JOCD Cases

Maintain vigilance when hip pain presents with a normal X-ray — the pathology may be extra-articular or systemic in origin.

Keep a broad differential diagnosis and a low threshold for investigating atypical causes of hip and leg pain.

Listen carefully to the patient’s history — subtle details often provide diagnostic clues.

Do not underestimate disproportionate or persistent pain, as it may signal serious underlying pathology.

Perform a comprehensive clinical examination, including assessment of the spine and adjacent joints.

Always examine the joint above and below the site of reported pain to avoid diagnostic oversight.

Consider advanced imaging (e.g. MRI of the pelvis and lumbar spine) when initial investigations are inconclusive.

Adopt a multidisciplinary approach — refer appropriately (e.g. to gynaecology or other specialties) when non-orthopaedic causes are suspected.