Version June 2024
| Condition | Clinical features to distinguish from FAIS | Diagnostic testing to establish diagnosis |
| Other hip joint pathology | ||
| Dysplasia/hip instability | Insidious onset of hip pain sometimes associated with popping or clicking; history of hypermobility | Radiographs (AP pelvis) |
| Labral disease | Hip pain, often sharp with clicking and catching sensation; patient may feel hip joint is locking; pain at extremes of hip motion; FADIR and FABER tests often painful | MRI |
| Chondral disease | Signs and symptoms similar to labral disease; may experience night time pain | MRI |
| Osteoarthritis | Insidious onset of groin and thigh pain, usually in older adults; activity-related pain may progress to nighttime pain; difficulty with hip rotation; pain after standing | Radiographs (AP pelvis) |
| Avascular necrosis of hip | Insidious onset of groin and thigh pain lasting longer than six weeks; occurs in any age group; pain worse with weight bearing and movement; risk factors (previous AVN; FH; excess alcohol; steroid therapy; sickle cell disease) | Radiographs (often normal)/MRI |
| Legg-Calvé-Perthes disease | Unilateral hip or knee pain and limp; usually occurs in boys 4 to 8 years | Radiographs (bilateral hips – AP pelvis and lateral) |
| Slipped capital femoral epiphysis | Acute or insidious onset of unilateral hip or knee pain; limp; occurs in adolescents; obligatory external rotation of hip | Radiographs (bilateral hips – AP pelvis and lateral)/MRI |
| Muscle and tendon conditions of the hip and groin | ||
| Adductor-related groin pain (eg, adductor tendinopathy/enthesopathy; adductor muscle strain) | FADIR test negative; adductor squeeze test positive; focal tenderness at adductor muscle/muscle-tendon junction/tendon/enthesis | MSK ultrasound; MRI |
| Iliopsoas-related groin pain (eg, iliopsoas muscle strain; iliopsoas tendinopathy or bursitis) | FADIR test negative; iliopsoas tenderness; pain with resisted hip flexion; pain with passive stretching of hip flexors; may complain of hip "snapping" | MRI |
| Inguinal-related groin pain | FADIR test negative; pain and tenderness of inguinal canal; no palpable inguinal hernia | MSK ultrasound |
| Pubic-related groin pain (eg, osteoarthritis of symphysis pubis) | FADIR test negative; local tenderness of the pubic symphysis; may have pain with tuning fork vibration test or percussion of pubic bone | Radiographs; MRI |
| Bone conditions | ||
| Stress fractures of hip and pelvis | Subacute onset of exercise-associated hip and/or groin pain; hop test helpful if positive | Radiographs; MRI |
| Apophysitis | Exercise-associated groin pain and tenderness in active adolescents | Radiographs; MSK ultrasound |
| Nerve injury | ||
| Ilioinguinal nerve entrapment | Lower abdominal/pelvic pain typically radiating to groin and thigh; altered sensation at medial groin including upper scrotum in men and labia in women | Pain relief with local anesthetic injection just medial to ASIS |
| Obturator nerve entrapment | Insidious onset of deep groin pain at adductor origin | Electromyography; pain relief with nerve block |
| Other: Genitofemoral; iliohypogastric | Unilateral pain and numbness in distribution of nerve | Pain relief with nerve block |
| Tumor (eg, testicular cancer; prostate cancer; urinary tract cancer; bone or soft tissue cancer; digestive tract cancer) | Pain not associated with exercise; insidious onset of symptoms with no history of trauma or acute injury; night pain; pain at rest | Radiographs; MRI; appropriate blood tests |
| Rheumatologic disease (eg, spondyloarthropathy; rheumatoid arthritis) | Insidious onset of joint pain often involving more than one joint; fatigue; fever; morning stiffness/pain that improves with activity | Radiographs; appropriate blood tests |
| Genitourinary conditions (eg, prostatitis; urinary tract infection; kidney stone) | Low back, low abdominal, inguinal, or pelvic pain and tenderness; fever; urinary symptoms; hematuria | Appropriate urine tests; CT |
| Intra-abdominal conditions (eg, appendicitis; diverticulitis) | Low abdominal pain and tenderness; bowel symptoms; fever | CT |
| Gynecologic conditions | Gynecologic symptoms and signs, possibly including pelvic pain and tenderness; vaginal bleeding | Pelvic ultrasound |
| Referred pain (eg, lumbar spine; sacroiliac joint) | Lower back/sacroiliac joint pain and tenderness; radiculopathy – unilateral pain and/or weakness; positive SLR test | Clinical diagnosis; imaging often not helpful unless neurologic signs present |
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