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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:

  • 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”.

  • 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).

  • Labral tears have recently been recognised in younger athletic patients with unexplained hip joint pain and normal radiographic findings (Hickman et al 2001).

Table 2: Anterior Pain Presentation and Findings

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)