HIP PAIN
Pain in the groin and pain in the buttock are not the same diagnosis.
Where your hip hurts tells us more than how much it hurts. Groin pain usually points inside the joint; pain over the outer hip or buttock usually points outside it, or to the spine above it entirely. Getting that distinction right the first visit saves months of treating the wrong structure.
The map that does most of the diagnostic work
Deep groin pain, sometimes felt as far as the inner thigh, is the signature of a problem inside the joint itself — a labral tear, femoroacetabular impingement, or osteoarthritis. Pain over the point of the hip or across the buttock is usually extra-articular, most often the tendons and bursa on the outside of the joint, and it is frequently mistaken for hip disease when it is not coming from the joint at all. Pain that runs down the back of the leg past the knee is rarely the hip — that pattern belongs to the lumbar spine, and treating it as a hip problem delays finding the actual source.
Inside the joint: labral tears and osteoarthritis
Two mechanical drivers do most of the intra-articular damage. In younger, active patients, femoroacetabular impingement — extra bone on the ball, the socket, or both — repeatedly pinches the labrum, the cartilage rim that seals the joint, until it tears. In older patients, that same cartilage simply wears thin over decades of load, and osteoarthritis is the endpoint. The third driver is behavioral and compounding: a hip that hurts to move gets moved less, the surrounding musculature deconditions, and the joint loses the muscular support that was partially compensating for the mechanical problem, accelerating the very process that started the pain.
Confirming the joint with an injection, not a guess
The hip sits too deep to reach reliably by feel, and imaging alone overcalls the diagnosis — plenty of hips with labral fraying or mild arthritis on a scan are not the actual source of a given patient’s pain. An image-guided intra-articular injection, placed under fluoroscopic or ultrasound guidance, tells us definitively whether the joint itself is generating your symptoms: meaningful relief confirms it, and a joint that does not respond sends us looking elsewhere before any bigger step is taken.
The impostor: gluteal tendinopathy
GREATER TROCHANTERIC PAIN SYNDROME
Pain over the outer point of the hip, worse lying on that side at night and worse climbing stairs, is more often gluteal tendinopathy — injury to the gluteus medius or minimus tendons where they attach at the greater trochanter — than it is arthritis. This is the single most common reason a patient is told they need a hip replacement when what they actually need is targeted loading exercise and, sometimes, a guided injection into the tendon or bursa. It is diagnosed on exam and confirmed with ultrasound, not by the same workup used for joint disease.
The load and metabolic terrain
Whichever structure is generating the pain, what it sits inside matters. Systemic inflammation from insulin resistance circulates through hip cartilage the same way it does through the knee, accelerating breakdown independent of body weight, and prolonged sitting — a desk job, a long commute — shortens the hip flexors and changes the load pattern across the joint in ways patients rarely connect to their pain. Rebuilding hip strength and mobility, paired with the same metabolic work we build into every plan here, is what keeps an injection’s relief from being temporary. See metabolic health and pain.
When replacement is right
Advanced osteoarthritis with bone-on-bone contact and a fixed loss of motion is a hip that has moved past what injections and therapy can offer, and total hip replacement is one of the most reliably successful operations in orthopedics for that patient. We do not delay that referral to sell one more injection. What we will not do is send a patient with gluteal tendinopathy or an unconfirmed diagnosis toward that same operation because the imaging showed some wear that isn’t actually the source of their pain.
Red flags that change the visit
- Sudden inability to bear weight, especially after a fall — rule out a fracture before anything else, particularly in older patients with osteoporosis.
- Hip pain with fever — needs same-day evaluation for a septic joint.
- New weakness, numbness, or bowel or bladder change alongside hip and leg pain — suggests a spinal source needing urgent workup. See when it is an emergency.
Common questions
Why does my back exam matter if my hip is what hurts?
Because a pinched lumbar nerve root and a diseased hip can produce overlapping pain patterns, and treating the wrong one delays relief for months. We examine the spine on every hip visit for this reason; see sciatica for the pattern that most often gets confused with hip disease.
Can an MRI tell me for certain what is wrong?
Not on its own. Labral fraying and mild arthritis show up on scans of hips that do not hurt at all, so imaging findings need to be matched against your exam and, often, an injection’s response before we call them the cause. What to expect covers how we sequence imaging against exam findings.
I was told I need a hip replacement. Should I get a second opinion?
If a confirming intra-articular injection has not been done, yes — gluteal tendinopathy and referred lumbar pain are both routinely mistaken for end-stage hip arthritis, and a diagnostic block is a low-risk way to confirm the joint before agreeing to surgery. Image-guided joint injections explains how that confirmation works.
Does losing weight fix hip pain?
It reduces one input — mechanical load — but the metabolic and behavioral drivers matter just as much, and a hip too painful to move makes weight loss harder, not easier. We address the pain and the terrain together rather than asking you to fix one before we treat the other, the same approach described in knee pain for the joint that shares this same terrain problem.
Related reading
We will find the actual structure before we treat one
Groin, outer hip, buttock, and referred back pain get treated differently because they come from different places. We will tell you which one is yours, confirm it, and only then build a plan.
4479 Woodson Rd, Suite 401
St. Louis, MO 63134
Next to St. Louis Lambert International Airport, off I-70 at Woodson Road.
Sources
- Chamberlain R. Hip Pain in Adults: Evaluation and Differential Diagnosis. American Family Physician, 2021. PubMed 33448767
- Klauser AS et al. Greater trochanteric pain syndrome. Seminars in Musculoskeletal Radiology, 2013. PubMed 23487333
- Brinkman JC et al. The Management of Acetabular Labral Tears: A Contemporary Review. Current Reviews in Musculoskeletal Medicine, 2026. PubMed 42334787