As someone entering your 50s or 60s, hip pain can be both unwelcome and concerning. Is it a nagging inflammation—or perhaps joint wear and tear? Let’s explore the differential diagnosis of three common causes of hip pain in this age group: bursitis, labral tear, and arthritis. We’ll also discuss when imaging is helpful and when it’s wise to refer to a specialist like Dr Khoo.
1. What Are We Dealing With?
A. Bursitis
- What’s happening? Inflammation of the fluid-filled sacs (bursae) around the hip, most commonly the greater trochanteric bursa.
- Symptoms: Sharp or aching pain on the outer hip or thigh, often worse with lying on the affected side, climbing stairs, or prolonged walking. Tenderness to touch and sometimes a tight feeling.
B. Labral Tear
- What’s happening? A tear of the cartilage rim (labrum) around the hip socket, which can cause instability or impingement.
- Symptoms: Deep groin pain or pinching, catching, clicking, or locking, especially when flexing the hip (e.g., putting on socks, squatting). Pain may come on suddenly or insidiously.
C. Arthritis (Osteoarthritis)
- What’s happening? Cartilage breakdown in the hip joint, leading to bone-on-bone contact.
- Symptoms: Stiffness and aching deep in the groin or buttock, difficulty with weight-bearing activities, early morning stiffness (less than 30 minutes) that eases with movement. Progressively worsens over months to years.
2. How to Tell Them Apart? Key Clues in the History & Exam
When you describe your hip pain, certain details can help your doctor distinguish between bursitis, a labral tear, and arthritis:
Bursitis
- Pain is usually felt on the outer side of the hip.
- Often develops gradually, particularly after activity.
- Common to feel pain when lying on the affected side at night.
- Rarely causes clicking or catching sensations.
- On examination, there is tenderness directly over the bony point (greater trochanter), and pain may increase when pushing against hip abduction (lifting leg sideways).
Labral Tear
- Pain is typically a deep ache in the groin.
- May come on suddenly after a twist, or gradually over time.
- Can cause clicking, catching, or locking inside the joint.
- Pain worsens with movements like squatting, pivoting, or bringing the knee up towards the chest.
- Tests such as the FADIR or FABER manoeuvre (specific hip movements performed during examination) may reproduce the pain.
Arthritis (Osteoarthritis)
- Pain is also felt deep in the groin or buttock.
- Tends to develop slowly and progressively over months or years.
- Morning stiffness is common, though usually eases within 30 minutes of movement.
- Activities such as long walks, climbing stairs, or standing for extended periods can make symptoms worse.
- On examination, there may be stiffness and loss of range of motion, particularly with internal rotation of the hip.
3. When Should You Consider Imaging?
No immediate imaging is needed if your pain:
- Has been present for only a few days, is mild, and improves with conservative measures (rest, analgesia, physiotherapy).
- Has classic bursitis features: focal lateral tenderness, no mechanical locking.
Consider X-rays if:
- Pain persists beyond 6 to 8 weeks despite conservative treatment.
- You’re noticing morning stiffness, reduced range of motion, or activity-limiting discomfort suggesting arthritis.
Magnetic Resonance Imaging (MRI) is appropriate when:
- Mechanical symptoms (catching, clicking, locking) suggest a labral tear or hip impingement.
- Symptoms persist despite normal X-rays and physiotherapy.
In certain cases, a hip ultrasound can confirm bursitis quickly and cost-effectively.
4. When Should You See a Specialist (Referral)?
Referral to an orthopaedic surgeon—such as Dr Khoo—is wise when:
- Pain persists for more than 3 months, limiting daily activities, despite trial of physiotherapy and medications.
- Severe mechanical symptoms: catching, locking or a feeling of the hip “giving way”.
- X-rays show moderate to severe arthritis, and lifestyle modifications or medications aren’t enough.
- MRI confirms a labral tear in an otherwise healthy joint, and symptoms are persistent or prevent desired activities.
5. What Can You Do Now? Simple Strategies to Feel Better
- Rest & joint protection: avoid positions that aggravate the pain, use a cane on the opposite side if needed.
- Heat or cold therapy: a warm compress for stiffness; an ice pack for inflamed bursae.
- Non-prescription analgesics: paracetamol or NSAIDs (if safe for you)—use short-term under guidance.
- Gentle stretches & exercises: hip abductor strengthening (side-lying leg lifts), core stability, gentle range-of-motion.
- Weight management, if applicable, to reduce load on the hip.
If bursitis seems likely, a corticosteroid injection into the bursa may be offered after confirming diagnosis via clinical eval or ultrasound. This should be discussed with your GP or physiotherapist before referral.
6. Expected Timeline & When to Act
- 0–6 weeks: Conservative management is the first line. Most bursitis and minor injuries improve.
- 6–12 weeks: If pain doesn’t settle, and you've done guided physiotherapy, consider imaging (X-ray or MRI as indicated).
- Beyond 12 weeks: Persistent limiting symptoms—especially with imaging findings—warrant referral to an orthopaedic specialist.
Frequently Asked Questions (FAQs)
Q: Can I have both bursitis and arthritis?
Yes—especially if arthritis alters your gait and overloads the lateral hip. It’s possible to have coexisting conditions; imaging and clinical evaluation can help differentiate.
Q: Are labral tears common at my age?
Less common than in younger athletes but still seen if there’s impingement or cartilage wear. Age-related joint changes don’t eliminate the possibility of labrum involvement.
Q: If X-rays are normal, can I still have arthritis?
X-ray changes can lag symptoms. MRI may show early cartilage wear or labral damage, but clinical context is vital.
Q: Should I worry about cancer or infection?
Rarely. Red-flag signs such as fever, night sweats, unexplained weight loss, or worse pain at rest should prompt urgent evaluation—but are uncommon in straightforward bursitis or arthritis.
Summary and When to Seek Help
In your 50s or 60s, hip pain might stem from bursitis, a labral tear, or arthritis.
- Bursitis: outer-hip tenderness, worse when lying on that side.
- Labral tear: deep groin pain, mechanical symptoms like clicking or locking.
- Arthritis: insidious onset, deep hip/groin pain with stiffness and reduced range of motion.
Start with conservative care for a few weeks. If symptoms are persistent, significant, or mechanical in nature—or if initial care fails—then imaging (X-ray, MRI, ultrasound) may be needed. Referral to a specialist like Dr Khoo is appropriate when symptoms hinder your quality of life, imaging confirms structural problems, or when you need expert management options such as physical therapy guidance, injection therapy, or surgical consideration.
