Causes of hip and groin pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Pain in the hip and groin can indicate various hip conditions.
True hip joint pain is often felt as groin pain, and needs to be distinguished from thigh pain, particularly upper thigh pain, buttock pain, and abdominal or pelvic pain.
Athletes often present with groin pain or hip pain.
A specific cause is not diagnosed in 30% of cases. However, among the other common causes are adductor strain or adductor tendinitis (groin pull) most common in runners. The adductors are the muscles that bring the leg in toward the midline.
Osteitis pubis is inflammation of the cartilage that joins the front bones of the pelvis. The cause is unknown. It is more common in women than men.
Myositis ossificans is a condition where the muscle calcifies. This develops after trauma to the muscle. It’s an uncommon condition but is seen in football players- particularly in the thighs.
Sports hernias occur in athletes and present with groin pain and swelling.
Both the iliopsoas muscle group and the iliopsoas bursa lie in front of the hip joint. Iliopsoas bursitis and iliopsoas muscle strain are two common causes of groin pain. Typically the pain is felt in the front of the hip and groin and is aggravated by flexion of the hip. Running or going up stairs are common aggravating activities.
Femoral neck stress fracture and pubic ramus insufficiency fracture are another cause of hip and groin discomfort. Pain is aggravated by weight-bearing. This is seen in people with low bone denisty. The diagnosis can be made by bone scan or MRI.
Avulsion fracture are common in the adolescent athletes and are due to the pulling away of the tendons from the bone.
Nerve entrapment disorders are another cause of hip and groin pain. Among these syndromes are: genitofemoral nerve entrapment, lateral femoral cutaneous nerve entrapment, ilioinguinal nerve entrapment, and obturator nerve entrapment. The diagnosis is difficult because the nerves are relatively small in diameter and the disorders are also not that common (with the exception of the lateral femoral cutaneous nerve which causes lateral thigh burning- meralgia paresthetica). Neurology consultation with nerve conduction studies are helpful in establishing the diagnosis. The character of the pain- burning with an uncomfortable tingling pain- may be a clue.
Osteoarthritis of the femoral acetabular joint, avascular necrosis of the femoral head, and acetabular labral tear all can cause hip and groin pain. Osteoarthritis is seen in middle-aged and older people. It is due to wearing away of cartilage and is characterized by limitation of internal rotation of the hip and groin pain. Avascular necrosis is death of the bone and commonly affects the head of the femur. Finally, tears of the labrum (the lip of cartilage that runs around the rim of the acetabulum) can cause groin pain.
Hip fracture also causes hip and groin pain. While the diagnosis is usually obvious, it sometimes is hard to diagnose if it is a stress fracture or insufficiency fracture in a patient with osteoporosis.
Cancer (primary site or metastases) is another cause of hip pain. The history as well as imaging studies will aid in diagnosis.
Among other joint causes are rheumatoid arthritis, septic arthritis (infected joint), gout, and a condition called osteoid osteoma. This latter problem is a benign tumor that causes a significant amount of night pain and responds to aspirin. Diagnosis is made on x-ray or MRI.
Pain felt on the outside part of the hip can be due to a number of conditions. Muscle or tendon causes include iliotibial band syndrome, which is form of tendonitis pain felt on the outside of the hip and thigh. Trochanteric bursitis is an inflammation of the large cushion on the lateral part of the hip. Pain is aggravated by walking and by lying on the affected side. The gluteus medius and minimus tendons insert into the greater trochanter on the lateral side of the hip. Tendinopathy of these structures causes lateral hip pain that mimics the pain of trochanteric bursitis.
Different leg lengths may aggravate and sometimes even cause lateral hip pain.
Pain in the rear of the hip can also be caused by a number of problems. Piriformis Syndrome is a condition where the piriformis muscle that runs from the low back to the greater trochanter of the hip becomes inflamed or traumatized and pushes down on the sciatic nerve.
Severe osteoarthritis of the hip may cause posterior hip pain.
Many types of low back problems may cause referred pain to the back or front of the hip. Referred pain to the front of the hip is due to problems at L1 or L2. Pain referred to the buttock comes from L4-S1.
Medical conditions unrelated to the musculoskeletal system can also cause pain in the hip and groin. These include inguinal hernia , inguinal lymphadenopathy or lymphadenitis, kidney stones, abdominal aortic aneurysm, appendicitis, diverticulitis, endometriosis, inflammatory bowel disease, abdominal malignancy, ovarian cysts, urinary tract infections, pelvic inflammatory disease, epididymitis, hydrocele, varicocele, prostatitis, and testicular cancer.
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