Differential Diagnosis for 83-year-old Female with Right Hip Pain
Single Most Likely Diagnosis
- Osteoarthritis: Although the hip X-ray shows no significant arthritic changes, osteoarthritis is a common cause of hip pain in elderly patients, and radiographic findings may not always correlate with symptoms. The patient's age and presentation of hip pain radiating to the leg are consistent with this diagnosis.
Other Likely Diagnoses
- Lumbar Radiculopathy: The patient's hip pain radiating to the right leg could be due to nerve root compression in the lumbar spine, which is a common cause of radiating pain in the elderly.
- Trochanteric Bursitis: Inflammation of the bursa over the trochanteric region of the femur can cause hip pain that radiates down the leg, and is a common condition in older adults.
- Degenerative Disc Disease: Degeneration of the intervertebral discs in the lumbar spine can cause pain that radiates to the hip and leg.
Do Not Miss Diagnoses
- Hip Fracture: Although the X-ray shows no acute fracture, a stress fracture or an occult fracture not visible on X-ray could be present, and is a potentially life-threatening condition if missed.
- Avascular Necrosis: This condition, which can cause hip pain, is more common in older adults and can be missed on initial X-ray.
- Infection (e.g., Septic Arthritis): Although less likely, infection is a serious condition that requires prompt diagnosis and treatment to prevent serious complications.
- Cancer (e.g., Metastatic Disease): Although rare, cancer can cause hip pain and should be considered in the differential diagnosis, especially in older adults.
Rare Diagnoses
- Paget's Disease: A rare condition that can cause bone pain and deformity, including in the hip region.
- Osteonecrosis of the Femoral Head: A rare condition that can cause hip pain, although it is more common in younger patients.
- Inflammatory Arthritis (e.g., Rheumatoid Arthritis): Although less common in older adults, inflammatory arthritis can cause hip pain and should be considered in the differential diagnosis.