Hip Pain: Joint, Tendon, Bursa, Nerve or Referred Pain?

More Than One Candidate Structure

"Hip pain" is a location, not a diagnosis. The hip region houses several structures capable of generating remarkably similar pain patterns: the hip joint itself (labrum, cartilage, femoroacetabular structures), the surrounding tendons (particularly gluteal tendons laterally and iliopsoas anteriorly), the trochanteric bursa, the lumbar spine and sacroiliac joint via referral, and peripheral nerves passing through the region.

Why Getting This Right Changes Treatment

A systematic review of clinical tests for hip pathology found that no single special test reliably distinguishes between these structures in isolation, and diagnostic accuracy improves substantially when tests are interpreted as part of a broader cluster alongside history and movement pattern (Reiman et al., 2013). A joint capsule problem, a tendinopathy and a bursitis may all present with similar lateral hip pain, yet require meaningfully different loading and treatment strategies to resolve.

A Structured Approach to Differentiation

Clinicians typically combine the pattern of aggravating activities, the precise location and behaviour of the pain, palpation findings, and a cluster of movement and resisted tests — rather than relying on any single test — to build a working hypothesis about which structure is the primary driver.