What your diagnosis means

Hip pain often shows up in the small moments. Swinging your legs out of the car, pulling on your socks, climbing the stairs, or lying on your side at night. And when you ask about it, the answer can arrive as a label: arthritis, bursitis, a labral tear, or something called femoroacetabular impingement (FAI).

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Over the years, many of the people I've worked with have told me they weren't quite sure what their hip diagnosis meant, only that it sounded worrying. So on this page I'll explain, as simply as I can, what each common label describes.

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A quick tour of the hip

The hip is a ball-and-socket joint, like the shoulder, but much deeper and more stable. The ball is the top of your thigh bone (the head of the femur) and the socket is a cup in the pelvis called the acetabulum. Both surfaces are covered in smooth cartilage.

 

Around the rim of the socket runs a ring of tougher cartilage called the labrum, which deepens the socket. On the outside of the hip is a bony point you can feel, the greater trochanter, where the buttock (gluteal) tendons attach, with small fluid-filled sacs (bursae) nearby.

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Hip osteoarthritis

Hip osteoarthritis is one of the most common labels for hip pain in people over 45. The diagnosis describes the smooth cartilage on the ends of the bones thinning and changing, alongside changes in the bone underneath and sometimes small bony growths at the edges of the joint. You'll often hear it called 'wear and tear'.

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People given this label often describe hip pain that is worse with walking and stiffness after moving. A GP can make the diagnosis from your age, your symptoms and an examination, so you may have been given it without an X-ray.

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Bursitis and greater trochanteric pain syndrome

If your pain is on the outside of the hip, you may have been told you have trochanteric bursitis. This label describes the bursa over the greater trochanter being irritated and swollen. More recently, many clinicians use the broader term 'greater trochanteric pain syndrome', or GTPS. This umbrella term covers changes in the gluteal tendons (gluteal tendinopathy) as well as the bursa, because studies have found the tendons are involved more often than the bursa alone.

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People given this label often describe tenderness over the bony point of the hip and discomfort lying on that side, climbing stairs or standing on one leg.

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Labral tear

A labral tear describes a split or fraying in the labrum, that ring of cartilage around the rim of the hip socket. The label may follow a twisting injury while your weight is on the leg, or it may be linked with the shape of the hip joint, which I'll come to next. Labral tears can be hard to see on a standard scan, so sometimes a dye is injected into the joint before an MRI to show the labrum more clearly. People given this label sometimes describe a catching or clicking sensation in the front of the hip or groin.

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Femoroacetabular impingement (FAI)

Femoroacetabular impingement, often shortened to FAI or 'hip impingement', describes a variation in the shape of the ball, the socket or both, so that the two bones meet earlier than usual in certain movements, such as deep bending or twisting. There are two main shapes. A 'cam' shape is extra bone where the ball meets the neck of the thigh bone, so the ball is less round. A 'pincer' shape is where the rim of the socket covers more of the ball than usual. Some people have both.

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When this shape is found alongside symptoms such as hip or groin pain and stiffness, clinicians call it 'FAI syndrome'. It's most often diagnosed in active younger adults, and it's sometimes mentioned in the same breath as a labral tear.

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These labels describe what a scan or examination shows. They don't explain why pain persists and for many people the nervous system is an important part of the picture.

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Where arthritis fits

'Arthritis' is probably the word people most often attach to a painful hip, sometimes before anyone has examined it. Yet the label you've been given may be one of the others above. If you'd like to understand more about arthritis, read my page on what arthritis means.