This document discusses diagnosis and treatment of hip and knee pain. It covers evaluating hip and knee pain through history, physical exam, and various imaging modalities like x-ray, CT, MRI, bone scan, and ultrasound. Specific causes of hip and knee pain are discussed like regional nerve entrapments, bursitis, and overuse syndromes. Evaluation and treatment of conditions like trochanteric bursitis, iliotibial band syndrome, and patellofemoral syndrome are summarized. Hip and knee anatomy, pediatric hip pain, and neural causes of groin pain are also outlined.

1. HIP AND KNEE PAIN
DR JAMSHEER VT
MCh SURGICAL ONCOLOGY

2. DIAGNOSIS OF HIP & KNEE PAIN
• The majority of knee and hip problems can be
diagnosed or excluded with a focused history
and physical examination

3. HIP & KNEE PAIN - History

4. DIAGNOSIS OF HIP & KNEE PAIN

5. DIAGNOSIS OF HIP & KNEE PAIN

6. HIP & KNEE RADIOLOGY
• The imaging modality used in a given patient
depends upon the differential diagnosis that
has been developed based upon the history
and physical examination

7. HIP & KNEE RADIOLOGY - XRAY
Plain film radiography of the is used in the
initial evaluation of
• any cause of pain.
• referred pain, such as sacroiliitis

8. HIP & KNEE RADIOLOGY - CT
NCCT
• trauma
• for preoperative planning,
• evaluation and guiding percutaneous biopsy
of tumors
CECT
• septic joint
• soft tissue abscess

9. HIP & KNEE RADIOLOGY - MRI
MRI of the hip accurately evaluates
• bone marrow
• joint space
• neurovascular structures
• soft tissues

10. HIP & KNEE RADIOLOGY - MRI
MRI is the modality of choice for
• suspected femoral fracture not demonstrated
radiographically
• osteochondral injuries
• muscle injuries
• joint effusion
• early diagnosis and staging of AVN
• tumour

11. HIP & KNEE RADIOLOGY – Bone SCAN
• Radionuclide Tc-99m bone scan surveys
whole-body exam.
• Radionuclide bone scan is used for evaluation
of metastatic disease and infection.

12. HIP & KNEE RADIOLOGY - USG
Advantage
• Readily available even at the bedside
• Allows dynamic evaluation of the tendons and
muscles( soft tissues )
• Does not involve ionizing radiation

13. HIP & KNEE RADIOLOGY - USG
DISADVANTAGE
• highly operator- and patient-dependent.
USES
• Hip effusions
• bursal / periarticular fluid collections are
readily identified.

14. Hip Anatomy - Layer Concept
Osteochondral
• Femur
• Acetabulum
• Innominate
Inert
• Capsule
• Labrum
• Ligamentous Complex
• Ligamentum Teres
Draovitch et al. Curr Rev Musculoskelet Med 2012;5:1-8

15. Hip Anatomy - Layer Concept
Contractile
• Musculature crossing hip
• Lumbosacral muscles
• Pelvic floor
Neuro-mechanical
• Thoraco-lumbar mechanics
• Neuro-vascular structures
• Regional mechanoreceptors

16. Hip Anatomy - Osteochondral

17. Hip Anatomy - Osteochondral
• Purpose
• Joint congruence
• Arthrokinematic movement
• Pathology
– Developmental
• Dysplasia
– Dynamic
• Cam/pincer impingement

18. Hip Anatomy
Layer II: Inert

19. Hip Anatomy
Layer II: Inert
• Purpose
• Static stability
• Pathology
• Labral tear
• Capsular instability
• Ligamentum teres tear
• Adhesive capsulitis

20. Hip Anatomy
Layer III: Contractile

21. Hip Anatomy
Layer III: Contractile

22. Hip Anatomy
Layer III: Contractile
• Purpose
• Dynamic stability of hip, pelvis, and trunk
• Pathology
• Tendonopathies
• IT band syndrome
• Greater trochanteric bursitis

23. Hip Anatomy
Layer IV: Neuro-mechanical

24. Hip Anatomy
Layer IV: Neuro-mechanical
• Purpose
• Communicating, timing, and sequencing of the kinematic
chain
• Pathology
– Neural
• Pain syndromes, neuromuscular dysfunction, nerve
entrapments, spinal nerve pain
– Mechanical
• Pelvic posture over femur
• Osteitis pubis
• Sacro-iliac dysfunction

25. Neural Cause of Groin Pain

26. Hip pain in children
• Evaluation – The history and examination of
the child with hip pain is focused on
distinguishing between various causes
• This distinction helps to determine the
appropriate laboratory and radiographic
evaluation.

