Hip Pain Maps

This article is still missing information.

Cumulative pain drawings in 109 patients with unilateral hip OA. Modified from Poulsen et al.

Hip joint pain can occur anywhere in the hip girdle. That is, it can occur anteriorly, laterally, posteriorly, or even distally. It can sometimes co-exist with lumbar spine pain either as a separate entity or as a provocative factor (see Hip-Spine Syndrome)

Patterns are typically mapped by analyzing pre-procedure pain diagrams of patients who subsequently achieve significant pain relief from fluoroscopically guided intra-articular (FGIA) anesthetic injections. Some studies specifically correlate patterns with confirmed intra-articular pathology like labral tears or femoroacetabular impingement (FAI).

Pain Referral Patterns

There have been several studies that have reported on pain patterns in those with hip pain prior to surgery. However only two studies used diagnostic injections to determine the pain location (Lesher and Arnold)

Studies Analyzing Hip Joint Pain Referral Patterns in Patients with Symptomatic Hips or Patients Undergoing Total Hip Arthroscopy (Modified From Arnold)

Study	Groin (%)	Trochanter (%)	Thigh (%)	Buttock (%)	Knee (%)
Khan and Woolson	43	18	21	5	65
Khan et al	84	N/A	70	76	72
Burnett et al	92	59	52	38	52
Poulsen et al	53	77	42	38	17
Lesher et ala	50	37	47	11	42
Arnoldb	73	44	9	12	N/A
Average	69	37	40	24	51

^a These studies used fluoroscopically guided intra-articular anesthetic hip joint injections to determine the location(s) of each patient's referred hip pain. In the other studies, patients were asked to indicate the location(s) of their “hip” pain prior to their hip surgery.

Pain Referral Patterns (Lesher et al. 2008, Arnold et al.):

• The most frequently reported pain location in patients with confirmed hip joint pain (based on injection response) is the buttock (71% in Lesher study).
• Groin pain is also common (55% Lesher; 73% in Arnold's responders with labral tears). Central groin pain appears particularly indicative of intra-articular pathology like labral tears and is the classic presentation of FAI.
• Thigh pain, typically anterior or lateral, is reported frequently (57% Lesher; also common in FAI ). Pain in the lateral peritrochanteric area is also associated with labral tears.
• Referral distal to the knee occurs in a minority of patients (22% Lesher).
• Foot pain (6% Lesher) and knee pain (2% Lesher) are rare
• Referral to the lower lumbar spine was consistently absent in diagnostic injection studies.
• Multiple distinct patterns combining these areas are observed (14 patterns in Lesher study).

Resources

Hip Joint Pain Referral - lesher 2008.pdf - 111 KB (f)

Hip Joint Pain Referral - Arnold 2011.pdf - 526 KB (f)

Hip OA Pain - Poulsen 2015.pdf - 348 KB (f)

Hip Labral tear clinical presentation - burnett2006 .pdf - 327 KB (f)

Hip OA where is the pain - khan 2004.pdf - 207 KB (f)

Note on Buttock Pain

A significant finding from diagnostic injection studies is the high prevalence of buttock pain as the primary or co-existing symptom of intra-articular hip pathology. This contradicts the traditional clinical teaching that often emphasizes groin or anterior thigh pain as the hallmark of hip joint problems. While groin pain remains a key indicator, especially for conditions like FAI or labral tears, clinicians should maintain a high index of suspicion for hip joint pathology even when the patient's predominant complaint is located in the buttock. This is crucial for accurate diagnosis, as buttock pain could otherwise be misattributed solely to lumbar spine or SIJ sources.