Browse categories and answer follow-up questions to refine your symptom profile.
History
Chief concern and context
Presenting pattern
Acute traumatic
Acute atraumatic
Subacute or chronic
Post procedure
Laterality
Right
Left
Bilateral
Mechanism and trigger
Fall from standing
High energy trauma
Sports or overuse
Recent infection
Recent dental or skin infection
Recent intraarticular injection
Pain location by patient pointing
Groin or anterior hip
Lateral hip
Buttock or posterior hip
Thigh
Functional impact
Weight bearing tolerance
Sleep disruption
Work or sport limitation
Assistive device use
OPQRST
OPQRST framework
Onset details
Provocation and palliation details
Quality descriptors
Region and radiation pattern
Severity scale and trajectory
Timing pattern
Onset
Onset pattern
Sudden
Gradual
Temporal context
Minutes to hours
Days
Weeks
Preceding events
Trauma
New exercise load
Immobilization
Febrile illness
Provocation/Palliation
Exacerbating factors
Weight bearing
Hip flexion
Hip internal rotation
Stairs
Lying on affected side
Relieving factors
Rest
Position change
NSAID response
Heat or ice response
Mechanical features
Catching
Locking
Clicking
Quality
Pain descriptors
Deep ache
Sharp
Burning
Electric
Inflammatory features
Morning stiffness over 30 minutes
Night pain
Improvement with activity
Neuropathic features
Paresthesia
Allodynia
Region/Radiation
Primary region
Groin
Greater trochanter
Gluteal
Lumbosacral
Radiation pattern
Anterior thigh
Lateral thigh
Below knee
To knee only
Referred pain considerations
Lumbar radiculopathy
Sacroiliac source
Severity
Severity scale
Current pain score
Peak pain score
Severity markers
Inability to bear weight
Pain at rest
Escalating analgesic requirement
Timing
Temporal pattern
Constant
Intermittent
Episodic with activity
Diurnal variation
Worse in morning
Worse at night
Course
Improving
Stable
Worsening
Associated symptoms
Constitutional
Fever
Chills
Weight loss
Fatigue
Musculoskeletal
Other joint pain
Back pain
Recent trauma elsewhere
Neurologic
Numbness
Weakness
Bowel or bladder change
Infectious focus
Skin infection
Urinary symptoms
Recent sore throat
Vascular
Leg swelling
Calf pain
Prior episodes and baseline
Prior similar pain
Prior diagnosis
Prior imaging
Prior injections
Baseline function
Baseline walking distance
Baseline stair tolerance
Baseline use of cane or walker
Prior operations
Total hip arthroplasty
Prior fracture repair
Alarm Features
Immediate threats
Cannot miss diagnoses
Septic arthritis (M00.9)
Hip fracture (S72.0 to S72.2)
Hip dislocation (S73.0)
Necrotizing soft tissue infection (M72.6)
Acute limb ischemia (I74.3)
Escalation triggers
Hemodynamic instability
Toxic appearance
Rapidly progressive pain
Pain out of proportion
New neurologic deficit
Time critical actions
If suspected septic arthritis, urgent ortho and aspiration
If suspected hip fracture, early analgesia and early imaging
If suspected acute limb ischemia, urgent vascular consult
High risk vital signs
Danger thresholds
Temperature 38.0 C or higher
Heart rate 120 or higher
Systolic blood pressure under 90
Respiratory rate 22 or higher
Oxygen saturation under 92 percent on room air
Sepsis features
Altered mental status
Hypoperfusion markers
Rising lactate
High risk exam findings
Joint infection pattern
Severe pain with any passive range of motion
Held in flexion and external rotation
Inability to bear weight
Fracture or dislocation pattern
Shortened and externally rotated limb
Groin pain with log roll
Bony tenderness
Skin and soft tissue danger
Crepitus
Bullae
Rapidly spreading erythema
Pain beyond visible changes
Neurovascular compromise
Diminished distal pulses
Cool pale limb
New foot drop
High risk populations
Immunocompromised
Neutropenia
HIV with low CD4
Chronic steroids
Transplant
Bleeding risk
Anticoagulant use
Bleeding disorder
Pregnancy and postpartum
Pelvic girdle pain mimics
Increased venous thromboembolism risk
Pediatrics and adolescents
Septic arthritis
Transient synovitis
Slipped capital femoral epiphysis (M93.0)
Legg Calve Perthes disease (M91.1)
Medications
Current medication list
Prescription exposures
Anticoagulants
Antiplatelets
Chronic corticosteroids
Bisphosphonates
Statins
OTC exposures
NSAIDs
Acetaminophen
Topical analgesics
Substance exposures
Alcohol
Illicit drug use