27. Hip Pain In Children
INFECTIOUS
• Septic arthritis of the hip / the sacroiliac joint
• Osteomyelitis of femoral head
• Psoas abscess
• Spinal epidural abscess
• Appendicitis or abdominal/pelvic abscess

28. Hip Pain In Children
INFLAMMATORY
• Transient synovitis
• Systemic arthritis
• Infectious/post-infectious (eg, ARF,
poststreptococcal arthritis)
• Rheumatologic conditions (eg SLE , vasculitis,
dermatomyositis , localized scleroderma )
• Arthritis associated with gastrointestinal
conditions (eg, IBD, celiac disease)

29. Hip Pain In Children
MECHANICAL/ORTHOPEDIC
• Avascular necrosis
• Femoral stress fracture
• Muscular strain
• Trochanteric bursitis
• Acetabular labral tear
NEOPLASTIC
• Osteoid osteoma
• Leukemia
• Solid tumor
• primary or metastatic

30. Hip Pain In Children - History
• Associated systemic symptoms
• Past medical history;
• Family history

31. Trendelenburg Test

32. Hip and knee pain in adults

33. SPECIFIC SYNDROMES AND DISEASES
BY LOCATION
• Regional Nerve Entrapment Syndromes
• Bursitis
• Over Use Syndromes

34. DIAGNOSIS CATEGORY DIAGNOSIS PAIN LOCATION
NERVE ENTRAPMENT Meralgia paresthetica
Obturator nerve
entrapment
Ilioinguinal nerve
entrapment
Piriformis syndrome (sciatic
nerve compression by
piriformis muscle)
Anterolateral thigh pain
Groin and inner thigh pain
Groin pain
Buttocks and hamstrings
pain
HIP BURSITIS Trochanteric bursitis
Ischiogluteal bursitis
Iliopectineal and iliopsoas
bursitis
Anterolateral thigh pain or
paresthesias
Groin and inner thigh pain
Groin pain Buttocks and
hamstrings pain

35. DIAGNOSIS CATEGORY DIAGNOSIS PAIN LOCATIO
knee bursitis Anterior medial knee pain
Pain anterior to patella
Anterior medial knee pain
Pain anterior to patella
Hip overuse syndromes External snapping hip
syndrome (coxa saltans)
Fascia lata syndrome
Posterior lateral hip pain
Lateral thigh pain
Knee overuse syndromes Patellofemoral syndrome
(runner’s knee) Medial plica
syndrome Iliotibial band
syndrome or snapping knee
syndrome Popliteus tendinitis
Patellar tendinitis (jumper’s
Anterior knee pain, worse
with prolonged knee flexion
Anterior medial knee pain,
knee snapping during
repeated flexion/extension
Pain over lateral epicondyles,

36. REGIONAL NERVE ENTRAPMENT
SYNDROMES
• Lateral Femoral Cutaneous Nerve Entrapment
• Obturator Nerve Entrapment
• Ilioinguinal Nerve Entrapment
• Piriformis Syndrome

37. Lateral Femoral Cutaneous Nerve Entrapment

38. Lateral Femoral Cutaneous Nerve Entrapment
• Also called Meralgia paresthetica
• Is the best known of the lower extremity nerve entrapment
syndromes.
Nerve irritation can be triggered by
• tight clothing belts
• car seat belts
• pregnancy
• focal trauma
• Obesity
• INCLUDING SURGICAL INTERVENTIONS
a) such as appendectomy or
b) hysterectomy; and

39. • Symptoms include pain to the hip area, thigh,
or groin along the distribution of the nerve
(proximal anterior lateral aspect of the leg;
burning or tingling paresthesias may be
present.
• Pain may be worsened or by tapping over the
area of the anterior superior iliac spine

40. Lateral Femoral Cutaneous Nerve Entrapment
• Those affected should limit the exacerbating
activity and eliminate the source of the
irritation.
• NSAIDs
• local injections
• weight loss
• surgical excision of the nerve are other
treatment options

