04/05/2026
๐๐ข๐ฉ ๐๐จ๐ข๐ง๐ญ ๐๐ข๐ฆ๐ข๐๐ค๐ข๐ง๐ ๐๐๐ข๐๐ญ๐ข๐๐
๐ ๐๐ก๐ ๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ ๐๐ซ๐จ๐๐ฅ๐๐ฆ
โฌ Patients presenting with posterior thigh or leg pain are often labeled as lumbar radiculopathy, and that label tends to stick
๐ However, emerging evidence and clinical experience show that the hip joint can reproduce similar pain patterns, leading to frequent misdiagnosis
๐ฌ ๐๐๐ข๐ง ๐๐๐๐ก๐๐ง๐ข๐ฌ๐ฆ๐ฌ
๐ข ๐๐ข๐ฉ ๐๐จ๐ข๐ง๐ญ (๐๐๐๐๐ซ๐ซ๐๐ ๐๐๐ข๐ง)
โฌ Pain can originate from articular nociception (capsule, labrum)
โฌ It involves convergence at the spinal cord level โ non-dermatomal referral
โฌ It is often described as deep, aching, and poorly localized
๐ด ๐๐ฎ๐ฆ๐๐๐ซ ๐๐๐๐ข๐๐ฎ๐ฅ๐จ๐ฉ๐๐ญ๐ก๐ฒ
โฌ Pain is driven by nerve root compression or irritation
โฌ It follows a dermatomal distribution
โฌ It is usually accompanied by neurological involvement (sensory/motor/reflex)
โ๏ธ ๐๐๐ฒ ๐๐ข๐๐๐๐ซ๐๐ง๐ญ๐ข๐๐ญ๐ข๐จ๐ง ๐
๐ซ๐๐ฆ๐๐ฐ๐จ๐ซ๐ค
1๏ธโฃ ๐๐๐ข๐ง ๐๐จ๐๐๐ญ๐ข๐จ๐ง
โฌ When the pain is hip in origin, it is typically felt in the groin (primary), anterior thigh, and sometimes the lateral or posterior thigh
โฌ When it is radiculopathy, it tends to follow a clear dermatomal pattern, often extending below the knee
2๏ธโฃ ๐๐๐ง๐ ๐ ๐จ๐ ๐๐จ๐ญ๐ข๐จ๐ง
โฌ With hip-driven pain, you will often notice limited internal rotation (an early sign) and pain at end-range hip flexion or rotation
โฌ With spine-driven pain, lumbar movements tend to reproduce symptoms, while hip ROM is often relatively preserved
3๏ธโฃ ๐๐ฉ๐๐๐ข๐๐ฅ ๐๐๐ฌ๐ญ๐ฌ
๐น ๐๐ข๐ฉ ๐๐ฅ๐ฎ๐ฌ๐ญ๐๐ซ
โฌ Tests like FADIR (Flexion + Adduction + IR), FABER, and the Scour test are useful
โฌ ๐ Reproduction of the patientโs familiar pain is a strong indicator
๐น ๐๐๐ฎ๐ซ๐๐ฅ ๐๐๐ฌ๐ญ๐ฌ
โฌ Straight Leg Raise (SLR) and Slump test help assess neural involvement
โฌ ๐ A positive test combined with neurological signs makes radiculopathy more likely
4๏ธโฃ ๐๐๐ฎ๐ซ๐จ๐ฅ๐จ๐ ๐ข๐๐๐ฅ ๐๐ฑ๐๐ฆ๐ข๐ง๐๐ญ๐ข๐จ๐ง
โฌ In radiculopathy, you expect myotomal weakness, dermatomal sensory loss, and reflex changes
โฌ In hip pathology, the neurological exam is typically normal
โ ๏ธ ๐๐๐ ๐
๐ฅ๐๐ ๐ฌ ๐๐จ๐ซ ๐๐ข๐ฉ ๐๐ง๐ฏ๐จ๐ฅ๐ฏ๐๐ฆ๐๐ง๐ญ
โฌ Groin pain with movement
โฌ Difficulty putting on socks or shoes
โฌ Pain during pivoting or twisting movements
โฌ Reduced hip internal rotation compared to the other side
๐งฉ ๐๐จ๐ฆ๐ฆ๐จ๐ง ๐๐ข๐ฉ ๐๐๐ญ๐ก๐จ๐ฅ๐จ๐ ๐ข๐๐ฌ ๐๐ข๐ฆ๐ข๐๐ค๐ข๐ง๐ ๐๐๐ข๐๐ญ๐ข๐๐
โฌ Hip osteoarthritis
โฌ Femoroacetabular impingement (FAI)
โฌ Labral tears
โฌ Deep gluteal syndrome
๐ฅ ๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ ๐๐ฆ๐ฉ๐ฅ๐ข๐๐๐ญ๐ข๐จ๐ง
โฌ When hip pathology is misidentified as lumbar radiculopathy, the result is often:
โฌ Ineffective lumbar-based treatment
โฌ Delayed recovery
โฌ Progression toward chronicity
โฌ This is why the hip should always be included in the assessment of โsciatica-likeโ symptoms
๐ ๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ ๐๐๐๐ซ๐ฅ
๐ โNot all leg pain is neural.โ
๐ If the neurological exam is clean, it is worth stepping back and considering the hip first