Injection drug use
Medication risks relevant to hip pain
Bleeding and hematoma risk
Warfarin
Direct oral anticoagulants
Heparin products
Bone and tendon risk
Chronic systemic corticosteroids
Fluoroquinolones
Avascular necrosis risk
High dose steroids
Alcohol use disorder
Analgesics and interactions
NSAID safety
CKD risk
GI bleed risk
Anticoagulant interaction risk
Opioid considerations
Sedation risk
Fall risk
Constipation risk
Neuropathic agents
Gabapentinoids sedation risk
SNRI interaction considerations
Diet
Recent intake and hydration
Hydration pattern
Poor intake
Vomiting or diarrhea
Alcohol exposure
Heavy use pattern
Recent binge
Nutrition affecting bone health
Low calcium intake pattern
Low vitamin D intake pattern
Dietary triggers for specific etiologies
Crystal arthritis triggers
High purine intake
Dehydration
Weight and metabolic factors
Recent weight gain
Bariatric surgery history
Review of Systems
Musculoskeletal
Limb and joint symptoms
Knee pain
Back pain
Other joint swelling
Morning stiffness
Functional symptoms
Limp
Falls
Inability to bear weight
Infectious and inflammatory
Infection symptoms
Fever
Chills
Night sweats
Inflammatory symptoms
Rash
Uveitis symptoms
Oral ulcers
Neurologic and spine
Radicular features
Shooting pain
Paresthesia
Red flag neurologic symptoms
Saddle anesthesia
Urinary retention
Fecal incontinence
Cardiopulmonary and vascular
Thromboembolism symptoms
Leg swelling
Calf pain
Dyspnea
Cardiac symptoms
Chest pain
Syncope
Collateral History and Family History
Collateral sources
Source and reliability
Family
Caregiver
EMS
Facility records
Additional history elements
Baseline mobility
Baseline cognition
Recent falls details
Family history
Bone and joint disorders
Osteoarthritis (M19.90)
Rheumatoid arthritis (M06.9)
Ankylosing spondylitis (M45.9)
Inherited conditions
Sickle cell disease (D57.1)
Hemophilia (D66)
Early fragility fractures
Parental hip fracture
Osteoporosis history
Risk Factors
Trauma and bone fragility
Fracture risk
Age over 65
Prior fragility fracture
Osteoporosis (M81.0)
Low body weight
Frequent falls
Stress fracture risk
Endurance training
Female athlete triad features
Relative energy deficiency
Pathologic fracture risk
Known malignancy
Unexplained weight loss
Infection risk
Hematogenous seeding risk
Bacteremia history
Endocarditis history
Local inoculation risk
Recent injection
Recent surgery
Prosthetic joint
Immunosuppression
Diabetes (E11.9)
Chronic kidney disease (N18.9)
Chronic liver disease (K76.9)
Thrombosis and bleeding risk
Venous thromboembolism risk
Recent immobilization
Recent surgery
Estrogen therapy
Pregnancy and postpartum
Bleeding risk
Anticoagulant therapy
Thrombocytopenia history
Liver disease
Mechanical and overuse
Greater trochanteric pain syndrome risk
Running
Hip abductor weakness
Femoroacetabular impingement risk
Athletic pivot sports
Limited hip internal rotation baseline
Differential Diagnosis
Life threatening
Septic arthritis of hip (M00.9)
Fever
Inability to bear weight
Pain with passive range of motion
Elevated CRP
Hip fracture including occult femoral neck (S72.0)
Fall
Osteoporosis risk
Groin pain
Pain with log roll
Hip dislocation (S73.0)
High energy trauma
Abnormal limb position
Neurovascular deficit
Necrotizing soft tissue infection (M72.6)
Pain out of proportion
Crepitus
Systemic toxicity
Osteomyelitis or pelvic osteomyelitis (M86.9)
Persistent fever
Elevated inflammatory markers
Immunocompromise
Spinal epidural abscess (G06.1)
Back pain
Fever
Neurologic deficit
Injection drug use
Acute limb ischemia (I74.3)
Pain with pallor
Cool limb
Pulse deficit
Common
Osteoarthritis of hip (M16.9)
Activity related groin pain
Reduced internal rotation
Morning stiffness under 30 minutes
Greater trochanteric pain syndrome (M70.60)
Lateral hip pain
Worse lying on affected side
Tenderness over greater trochanter
Iliopsoas tendinopathy or bursitis (M76.1)
Anterior hip pain
Pain with resisted hip flexion
Lumbar radiculopathy (M54.16)
Pain below knee
Positive straight leg raise
Neurologic symptoms
Sacroiliac joint dysfunction (M53.3)
Buttock pain
Pain with FABER pattern
Muscle strain
Clear overuse trigger
Focal tenderness
Preserved passive range of motion
Less common
Avascular necrosis of femoral head (M87.059)
Steroid exposure
Heavy alcohol exposure
Pain at rest