41. Obturator Nerve Entrapment
• Obturator nerve entrapment is typically a sequela of pelvic
fractures or abdominal/ pelvic surgery.
• Obturator nerve inflammation is generally sensed in the groin and
down the inner thigh and aggravated by movement of the hip.
• Exercise-induced medial thigh pain may be the predominant
symptom.
• Imaging studies are of limited value
• Surgery may be required for pain relief. Local injection of lidocaine
into the area of the nerve relieves the pain and associated reactive
weakness and may make the diagnosis

42. Ilioinguinal Nerve Entrapment
• The ilioinguinal nerve arises from the lumbar
plexus and passes through the psoas and then
travese near to anterior superior iliac spine, and
the abdominal oblique muscles
• Entrapment occurs due to hypertrophy of the
abdominal wall musculature or pregnancy.
• Hypoesthesia in the distribution of the nerve,
yielding groin pain

43. Piriformis Syndrome

44. Piriformis Syndrome
• Irritation of the sciatic nerve from the piriformis muscle
• Pain in the area of the buttocks and hamstring muscles that
is worsened by sitting, climbing stairs, or squatting .
• The clinician may palpate a tender mass over the piriformis
muscle and elicit pain in the region of the sacroiliac joint or
gluteal musculature.
• Hip flexion will exacerbate the symptoms.
• Imaging is useful only to rule out other conditions.
• Treatment is conservative.

45. BURSAL SYNDROMES OF THE HIP AREA

46. BURSAL SYNDROMES OF THE HIP AREA
• New bursae may form at any area that is subject to repeat irritation.
• Causes of bursal pain include inflammation
• with repetitive minor trauma
• infection.
• rheumatologic disorders
a) such as psoriatic arthritis
b) rheumatoid arthritis
c) ankylosing spondylitis
d) gout or pseudogout
• Arthrocentesis is required when a septic joint is suspected. The
development of a draining sinus tract favors septic bursitis

47. BURSAL SYNDROMES OF THE HIP AREA
• Trochanteric Bursitis (Posterolateral Hip Pain)
• Ischiogluteal Bursitis (Posterior/Gluteal Pain)
• Iliopectineal Bursitis (Anterior Hip,Groin Pain)
• Iliopsoas Bursitis (Groin Pain)

48. BURSAL SYNDROMES OF THE KNEE

49. BURSAL SYNDROMES OF THE KNEE
• Pes Anserine Bursitis (Anterior Medial Knee
Pain)
• Prepatellar Bursitis (Pain Anterior to the
Patella)

50. TREATMENT OF BURSITIS
• Treatment is aimed at the suspected cause.
• For inflammatory conditions, NSAIDs, rest,
heat, and time are the basis of conservative
treatment.
• Steroids with caution..
• Do not inject steroids into tendons, because
this may weaken the tendon and lead to
rupture.
• Associated infection....antibiotics

51. TREATMENT OF BURSITIS
• Serial aspiration and surgical drainage or
removal of the afflicted bursa are indicated for
refractory conditions.
• If any patient presents with toxicity, admit for
IV antibiotics and consultation with
orthopedic surgery.
• When fibrosis or synovial thickening leads to
the development of painful nodules, surgical
excision of the bursa is indicated.

52. HIP MYOFASCIAL
SYNDROMES/OVERUSE SYNDROMES
• The diagnosis of these syndromes is clinical.
Overuse syndromes are simply the result of
repetitive stresses and microtrauma outpacing
the body’s ability to heal.
a) External Snapping Hip Syndrome
b) Fascia Lata Syndrome

53. External Snapping Hip Syndrome
• Also known as coxa saltans
• a snapping sound is heard and popping
sensation felt as the iliotibial band (an
extension of the fascia lata) slips over the
greater trochanter
• In athletes, the syndrome is usually associated
with painful inflammation of the band and the
involved bursa.

54. • The patient will be able to voluntarily cause the
snap with hip flexion and extension.
• Young women are predisposed to this syndrome,
which occurs with activities such as dancing or
stair climbing.
• MRI may identify intra-articular causes or
demonstrate inflammation of the local bursa, the
iliotibial band, or the gluteal musculature.
Dynamic sonography is also an aid for the
diagnosis of extra-articular causes

55. Fascia Lata Syndrome
• The fascia lata syndrome is a potential cause of
pain in the lateral thigh region and is associated
with pain to palpation and trigger points.
• Unilateral enlargement of the tensor fascia lata
may occur with overuse
• Athletes develop pain in the anterior groin and
point tenderness over the anterior iliac crest.
• US is a useful aid to confirm the diagnosis.
• Treatment conservative

56. •
KNEE MYOFASCIAL SYNDROMES/OVERUSE
SYNDROMES
• Patellofemoral Syndrome/Runner’s Knee
• Chondromalacia Patellae
• Quadriceps Tendinitis
• Semimembranosus Tendinitis
• Snapping Knee Syndrome

57. Patellofemoral Syndrome/Runner’s
Knee
• This syndrome is a major cause of anterior
knee pain, with three typical causes:
• focal trauma (least common),
• overuse
• abnormal patellar movement in the patellar
groove.
• A major contributor is weakness of the
quadriceps muscle.

