Initial pre-referral workup

Clinical history

• location of pain 
• groin – usually hip joint
• lateral – extra-articular or hip joint
• Fhx – of hip replacements, hip surgery or DDH
• sporting Hx

Physical examination

• Trendlenberg – single keg stance or waddle when walking is a sign of hip disease
• loss of range of motion in flexion and internal rotation <90 <0, suggestive of impingement
• significant ligamentous laxity

Investigations

• weight bearing AP pelvis, faux profile both hips, Dunn lateral, Von Rosen film
•  MRI hips

GP management

Reassurance that the vast majority of patients with hip and groin pain will improve with a good physical therapy program.

Physiotherapy – adjust swayback posture with gait.

Abductor strengthening – avoid CLAMS, hip hitches, drinking bird, twists.

The vast majority of patients with hip and groin pain will improve with a good physical therapy program.

NSAIDS together with Nexium for three months.

Intra-articular cortisone injection under image guidance.

Referral to pain management service if they have red flags such as global pain, stopped school, light headedness, other joints, dizziness, chronic fatigue syndrome.

Indications for specialist referral

Urgent

• severe pain requiring crutches or not being controlled with simple analgesics

Routine

• DDH on X-rays for advice on prognosis and consideration of surgery
• impingement on x-rays for advice on prognosis and consideration of surgery
• severe hypermobility is best referred to Pain Management service