Normal early radiographs
Femoroacetabular impingement (M25.85)
Young athlete
Pain with hip flexion and internal rotation
Positive FADIR pattern
Labral tear
Clicking
Catching
Mechanical symptoms
Crystal arthritis including gout (M10.9)
Abrupt severe pain
Elevated inflammatory markers possible
Crystal identification on aspirate
Inflammatory arthritis flare (M06.9)
Prolonged morning stiffness
Multiple joints
Systemic features
Malignancy or metastasis (C79.51)
Night pain
Weight loss
Known cancer history
Psoas abscess (K68.12)
Fever
Pain with hip extension
Back or flank pain
Prosthetic joint infection (T84.50)
Prior arthroplasty
New pain
Fever sometimes absent
Past Medical History
Relevant chronic conditions
Metabolic and vascular
Diabetes (E11.9)
Peripheral arterial disease (I73.9)
Chronic kidney disease (N18.9)
Bone health
Osteoporosis (M81.0)
Prior fractures
Paget disease (M88.9)
Rheumatologic
Rheumatoid arthritis (M06.9)
Spondyloarthropathy (M45.9)
Gout (M10.9)
Infection risk conditions
HIV (B20)
Sickle cell disease (D57.1)
Malignancy (C80.1)
Prior procedures and devices
Orthopedic history
Total hip arthroplasty
Prior hip surgery
Prior steroid injections
Recent procedures
Joint aspiration history
Recent catheterization
Baseline functional status
Independent ambulation
Walker or cane baseline
Long term care residence
Physical Exam
General and vital sign interpretation
Appearance
Toxic
Comfortable at rest
Distress with movement
Vital sign patterns
Fever pattern
Tachycardia out of proportion
Hypotension
Hemodynamic clues
Capillary refill
Peripheral perfusion
Hip inspection and palpation
Visual inspection
Deformity
Swelling
Ecchymosis
Surgical scar
Palpation
Greater trochanter tenderness
Groin tenderness
Pubic symphysis tenderness
Sacroiliac tenderness
Skin and soft tissue
Erythema
Warmth
Fluctuance
Crepitus
Range of motion and strength
Passive range of motion
Pain with internal rotation
Pain with flexion
Pain with extension
Log roll pain
Suggests intraarticular pathology
Disproportionate pain suggests fracture or septic arthritis
Strength testing
Hip flexion
Hip abduction
Knee extension
Gait and function
Gait assessment
Antalgic
Trendelenburg pattern
Unable to bear weight
Functional tests
Single leg stance tolerance
Sit to stand tolerance
Neurovascular
Motor
L4 knee extension
L5 ankle dorsiflexion
S1 plantarflexion
Sensory
L4 medial leg
L5 dorsum foot
S1 lateral foot
Reflexes
Patellar
Achilles
Vascular
Dorsalis pedis pulse
Posterior tibial pulse
Limb temperature comparison
Adjacent regions and mimics
Lumbar spine
Midline tenderness
Paraspinal tenderness
Straight leg raise pattern
Knee exam
Effusion
Joint line tenderness
Abdomen and pelvis
Inguinal hernia signs
Abdominal tenderness
Genitourinary
Testicular or adnexal symptoms screen
Flank tenderness screen
Lab Studies
Core labs when systemic or high risk features
CBC
Leukocytosis supports infection
Normal WBC does not exclude septic arthritis
CRP
Elevated supports infection or inflammation
Trend useful for response monitoring
ESR
Elevated supports inflammation
Slow to rise and fall
Basic metabolic panel
Renal function for NSAID and contrast safety
Electrolytes for systemic illness
Infection workup and sepsis evaluation
Blood cultures
Prior to antibiotics if feasible
Higher yield with fever or sepsis
Lactate
Elevated suggests hypoperfusion
Serial trend supports resuscitation response
Urinalysis
UTI as bacteremia source
Hematuria for stone mimic
Coagulation and special populations
INR and aPTT
Anticoagulant effect estimate
Procedure planning for aspiration
Pregnancy test
Imaging and medication safety planning
Ectopic and pelvic mimic context
Synovial fluid studies when aspiration performed
Cell count and differential
High WBC supports septic arthritis
Overlap with crystal arthritis possible
Gram stain and culture
Culture guides targeted therapy
Prior antibiotics reduce yield
Crystal analysis
Monosodium urate
Calcium pyrophosphate
Imaging
Scoring Systems
Kocher criteria for pediatric hip septic arthritis
Fever over 38.5 C
Non weight bearing
ESR 40 or higher
WBC 12 or higher
Higher count increases probability
Modified Kocher additions
CRP elevation
Improves discrimination in some cohorts
Clinical probability tools for mimics
Wells DVT pretest probability
Guides compression ultrasound selection
