Clinical examination of the patient with posterior hip pain

Abstract

Advancements in the understanding of hip joint anatomy and biomechanics have contributed to the improvement of diagnosis and treatment decisions for distal causes of deep gluteal syndrome (DGS). Ischiofemoral impingement, hamstring syndrome, and pudendal nerve entrapment are sources of posterior hip pain that can simulate symptoms of DGS. To evaluate the etiology of posterior hip pain, it is necessary to understand and assess the interaction between the osseous, capsulolabral, musculotendinous, neurovascular, and kinematic levels. The combination of a comprehensive history and physical examination with imaging and ancillary testing is critical to diagnose posterior hip pain. Six key physical examination tests are described to differentiate distal versus proximal sources of extrapelvic posterior hip pain. Differential diagnosis of DGS, IFI, hamstring syndrome, and pudendal nerve entrapment is dependent upon the understanding of the entire anatomy, biomechanics, and clinical presentation of posterior hip pain.