Hip Pain: When It's the Joint, the Spine, or Something Else

"Hip pain" is one of the most diagnostically challenging complaints I evaluate because the hip, lumbar spine, sacroiliac joint, and surrounding soft tissues can all cause pain in similar locations — and frequently coexist.

Correct diagnosis determines correct treatment. Here's how I approach hip pain.

The Three Main Sources of "Hip Pain"

1. True Hip Joint Pain (Glenohumeral OA, Labral Tear)

• Location: Deep in the groin, occasionally lateral hip
• Worse with walking, weight-bearing, internal rotation of the leg
• Limited internal rotation on examination
• X-ray or MRI shows joint space narrowing, labral pathology

2. Lumbar Spine (Referred Pain)

• Location: Can mimic hip pain; often buttock and back of thigh
• May have associated back pain, worse bending
• Radicular features (leg pain below knee) suggest disc/nerve involvement
• MRI lumbar spine is the key diagnostic study

3. Greater Trochanteric Pain Syndrome (Bursitis/Tendinopathy)

• Location: Side of the hip, over the bony prominence (greater trochanter)
• Worse lying on the affected side, walking uphill, crossing legs
• Tenderness directly over the greater trochanter

Diagnostic Injection to the Rescue

When imaging and clinical exam don't definitively identify the source, a hip joint injection with local anesthetic can be diagnostic: if your pain improves significantly after fluoroscopic-guided intra-articular anesthetic, the hip joint is confirmed as the pain source.

Treatment Based on Diagnosis

Hip joint OA:

• Corticosteroid injections (rapid anti-inflammatory relief, 1–3 months)
• PRP injections (longer-lasting, promotes cartilage health)
• Hyaluronic acid injections (lubrication supplementation)
• Physical therapy for hip strengthening

Greater trochanteric bursitis/tendinopathy:

• Ultrasound-guided corticosteroid injection adjacent to the bursa
• PRP injection into the gluteus medius tendon for chronic tendinopathy

Lumbar-referred pain: Appropriate lumbar evaluation and treatment (see our conditions pages)

Femoroacetabular impingement (FAI) or labral tear: Intra-articular injection for symptom management; surgical consultation for definitive labral repair

When to Seek Hip Replacement Consultation

Hip replacement is appropriate for severe OA with bone-on-bone changes causing significant functional limitation that doesn't respond to conservative management. But for many patients — particularly those over 70 or with medical comorbidities — ongoing non-surgical management is preferable.

Call 516-492-3100 for an evaluation of hip pain or to discuss non-surgical hip pain management.