MRI
Indications
Occult femoral neck fracture with negative radiographs
Avascular necrosis assessment
Osteomyelitis evaluation
Soft tissue abscess evaluation
Protocol considerations
Metal artifact reduction sequences with prosthesis
Contrast use for abscess and osteomyelitis questions
Interpretation pearls
Early AVN may be radiograph negative
Stress fracture marrow edema patterns
Limitations
Time and availability constraints
Claustrophobia and implant contraindications
CT
Indications
Complex pelvic or acetabular fracture definition
Occult fracture when MRI unavailable
Psoas abscess evaluation
Protocol considerations
Contrast for suspected abscess
Noncontrast for fracture definition typically sufficient
Interpretation pearls
Femoral neck fracture can be subtle
Compare to contralateral side when uncertain
Limitations
Radiation exposure
Contrast nephropathy risk
Ultrasound
Hip joint effusion detection
Effusion supports septic arthritis possibility
Absence does not exclude early infection
Ultrasound guided aspiration support
Improves procedural accuracy
Consider anticoagulation status
Compression ultrasound for DVT mimic
Consider if leg swelling or risk factors
Proximal DVT assessment
Pitfalls
Effusion can be reactive in transient synovitis
Operator dependence
Special Tests
Bedside maneuvers
FABER pattern
Pain suggests sacroiliac or hip pathology
Compare side to side
FADIR pattern
Pain suggests femoroacetabular impingement
Groin pain more specific than lateral pain
Stinchfield test pattern
Pain with resisted straight leg raise suggests intraarticular pathology
Limited specificity
Trendelenburg sign pattern
Hip abductor weakness
Supports greater trochanteric pain syndrome
Arthrocentesis and procedural diagnostics
Hip aspiration indications
Suspected septic arthritis
Suspected crystal arthritis with systemic features
Synovial analysis components
Cell count and differential
Gram stain and culture
Crystal analysis
Antibiotic timing logic
If septic shock, antibiotics after blood cultures even if aspiration delayed
If stable, aspiration before antibiotics improves culture yield
Prosthetic joint considerations
Prosthetic joint infection workup
ESR and CRP supportive but not definitive
Aspiration typically specialist guided
Imaging adjuncts
Radiographs for loosening signs
MRI metal artifact reduction when available
ECG
When ECG is relevant in hip pain presentations
Indications
Syncope associated fall
Sepsis with tachycardia
Preoperative assessment for fracture pathway
High risk patterns
Ischemic changes
New atrial fibrillation
High grade AV block
Serial ECG logic when indicated
Chest pain or dyspnea overlap
Initial ECG timing at presentation
Repeat if symptoms evolve
Medication related concerns
QT prolonging medications
Electrolyte abnormality context
Assessment
Working diagnosis framework
Anatomic bucket
Intraarticular hip joint
Peritrochanteric soft tissue
Spine referred
Pelvic or abdominal referred
Severity stratification
Weight bearing ability
Systemic toxicity
Neurovascular status
Complications to exclude
Septic arthritis
Occult fracture
Neurovascular compromise
Problem oriented examples
Suspected septic arthritis (M00.9)
Fever or systemic features
Pain with passive range of motion
Elevated CRP or ESR
Suspected hip fracture including occult (S72.0)
Fall or trauma
Inability to bear weight
Pain with log roll
Greater trochanteric pain syndrome (M70.60)
Lateral tenderness
Pain lying on affected side
Preserved passive hip range of motion
Plan
Approach to the critical patient
First 5 minutes
Continuous monitoring if instability or sepsis concern
IV access criteria
Two large bore IV for sepsis or major trauma
One IV for stable analgesia and labs
Oxygen criteria
If oxygen saturation under 92 percent
If respiratory distress
Early tests time targets
Blood cultures if febrile
Lactate if sepsis concern
Hip and pelvis radiographs if trauma or inability to bear weight
Immediate consult triggers
Ortho for suspected septic arthritis
Ortho for fracture or dislocation
Vascular for limb ischemia signs
Analgesia and symptom control
Nonopioid analgesia examples
Acetaminophen PO 1000 mg once
Maximum 3000 mg per day in older adults or liver disease risk
Ibuprofen PO 400 mg once
Avoid in CKD or GI bleed risk
Ketorolac IV 15 mg once
