Differential Diagnosis for Hip Pain and Decreased Flexibility
Single Most Likely Diagnosis
- Osteoarthritis (OA) of the Hip: This is the most likely diagnosis given the aching pain at rest and with activity, decreased flexibility, limping, and a shorter stride. The pain radiating to the groin, buttock, lateral hip, and sometimes down to the knee is also consistent with hip OA.
Other Likely Diagnoses
- Rheumatoid Arthritis (RA): Although less common in the hip compared to other joints, RA can cause hip pain, stiffness, and decreased flexibility, especially in patients with a history of RA.
- Trochanteric Bursitis: Inflammation of the bursa over the trochanter can cause lateral hip pain, which may radiate down to the knee, and is often associated with decreased flexibility and limping.
- Piriformis Syndrome: Compression of the sciatic nerve by the piriformis muscle can cause buttock and hip pain, which may radiate down to the knee, and is often associated with decreased flexibility and limping.
Do Not Miss Diagnoses
- Avascular Necrosis (AVN) of the Femoral Head: A condition where the blood supply to the femoral head is disrupted, leading to necrosis of the bone tissue. It can cause severe hip pain, especially at night, and is often associated with a history of trauma, steroid use, or excessive alcohol consumption.
- Septic Arthritis: A bacterial infection of the joint, which can cause severe hip pain, fever, and decreased flexibility. It is a medical emergency that requires prompt treatment.
- Fracture (e.g., Stress Fracture or Pathologic Fracture): A fracture can cause severe hip pain, especially with weight-bearing activities, and is often associated with a history of trauma or underlying bone disease.
Rare Diagnoses
- Synovial Chondromatosis: A rare condition where cartilaginous nodules form in the synovial membrane of the joint, causing hip pain, stiffness, and decreased flexibility.
- Paget's Disease of Bone: A rare condition where the bone remodeling process is disrupted, leading to weakened bones and increased risk of fractures. It can cause hip pain, especially in older adults.
- Inflammatory Spondyloarthropathies (e.g., Ankylosing Spondylitis): A group of conditions that cause inflammation of the spine and other joints, leading to hip pain, stiffness, and decreased flexibility.