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 the elderly, and radiographic findings may not always correlate with symptoms. The patient's age and presentation of hip pain radiating to the leg make this a plausible diagnosis.
Other Likely Diagnoses
- Musculoskeletal strain: Given the patient's age and the absence of significant findings on the hip X-ray, a musculoskeletal strain or soft tissue injury could be causing her pain.
- Lumbar radiculopathy: Pain radiating from the hip to the leg could also be indicative of a lumbar radiculopathy, where a nerve root in the lower back is irritated or compressed.
- Trochanteric bursitis: Inflammation of the bursa over the trochanteric region of the femur could cause hip pain that radiates down the leg.
Do Not Miss Diagnoses
- Hip fracture: Although the X-ray did not show an acute fracture, it is crucial to consider the possibility of a fracture not visible on initial X-ray, especially in an elderly patient with significant trauma or osteoporosis. Further imaging like an MRI might be necessary if suspicion remains high.
- Avascular necrosis of the femoral head: This condition, often associated with chronic steroid use, significant alcohol consumption, or trauma, can cause hip pain and might not be immediately visible on X-ray.
- Infection (septic arthritis or osteomyelitis): Infections in the hip joint or bone can present with pain and might not have significant findings on initial X-ray. The patient's elevated creatinine and decreased eGFR could indicate a systemic infection or sepsis.
- Cauda equina syndrome: A serious condition where the nerves in the spinal canal are compressed, causing pain, numbness, and potentially bladder and bowel dysfunction. It requires immediate medical attention.
Rare Diagnoses
- Paget's disease of bone: A chronic condition that can cause enlarged and misshapen bones due to abnormal bone destruction and regrowth. It could potentially cause hip pain but is less common.
- Bone metastasis: Although less likely without a known primary cancer, bone metastases could cause hip pain and should be considered, especially if other systemic symptoms are present.
- Osteonecrosis of the femoral head due to other causes: Besides avascular necrosis, other conditions like sickle cell disease or Gaucher's disease could lead to osteonecrosis, though these would be rare in an 83-year-old without a known history of such conditions.