58. Patellofemoral Syndrome/Runner’s
Knee
• Typically unilateral & common in females
• Pain is exacerbated by prolonged flexion of
the knee, such as sitting & stair climbing.
• The patellar grind test is accomplished by
direct anterior to posterior pressure on the
patella or the quadriceps tendon while asking
the patient to contract the quadriceps muscles

59. • Radiographic studies are of limited value but
may detect arthritis.
• Treatment is usually conservative, with an
emphasis on physical therapy and
strengthening. Brace support of the knee will
also help
• If severe arthroscopic management

60. Chondromalacia Patellae
• Chondromalacia patellae refers to a softening
of the cartilage on the posterior surface of the
patella
• This diagnosis is made by direct arthroscopic
visualization of a ragged appearance of the
affected cartilage.

61. Iliotibial Band Syndrome
• Iliotibial band syndrome is most common in
distance runners or cyclists.
• The iliotibial band inserts onto the lateral
femoral and tibial condyles .
• The thickened fascia serves as a ligament and
stabilizes the joint in extension.
• With overuse, the bursa underlying the band
becomes irritated.

62. Iliotibial Band Syndrome
• Pain is reproduced consistently after reaching a
certain mileage during running or other physical
exertion
• Examination reveals localized tenderness to
palpation over the lateral epicondyles.
• Treatment involves rest, decreasing the training
distance, changing shoes to reduce stress on the
structures, stretching exercises, and steroid
injections locally

64. Patellar Tendinitis/Jumper’s Knee
• The patella tendon is subject to significant wear,
with microtears and complete ruptures occurring
in athletes and nonathletes alike
• Any activity that involves jumping can result in
focal pain, typically at the inferior pole of the
patella or proximal portion of the tendon.
• Other activities that may exacerbate pain include
running (especially uphill), squatting, cutting
maneuvers, standing from a sitting position, or
even simple walking.

65. Patellar Tendinitis/Jumper’s Knee
• Treatment involves rest, NSAIDs, and
cryotherapy. Steroid injections are
contraindicated.
• Most recently, US-guided intratendinous
injection of platelet-rich plasma has been
suggested to allow rapid healing in the
patellar tendon and other major tendons.

66. Quadriceps Tendinitis
• The quadriceps muscles and tendon are
subject to significant forces in athletes
• Resulting in microtears and inflammatory
changes, localized predominantly at the
insertion of the tendon into the proximal pole
of the patella.
• Chronic recurrent injury or acute explosive
trauma can result in complete tear of the
tendon.

67. Semimembranosus Tendinitis
• Pain is elicited just distal to the joint line, where
the tendon is easily palpated in most patients.
• In younger patients, the pain is associated with
athletics and overuse.
• In older patients, it is seen secondary to
degenerative changes in the medial
compartment.
• MRI will confirm the diagnosis if conservative
therapy fails.

68. Snapping Knee Syndrome
• Similar to the same process in the hip, is a
result of the iliotibial band passing over the
lateral femoral condyle.
• The same effect may also result from the
semitendinosus muscle passing over the
medial condyle with the initiation of flexion
and termination of extension of the knee.

69. Snapping Knee Syndrome
• The snapping sensation and sound may be
accompanied by pain in the location of the
involved tendon.
• Managed conservatively

70. POPLITEAL (BAKER) CYST
• Presents with posteroinferior knee pain
• Develops posteriorly and inferiorly to the knee
as a distention of a local bursa
• The cyst frequently communicates with the
knee (especially in adults), and associated
intra-articular pathology is common.

71. POPLITEAL (BAKER) CYST
• The cyst may develop as a herniation of the
synovial membrane through the posterior
joint capsule.
• Popliteal venous thrombosis can be confused
with the pain and swelling produced by these
posterior cysts or may exist concomitantly.
• Other potential diagnoses include aneurysms,
vascular tumors, lipoma, and other tumors.

