Differential Diagnosis
The patient's symptoms, including limited and painful FABER position, difficulty with pigeon pose in yoga, pain with pushing hip down, and tenderness localized to the deep hip and buttock, suggest several possible diagnoses. These can be categorized as follows:
Single most likely diagnosis
- Piriformis syndrome: This condition is characterized by pain and tenderness in the deep hip and buttock area, often due to compression of the sciatic nerve by the piriformis muscle. The patient's symptoms, such as pain with pushing the hip down and difficulty with certain yoga poses, are consistent with piriformis syndrome. The FABER position (Flexion, ABduction, and External Rotation) can exacerbate symptoms of piriformis syndrome, making it a likely diagnosis.
Other Likely diagnoses
- Gluteus medius or minimus tendinopathy: These conditions can cause deep hip and buttock pain, especially with activities that involve hip abduction or external rotation. The patient's symptoms, such as pain with pushing the hip down, could be related to tendinopathy of these muscles.
- Deep gluteal syndrome: This condition involves pain and tenderness in the deep hip and buttock area, often due to compression of the sciatic nerve or other structures by the gluteal muscles. The patient's symptoms are consistent with deep gluteal syndrome.
- Hip flexor or adductor strain: Strains of the hip flexor or adductor muscles can cause pain and limited mobility in the hip, especially with activities that involve flexion, abduction, or adduction.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Septic arthritis or osteomyelitis: Although less likely, these conditions can cause severe pain and limited mobility in the hip and must be ruled out to avoid serious complications. A delayed diagnosis can lead to significant morbidity or mortality.
- Tumor or cancer: Although rare, a tumor or cancer in the hip or buttock area can cause pain and limited mobility. It is essential to consider this possibility, especially if the patient has a history of cancer or if the symptoms are persistent and unexplained.
Rare diagnoses
- Obturator internus or gemellus muscle strain: Strains of these deep hip muscles can cause pain and limited mobility in the hip, especially with activities that involve rotation or adduction.
- Ischiogluteal bursitis: Inflammation of the ischiogluteal bursa can cause pain and tenderness in the deep hip and buttock area, especially with activities that involve sitting or hip flexion.