Posterior, lateral and anterior pain of musculoskeletal origin: a review of the literature, the history, the physical examination and imaging

The purpose of this study was to present a review of the literature on the causes of musculoskeletal hip pain in adults, with particular attention to the history, the physical examination and imaging.
A search of the English-language literature was carried out using the terms “hip pain”, and “anterior”, “lateral”, “posterior”. In addition, a search was made for specific entities of hip pain or for sources of pain referred to it.
The sources of musculoskeletal hip pain in the adult can be divided into the posterior, lateral and anterior categories. Posterior hip pain includes the lumbar spine and pain referred from femoroacetabular impingement, sacroiliac joint pathology, piriformis syndrome and proximal hamstring tendinopathy. Gluteal tendinopathy and thickening of the iliotibial band are the two commonest causes of pain on the lateral side of the hip. Anterior pain is further divided into intra-articular causes (tear of the labrum, osteoarthritis, osteonecrosis) and extra-articular causes (snapping hip and athletic pubalgia). Entrapment neuropathies and myofascial pain should also be considered in every compartment. A limited number of features of the history and of the clinical examination tests for the assessment of hip pain are also set out in this article. The imaging investigations reported for the precise diagnosis of the pain are plain radiographs, computed tomography, magnetic resonance imaging, bone scintigraphy and ultrasonography.
The assessment of hip pain in adults is difficult. Clinicians should always look for the sources of posterior, lateral and anterior hip pain, and should always bear in mind that these may overlap.
Source: “Journal of Chiropractic Medicine”, December 2016