72. BAKER CYST - USG

73. BAKER CYST - MRI

74. POPLITEAL (BAKER) CYST
• Treatment - surgical excision

75. PSOAS ABSCESS
• The psoas muscle is susceptible to the
hematogenous spread of infection from distant
sites because of its rich blood supply and
proximity to overlying retroperitoneal lymphatic
channels.
• Mycobacterium tuberculosis & Staphylococcus
aureus is the most common pathogens
•
• Mycobacterium is more common in
immunocompromised hosts

76. PSOAS ABSCESS
• Symptoms include hip or flank pain (43%), abdominal pain (14%),
fever (41%)
• To provoke pain, instruct the patient to perform forceful contraction
of the psoas. Place your hand just proximal to the patient’s
ipsilateral knee, and have the patient raise his or her thigh against
your hand
• . The overall sensitivity of contrasted CT imaging for the diagnosis is
over 90%,
• Treatment includes antibiotics & drainage.
• Consult surgery for percutaneous or open drainage

77. PSOAS ABSCESS

78. AVN
• Osteonecrosis Other terms used to describe
osteonecrosis include avascular necrosis,
aseptic necrosis, and ischemic necrosis.
• Osteonecrosis is the result of bone infarction
caused by a lack of blood supply.
• CAUSES :- Major / Minor Trauma

79. AVN – ETIOLOGY

80. AVN ..
• Plain radiographs are helpful in establishing
the diagnosis
• findings ranging from mottled densities and
lucencies to severe collapse of the femoral
head
• Joint replacement may be required.

81. AVN HIP - XRAY

82. AVN HIP - CT

83. AVN MRI- T1-weighted MRI - low-
density signal in the right femoral head

84. Osteomyelitis
• Osteomyelitis is an infection of the bone by bacteria or
fungus, resulting in bony changes and destruction .
• It develops by spread of infection from contiguous
structures (∼80%) or by hematogenous spread (∼20%).
• Hematogenous spread is more common to the long
bones in children and to the spine in adults.
• Spinal epidural abscess is an important differential
diagnosis to consider
• Pain at the site is a universal complaint and may be
accompanied by warmth, swelling, and erythema.

85. Osteomyelitis
• Radiographs are normal early in the course,
but later will show periosteal elevation, and
lytic lesions.
• MRI is the preferred imaging modality, with
approximately 95% sensitivity

86. Risk Factors, Likely Infecting Organism, and
Recommended Initial Empiric Antibiotic Therapy
for Osteomyelitis

87. Risk Factors, Likely Infecting Organism, and
Recommended Initial Empiric Antibiotic Therapy
for Osteomyelitis

88. Osteomyelitis
• Bone biopsy confirms the diagnosis with
certainty. S. aureus is the most common
causative agent overall.
• In acutely ill patients, begin presumptive
treatment based on the clinical findings, with
high-dose, broad-spectrum, parenteral
antibiotics ensuring coverage for S. aureus.

89. Osteochondritis Dissecans (Knee Pain)
• In osteochondritis dissecans, a portion of the
joint surface cartilage separates from the
underlying bone.
• Seen most often in adolescents, and is of
unclear origin.
• The medial femoral condyle is predominantly
involved, with unilateral occurrence.
•

90. Osteochondritis Dissecans (Knee Pain)

91. Osteochondritis Dissecans (Knee Pain)
• The patient experiences pain and swelling.
• Plain radiographs may reveal a thin rim of
calcium separated from the underlying bone),
with
• MRI is sinvestigation of choice
• conservative therapy
• If fail go for Arthroscopic repair & removal of
associated loose bodies

92. Synovial Osteochondromatosis
• Synovial osteochondromatosis is characterized by
idiopathic, nodular synovial membrane
proliferation and subsequent calcification of the
affected tissue.
• Eventually, multiple fragments of this growth (as
large as 2 cm) break off and occupy the joint
space or the area of the bursa and tendon
sheaths.
• With time, degenerative changes and secondary
osteoarthritis occur.

93. Synovial Osteochondromatosis clinical
features & investigation
• The disease is more common in males
between the ages of 20 and 50 years old.
• Patients complain of pain and joint swelling.
• There is a limitation in range of motion, and
the joint may lock. The large joints are
commonly involved. Radiographs will show
the calcification and the intra-articular bodies
and later the changes of osteoarthritis.

94. Synovial Osteochondromatosis -
treatment
• Surgical excision of the proliferating synovium
and removal of the ossified bodies from the
joint space are required.

