Differential Diagnosis
The patient's symptoms and physical examination findings suggest a hip-related condition. Here's a categorized differential diagnosis:
Single most likely diagnosis
- D. Slipped capital femoral epiphysis (SCFE): The patient's symptoms, such as a waddling gait, limited internal rotation, and mild tenderness to palpation at the bilateral anterior groin, are consistent with SCFE. The patient's age, weight, and recent onset of symptoms also support this diagnosis. SCFE is a common hip condition in adolescents, especially during periods of rapid growth.
Other Likely diagnoses
- E. Transient synovitis: This condition is characterized by hip pain and limited mobility, which could be similar to the patient's symptoms. However, transient synovitis typically presents with more acute onset and is often associated with a recent viral illness.
- A. Iliopsoas bursitis: Although less likely, ilipsoas bursitis could cause hip pain and limited mobility. The patient's symptoms, such as tenderness to palpation at the anterior groin, might be consistent with this diagnosis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B. Osteosarcoma: Although rare, osteosarcoma is a malignant bone tumor that can present with hip pain and limited mobility. It is essential to consider this diagnosis, especially if the patient's symptoms worsen or do not respond to treatment.
- Infection (e.g., septic arthritis): Although not listed among the options, infection is a critical diagnosis to consider, as it can lead to severe consequences if left untreated. The patient's symptoms, such as hip pain and limited mobility, could be consistent with an infectious process.
Rare diagnoses
- C. Physiologic genu valgum: This condition is a normal variant of knee alignment in children and is unlikely to cause the patient's symptoms.
- Other rare hip conditions (e.g., Legg-Calve-Perthes disease, hip dysplasia): These conditions are less likely to present with the patient's specific symptoms and age. However, they should be considered if the patient's symptoms do not respond to treatment or if further evaluation is necessary.