Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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J.C. Campbell and G.D. Paiement
studies show that the labrum additionally contributes to both cartilage
nourishment and synovial fluid lubrication [ 3 ].
The hip capsule is innervated by femoral, sciatic, and obturator
nerves [ 1 ]. Hip pain may present as pain reported in any of these nerve
distributions. This often makes symptoms of hip pathology somewhat
vague and nonspecific.
Several muscles are in proximity of the hip joint and may be the
source of pain about the hip. These include the hip abductors (glutei
maximus, medius, and minimus) and the tensor fascia lata with the iliotibial
band that runs from the anterior and lateral iliac crest along the
side of the thigh to insert onto the anterolateral tibia. Flexors crossing
the hip include the iliopsoas, which originates within the pelvis, exiting
below the inguinal ligament to attach on the lesser trochanter, and the
rectus femoris, which lies directly anterior to the hip, with its direct head
attaching just above the anterior hip capsule. Lastly, the adductor muscles
(adductors magnus, longus, and brevis) lie medial to the hip, originating
from the pubic rami and inserting on the medial femur.
Basics of Evaluation
A detailed history is crucial in the differential diagnosis. It is important
to ask the patient about any types and changes of physical activities
at work and any history of trauma, however minor or remote it may
seem. Ideally, a patient should be able to provide a detailed history of
the pain, including when and how it started as well as what makes the
pain better or worse. It is important to establish objective measures of
the symptoms: “I used to run 3 miles, but now I can barely walk 3
blocks,” or “I cannot sleep on my back anymore.” A complete medical,
occupational, and family history is important, as many conditions have
familial (Gaucher’s disease), developmental (hip dysplasia), environmental
(caisson disease), or exposure-related risk factors (avascular
necrosis).
A complete physical evaluation should include inspection and palpation
of all bony prominences: anterior superior iliac spine (ASIS) , anterior
inferior iliac spine (AIIS) , pubic symphysis, ischial tuberosity,
sacroiliac joints, and greater trochanters, with special emphasis on tenderness
at these areas. Close attention to the exact location of the pain
can narrow the differential diagnosis dramatically. Abnormal active and
passive hip range of motion may also point the clinician in the right
direction (Table 8.1 ; Figs. 8.1 , 8.2 , and 8.3 ). Comparison with the