal problems related to soft tissue tissues, such as the labrum or joint cartilage.

Ultrasound

Hip ultrasonography or ultrasound is useful for evaluating tendon inflammation or tears, fluid collection in the joint, and inflammation of the bursae (fluid-filled sacs that provide cushioning between the joint and nearby tendons).

Diagnostic Hip Injections

For some people, the doctor may suggest injecting a numbing medicine (such as lidocaine) into the hip joint. This type of injection is called a diagnostic intraarticular injection and is considered when the joint is suspected as the source of pain.

Ultrasound or fluoroscopy is used to guide the needle into the hip joint.

Significant pain relief after the injection typically indicates that the joint is the source of pain.

Arthroscopic Hip Surgery

This minimally invasive surgical procedure is used to diagnose a hip problem (in rare cases) and treat the condition at the same time.

During this surgery:

• Two or three small incisions, about 5 mm each, are made near the hip joint.
• A pencil-sized tool called an arthroscope, equipped with a tiny camera, is inserted through one of the incisions and guided near the hip joint using ultrasound or fluoroscopy (live x-ray). The camera displays the view around the joint on a computer screen for the doctor to identify the problem affecting the joint.
• Once the problem is identified, surgical treatment is performed by inserting instruments through the other incisions.

Arthroscopic surgery involves the use of general anesthesia and is only reserved for cases where a hip joint condition, such as a labral tear or hip impingement is strongly suspected or diagnosed.