Differential Diagnosis for Anterior Hip Pain Worse with Adduction

• Single most likely diagnosis
  • Femoroacetabular impingement (FAI): This condition is characterized by abnormal contact between the femoral head and the acetabulum, leading to pain, especially with hip flexion and adduction. The mechanism of pain worsening with adduction aligns with the typical presentation of FAI.
• Other Likely diagnoses
  • Hip flexor tendinopathy: Inflammation or degeneration of the hip flexor tendons can cause anterior hip pain that worsens with activities involving hip flexion and adduction.
  • Iliopsoas bursitis: Inflammation of the bursa surrounding the iliopsoas tendon can cause pain in the anterior hip region, which may be exacerbated by adduction.
  • Osteitis pubis: Inflammation of the pubic bone and its surrounding structures can lead to pain in the groin area, which may worsen with adduction.
• Do Not Miss diagnoses
  • Septic arthritis of the hip: Although less common, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. Hip pain, especially if accompanied by fever, redness, or swelling, should raise suspicion for this condition.
  • Avulsion fracture: A fracture at the site of muscle attachment can occur, especially in younger individuals. This would be particularly concerning in the context of acute trauma or severe pain.
• Rare diagnoses
  • Snapping hip syndrome (coxa saltans): This condition involves a snapping sensation in the hip due to the movement of a tendon over a bony prominence. While it can cause pain, it's less commonly associated with pain worsening specifically with adduction.
  • Intra-articular pathologies (e.g., loose bodies, chondral lesions): These conditions can cause hip pain but are less likely to present with a specific worsening of pain with adduction unless they involve structures that are directly impacted by adduction movements.