If you make a tentative diagnosis of iliopsoas tendinitis or iliopectineal bursitis and the condition does not improve reasonably quickly, consider another diagnosis such as stress fracture, undisplaced fracture, or bone metastases. A bone scan may give you the answer. Resisted hip flexion in the assessment of iliopsoas tendinitis. Have the seated or supine patient flex his hip against the resistance of your hand. If this causes pain, one cause is iliopsoas tendinitis.
Stress fractures do occur in the region of the hip but they are uncommon.
Such fractures are usually located in the pubic rami or the femoral neck. The most frequent precipitating factor is running, but stress fractures may also result from vigorous or prolonged walking. The patient usually complains of anterior groin pain which may not be present at rest and which may only be brought out by running. Pain may persist for weeks or months, and, in the case of stress fractures of the femoral neck, a complete fracture may evolve if the precipitating activity is not stopped. From the point of view of the family physician, it is important to think of the possibility of stress fracture in someone who has been participating in a fairly vigorous activity and who presents with groin pain of some duration.