The hip and pelvis should be assessed as part of a movement system.

Gradual cartilage degeneration and bone change in the joint between the femoral head and acetabulum. Imaging findings must be interpreted alongside symptoms and function.

• Pain most often in the groin, but also in the thigh, buttock or knee
• Stiffness after rest and restricted rotation or flexion
• Difficulty walking, using stairs, putting on socks or rising from a chair

Premature contact between the femur and acetabular rim associated with cam, pincer or combined morphology. Bone shape alone is not sufficient for diagnosis.

• Deep groin pain with hip flexion or rotation
• Pain after prolonged sitting, squatting or sport
• Stiffness, clicking or restricted movement

A tear or irritation of the fibrocartilage ring around the acetabulum that contributes to joint stability. Some labral tears may be asymptomatic.

• Groin or anterior-thigh pain
• Clicking, catching or locking with movement
• Pain with rotation, change of direction or prolonged sitting

Insufficient coverage of the femoral head by the acetabulum or reduced joint control, which may overload the labrum and cartilage.

• Groin or lateral-hip pain
• Giving-way, snapping or catching sensations
• Symptoms during long walks, running or single-leg stance

Articular cartilage injury or free fragments within the joint after trauma, overload or joint disease.

• Deep pain aggravated by loading
• Joint locking, catching or clicking
• Swelling, stiffness or restricted movement

An umbrella term most often involving gluteal tendinopathy, with or without bursal irritation, on the outside of the hip. It is not always simply bursitis.

• Lateral-hip pain and tenderness
• Pain when lying on that side or crossing the legs
• Pain with walking, stairs or single-leg stance

Irritation of the hip-flexor tendon or its movement over anterior structures, which may produce a painful snap.

• Anterior hip or groin pain
• Snapping while raising or lowering the leg
• Pain with running, stairs, kicking or rising from sitting

Overload of the hamstring tendons near their attachment at the ischial tuberosity.

• Deep pain below the buttock
• Pain with prolonged sitting or forward bending
• Symptoms with sprinting, uphill running or hamstring exercise

Pain localised to the adductors and reproduced by palpation and resisted contraction, often following increased sprinting, kicking or change-of-direction load.

• Groin or inner-thigh pain
• Pain while squeezing the legs together
• Symptoms with running, turning, kicking or a wide stride

A strain or tear of the hip flexors, adductors, gluteals or hamstrings after rapid force, stretching or sprinting.

• Sudden pain during activity
• Weakness and pain with muscle contraction or stretch
• Bruising, swelling or difficulty walking in larger injuries

Irritation of the pubic symphysis and surrounding structures, often related to repeated loading. Osteitis pubis does not necessarily indicate one single cause.

• Central pain over the pubic bone
• Pain with running, kicking, turning or rising from bed
• Local tenderness and pain while squeezing the legs

Pain in the inguinal canal aggravated by exertion, coughing or activity without necessarily having a palpable hernia. Abdominal and urological causes must be considered.

• Groin pain or pressure during sprinting and turning
• Pain with coughing, sneezing or abdominal exercise
• Inguinal tenderness; a visible bulge requires hernia assessment

Pain that may arise from the joint between the sacrum and pelvis; diagnosis requires a history and a cluster of tests rather than one test alone.

• One-sided low-back or buttock pain
• Pain with rolling in bed, stairs or asymmetrical stance
• Symptoms that may spread into the buttock or back of the thigh

Suboptimal coordination, strength or relaxation of the pelvic muscles, sometimes associated with pain and urinary, bowel or sexual dysfunction.

• Pelvic or perineal pain, including pain with intercourse
• Pelvic pressure or heaviness
• Urgency, urinary leakage or difficulty emptying requires appropriate specialist assessment

Lumbar-spine structures or nerve roots may cause buttock, groin or leg pain and mimic a local hip disorder.

• Pain associated with lumbar movement or posture
• Radiating pain, numbness or tingling in the leg
• Weakness, reflex or sensory change when a nerve root is affected

Compression of the lateral femoral cutaneous nerve, a sensory-only nerve, usually near the inguinal ligament.

• Burning, numbness or tingling on the outside of the thigh
• Skin sensitivity to clothing or touch
• No muscle weakness, although prolonged standing may aggravate symptoms

Irritation or entrapment of the sciatic nerve in the deep gluteal space. It is broader than “piriformis syndrome” and lumbar sources must be excluded.

• Deep buttock pain
• Pain or tingling spreading down the back of the thigh
• Aggravation with prolonged sitting or positions that tension the region

A fracture of the femoral neck, intertrochanteric or subtrochanteric region, usually after a fall in older adults or high-energy trauma.

• Severe hip or groin pain after trauma
• Inability to stand or bear weight
• The leg may appear shortened and externally rotated

Bone stress injury caused when repeated loading exceeds recovery, particularly in runners or people with reduced bone health.

• Gradual groin, buttock or anterior-thigh pain
• Pain with running or walking that may progress to pain at rest
• Limping and pain while bearing weight

Displacement of the femoral head from the acetabulum, usually after high-energy trauma or following hip replacement. It is a medical emergency.

• Severe pain and visible leg deformity
• Inability to move or bear weight through the leg
• Numbness, weakness or a circulation change in the leg

Loss of blood supply to the femoral head that can cause bone damage and collapse.

• Gradual pain in the groin, buttock or thigh
• Pain with weight-bearing and later at rest
• Stiffness, limping and reduced movement

A fracture of the pelvic ring or hip socket after trauma or, in fragile bone, lower loads. Organ and blood-vessel injury may coexist.

• Severe pelvic, groin or low-back pain
• Difficulty or inability to bear weight
• Bruising, dizziness, abdominal pain or bleeding requires emergency care

A slip through the growth plate of the femoral head in adolescents. Limping or inability to bear weight requires urgent orthopaedic assessment.

• Hip, thigh or isolated knee pain
• Limping with the foot turned outward
• Restricted internal rotation or inability to walk

Temporary interruption of blood supply to the femoral head in childhood, changing joint shape and function during healing.

• A gradually developing limp
• Hip, thigh or knee pain
• Restricted hip rotation and abduction

Irritation of a growth area or removal of a small bone fragment by forceful muscle contraction in active adolescents.

• Gradual activity-related pain with apophysitis
• Sudden pain or a pop during sprinting, jumping or kicking with avulsion
• Local tenderness, weakness and limping

Joint inflammation caused by rheumatological disease or infection. A very painful hip with fever or inability to bear weight is an emergency.

• Marked pain and severe restriction of movement
• Prolonged stiffness, other swollen joints or systemic symptoms
• Fever, systemic illness and refusal to walk with infection