95. Transient Osteoporosis of the Hip
• Transient osteoporosis of the hip occurs in
middle-aged men and in pregnant women in
the third trimester.
• The disease is uncommon, idiopathic, and
characterized by sudden onset of hip pain,
with the findings of osteoporosis on plain
films.
• The disease spontaneously resolves within 6
to 12 months

96. Paget’s Disease (Osteitis deformans)
• Paget’s disease, is a chronic disorder resulting in
enlarged, deformed bones from breakdown and
reformation.
• Most commonly affects hip joint (in 50% of
patients).
• The disease is familial and is suggested by an
elevated serum alkaline phosphate level. Patients
complain of pain, and radiographs reveal joint
space narrowing with minimal hypertrophic
changes

97. Paget’s Disease Osteitis deformans(R)

98. Paget’s Disease (Osteitis deformans)
• Treatment is symptomatic, and medications
that slow the rate of bone turnover
(calcitonin, alendronate, others)
• Surgery is required for complications of the
disease, such as fracture and severe arthritis.

99. Osteitis Pubis (Midline Pelvis and Groin
Pain With Radiation to Hips)
• Osteitis pubis should be considered as a
possible diagnosis in athletes with pain in the
region of the pubis.
• It is an inflammatory process related to
overuse of the adductors and gracilis muscles.
• Bony changes with periostitis occur at the
sites of the origins of the involved muscles.

100. characteristic “duck waddling gait.”

101. Osteitis Pubis – Showing Inflamation

102. Osteitis Pubis - Treatment
• Symptoms start off gradually and progress to
severe pain with any movement of the legs.
• The symptoms may resolve completely over a
period of months with rest and NSAID use.
• Rarely, arthrodesis of the pubic symphysis is
needed.

103. Myositis ossificans or heterotrophic
calcification
• Diseases of Abnormal Calcification, is the
deposition of bone at a site where bone does not
normally occur.
• The process is related to direct trauma, with the
thigh and hip muscles frequently involved.
• Bleeding follows direct trauma to the muscle, and
calcium deposits form inside the hematoma.
• A firm, palpable, painful mass will develop within
2 weeks and may persist for up to 1 year.

104. heterotrophic calcification

105. • The appearance may be confused with a primary
neoplasm, such as osteosarcoma or periosteal
osteogenic sarcoma.
• Range of motion in the muscle or joint is limited
due to pain or physical presence of the mass.
• Operative removal of the deposition may be
required.

107. HIP EXAMINATION
• INSPECTION (for asymmetry and position of
comfort)
• PALPATION
1. pain location
2. range of motion
3. assessment of ability to bear weight.
(The inability to bear weight is a sign of serious
pathology until proven otherwise. )

108. Hip Pain In Children - Laboratory
Evaluation
• complete blood count
• erythrocyte sedimentation rate(non specific)
• C-reactive protein
• blood cultures (if osteomyelitis or septic
arthritis is suspected).

109. Trendelenburg Test

110. Physical Exam
Palpation in Supine Position
• Abdominal fascial hernias
• Iliac crest
• Ilioinguinal ligament
• ASIS
• Pubic symphysis
• Pubic ramus

112. Physical Exam
Palpation in Prone Position
• Ischial tuberosity
• Sciatic notch
• Piriformis muscle.
• Sciatic nerve

113. Physical Exam
Palpation in Lateral Position
• Iliac crest
• Greater trochanter
• Tensor fascia latae and
IT band

114. Anterior Hip Pain
Intra-articular
• Osteoarthritis
• Stress fracture
• Inflammatory arthritis
• Avascular necrosis of femoral head
• Acetabular labral tear
• Articular cartilage injuries
• Ligamentum teres injuries

115. Anterior Hip Pain
Extra-Articular
• Hip flexor strain
• Iliopsoas bursitis
• Snapping hip syndromes
• Avulsions/apophysitis

116. Groin Pain
• Adductor strains
• Osteitis pubis
• Athletic pubalgia
• Nerve entrapment syndromes

117. Lateral Hip Pain
• Greater trochanteric bursitis
• Gluteus medius tendinopathy/dysfunction
• IT band syndrome
• Meralgia paresthetica

118. Posterior Hip Pain
• Referred from lumbar spine
• Piriformis syndrome
• Sacroiliac joint dysfunction
• High hamstring strain or ischial tuberosity
avulsion

119. •THANK YOU