Sign in

Hip, Buttock & Groin Pain

Written 20th February 2020 - Last Update 21st August 2026

Hip, buttock & groin pain (approach)

The regional hub for hip/buttock/groin/leg pain.

Key facts

  • Children get serious hip disease — DDH (0–4 yrs), Perthes (4–8 yrs), SCFE (10–15 yrs), septic arthritis (any age), TB, inflammatory arthritis — all demanding early recognition. See childhood hip disorders.
  • SCFE classically presents in the obese adolescent with knee pain and a slight limp — hip disorders commonly refer pain to the knee and thigh.
  • Limp is inseparable from painful hip/buttock conditions.
  • The spine is the most likely cause of buttock pain in adults.
  • Bilateral buttock/hip pain in a woman (especially multiparous) — think sacroiliac joint dysfunction.
  • Hip pain in a middle-aged or elderly woman — always consider the underdiagnosed greater trochanteric pain syndrome (trochanteric bursitis / gluteus medius tendinopathy).
  • Hip osteoarthritis is common but under-recognised outside the classically affected knee — population studies put its prevalence around 2.2–2.3% in those aged 60–65, versus roughly 11–13% for knee OA in the same age group. Presents with insidious groin/anterior thigh pain, morning stiffness under 30 minutes, and progressive loss of internal rotation.
  • Femoroacetabular impingement (FAI) and labral tears are an important cause of hip/groin pain in younger adults, distinct from the childhood and degenerative causes above — insidious anterolateral groin pain worsened by hip flexion/internal rotation (squatting, prolonged sitting, pivoting sports), sometimes with clicking or catching. Patients classically localise the pain with a “C sign” — cupping the hand over the anterolateral hip. See other hip disorders for detail.

Red flags

  • Swelling, redness, very limited joint motion
  • Pain + fever/systemic features (especially without trauma)
  • Rapid joint swelling after trauma
  • Constant localised pain unaffected by movement
  • Associated weight loss
  • Neurological changes — loss of power, saddle paraesthesia, bowel/urinary incontinence
  • Groin pain with loss of limb pulses, haemodynamic instability or abdominal pain (AAA); the 5 Ps of acute limb ischaemia (pain, pulseless, perishingly cold, pallor, paraesthesia ± paralysis)

Diagnostic strategy (Murtagh)

  • Probability: hip OA; referred pain from the spine; traumatic muscular strains; greater trochanteric pain syndrome.
  • Serious, not to miss:
    • Cardiovascular — aortoiliac occlusion (buttock claudication), AAA, critical limb ischaemia
    • Neoplasia — osteosarcoma, metastases
    • Infection — septic arthritis, osteomyelitis, TB, PID, pelvic abscess, prostatitis
    • Cauda equina syndrome
    • Childhood — DDH, Perthes, SCFE, juvenile chronic arthritis
  • Pitfalls: polymyalgia rheumatica; fractures (femoral-neck stress, subcapital, sacral, pubic rami); avascular necrosis of the femoral head; torn acetabular labrum / FAI; SIJ disorders; osteitis pubis; inguinal/femoral hernia; bursitis/tendinopathy; synovial chondromatosis.

Key questions

Onset and character of pain, and exactly where it is · claudication pattern (pain on walking, relieved by rest)? · morning stiffness? · difficulty with stairs, shoes and socks? · backache, limp, restricted movement? · shoulder- girdle aching (PMR)? · injury/fall? · weight loss, night pain? · painful to lie on that side at night (GTPS)? · walking distance · childhood hip problem? · response to treatments?

Management pointers

  • Hip OA: land-based therapeutic exercise (strengthening, range-of-motion, functional training) is first-line and guideline-recommended, though the Cochrane evidence base itself is more modest than the strength of that recommendation — exercise reduced pain by around 8 points on a 0–100 scale compared with no treatment/usual care, a small, not always clinically noticeable effect, with no demonstrated benefit for quality of life.
  • FAI/labral pathology: initial management is non-operative (physiotherapy, activity modification, NSAIDs); an intra-articular local anaesthetic + steroid injection can be both diagnostic (pain relief confirms an intra-articular source) and therapeutic. Refer for orthopaedic assessment if conservative treatment fails or arthritic change is already present.