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Hip PainAPPROACH

MUSCULOSKELETAL AND EXTREMITIES · 19 SECTIONS

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807 items

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Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Shoulder Pain Elbow Pain Wrist Pain Hand Pain Hip Pain Knee Pain Ankle Pain Foot Pain Cast Or Splint Complication Symptoms Wound Check And Suture Related Visits Joint Swelling And Monoarthritis Suspected Septic Joint Presentation Suspected Tendon Rupture Presentation Limp Or Refusal To Bear Weight

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx134

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

02Alarm Features/alarm59

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

03Medications/meds35

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

04Diet/diet15

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

05Review of Systems/ros31

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

06Collateral History and Family History/chafh19

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

07Risk Factors/rf39

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

08Differential Diagnosis/ddx86

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

09Past Medical History/pmh27

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

10Physical Exam/exam72

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

11Lab Studies/labs36

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

12Imaging/img51

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

13Special Tests/spec28

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

14ECG/ecg14

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

15Assessment/ax25

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

16Plan/plan67

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

Differential Management

›!Hip fracture→›!Septic arthritis→›Slipped Capital Femoral Epiphysis (SCFE)→

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

17Disposition/dispo33

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

18Discharge Instructions/di20

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

19References/r16

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

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.