Differential Diagnosis for 83-year-old Female with Right Hip Pain
Single Most Likely Diagnosis
- Osteoarthritis or Soft Tissue Injury: Despite the hip X-ray showing no significant arthritic changes, osteoarthritis is a common condition in the elderly that can cause hip pain radiating to the leg. Soft tissue injuries, such as strains or tendinitis, are also possible given the patient's age and presentation.
Other Likely Diagnoses
- Lumbar Radiculopathy: The pain radiating to the right leg suggests a possible lumbar spine origin, such as a herniated disc or spinal stenosis, which can cause nerve root irritation and pain in the hip and leg.
- Trochanteric Bursitis: Inflammation of the bursa over the trochanteric region of the femur can cause hip pain that radiates down the leg, especially in older adults.
- Chronic Kidney Disease (CKD) Related Bone Pain: The patient's elevated creatinine and decreased eGFR suggest CKD, which can cause bone pain due to secondary hyperparathyroidism or osteodystrophy.
Do Not Miss Diagnoses
- Hip Fracture: Although the X-ray shows no acute fracture, it's essential to consider the possibility of a non-displaced or stress fracture, especially in an elderly patient with osteoporosis risk factors.
- Avascular Necrosis (AVN) of the Femoral Head: AVN can cause hip pain and is more common in older adults, especially those with risk factors such as osteoporosis or steroid use.
- Infection (e.g., Septic Arthritis or Osteomyelitis): Infection can cause hip pain and is a medical emergency, especially in older adults with compromised immune systems.
- Cauda Equina Syndrome: A rare but serious condition caused by compression of the cauda equina nerves in the lumbar spine, which can cause severe pain, numbness, and weakness in the legs.
Rare Diagnoses
- Paget's Disease of Bone: A rare condition that can cause bone pain and deformity, especially in older adults.
- Bone Metastases: Although less likely, bone metastases from a primary cancer can cause hip pain and should be considered in the differential diagnosis, especially if there are other suspicious symptoms or findings.