Avoid in CKD or anticoagulation with bleeding risk
Opioid analgesia examples
Hydromorphone IV 0.2 mg
Repeat every 10 to 15 minutes to effect
Monitor for respiratory depression
Regional anesthesia for hip fracture
Fascia iliaca block local protocol dependent
Reduces opioid requirement
Contraindications include infection at site and anticoagulation risk assessment
Infection and inflammatory management
Suspected septic arthritis
Aspiration prior to antibiotics if stable
Empiric antibiotics after cultures local protocol dependent
Vancomycin IV weight based dosing local protocol dependent
Add gram negative coverage if immunocompromised local protocol dependent
Suspected necrotizing infection
Broad spectrum antibiotics immediately
Surgical consult emergent
Inflammatory arthritis flare
NSAID if safe
Steroid decision individualized and infection excluded
Diagnostic sequencing
Trauma or inability to bear weight
Radiographs pelvis and hip
If negative but high suspicion, MRI for occult fracture
Fever or toxic features
CBC
CRP and ESR
Blood cultures
Ultrasound for effusion
Neuro symptoms or back pain red flags
MRI spine if epidural abscess concern
Urgent neurosurgery or spine consult if deficit
Leg swelling or thromboembolism concern
Wells probability assessment
Compression ultrasound as indicated
Reassessment loop
Scheduled reassessment
Pain score after analgesia within 30 to 60 minutes
Repeat neurovascular exam after reduction or splinting actions
Change triggers
Rising fever
New inability to bear weight
New neurologic deficit
Worsening swelling or compartment concern
Disposition
ICU level care criteria
ICU triggers
Septic shock
Persistent hypotension after fluids
Rising lactate with instability
High risk infection with instability
Necrotizing infection concern
Immunocompromised with sepsis features
Inpatient admission criteria
Infection and surgery pathways
Suspected septic arthritis
Confirmed osteomyelitis
Psoas abscess
Trauma pathways
Hip fracture
Hip dislocation
Inability to ambulate safely
Pain and function
Uncontrolled pain despite ED regimen
Unsafe mobility at baseline and no support
Observation pathway criteria
Diagnostic uncertainty with stability
Pending MRI for occult fracture
Pending specialist assessment
Pain control monitoring
Opioid requirement with fall risk
Need for physiotherapy evaluation
Discharge criteria and follow up
Discharge criteria
Stable vital signs
Neurovascularly intact
Safe ambulation plan
Serious diagnoses reasonably excluded
Follow up timing
Primary care within 3 to 7 days
Ortho or sports medicine within 1 to 2 weeks if persistent
Urgent follow up within 24 to 72 hours if worsening function
Discharge Instructions
Copy discharge instructions
Hip pain evaluation today did not show an emergency cause requiring admission
Return now for fever
Return now for inability to bear weight
Return now for rapidly worsening pain
Return now for new numbness or weakness
Return now for leg swelling with shortness of breath
Pain control
Acetaminophen as directed on the label
Avoid NSAIDs if kidney disease or stomach bleeding history
If prescribed opioid do not drive or mix with alcohol
Activity
Relative rest for 48 hours
Gradual return to activity as pain allows
Use cane or walker if recommended
Follow up
Primary care within 3 to 7 days
Ortho or sports medicine if pain persists over 1 to 2 weeks
If you have a hip replacement
Return for fever or new redness around the hip area
Return for sudden severe pain or inability to move the leg
References
Guidelines and key sources
Hip fracture management guideline NICE 2023
Early analgesia and multidisciplinary pathway
Perioperative optimization guidance
Osteoarthritis management guideline ACR and AF 2019
Nonpharmacologic and pharmacologic options
Shared decision principles
Septic arthritis guidance SANJO guideline 2023
Aspiration and culture principles
Antibiotic timing considerations
Infectious diseases guidance for bone and joint infection IDSA guideline local protocol dependent
Empiric antibiotic selection framework
Duration and monitoring concepts
Pediatric hip septic arthritis probability criteria Kocher 1999
Four clinical predictors
Probability increases with criteria count
Formatting constraints reference
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.