A Layered Approach to the History and Physical Exam of the Athlete's Hip

Abstract

Hip pathology is a common source of pain and dysfunction in athletes. Taking a layered approach to the history and physical examination of the athlete's hip is imperative to deciphering the vast differential diagnoses for an athlete's hip pain. Systematic evaluation of the (1) osteochondral, (2) capsulolabral, (3) musculotendinous, (4) neurovascular, and (5) kinematic chain layers of the hip allow for the comprehensive consideration of hip pain etiologies, including femoroacetabular impingement syndrome, labral tears, osteoarthritis, Coxa Saltans, hamstring and gluteal tendinopathy, and sacroiliac joint dysfunction, among numerous other conditions. A thorough history, including the location, acuity, quality, radiation, and sport-specific limitations of the hip pain, followed by a methodologic physical examination, with ordered inspection, gait, palpation, range of motion, strength testing, and provocative maneuvers, allows clinicians to arrive at an early and accurate diagnosis of hip pain. Only after a thorough history and physical examination can more specific diagnostic and therapeutic modalities be applied.