Differential Diagnosis for Right Low Back Pain Radiating to the Right Hip
Single Most Likely Diagnosis
- Lumbar Radiculopathy (L4-L5 or L5-S1 Disc Herniation): This condition is the most likely cause of the patient's symptoms, as the pain radiating to the hip is consistent with nerve root irritation. The worsening of pain with ambulation also supports this diagnosis, as walking can exacerbate the pressure on the affected nerve root.
Other Likely Diagnoses
- Lumbar Strain: A common cause of low back pain, lumbar strain can occur due to overuse or injury, leading to pain that may radiate to the hip. The pain worsening with ambulation could be due to increased strain on the affected muscles.
- Trochanteric Bursitis: Inflammation of the bursa over the trochanter can cause pain in the hip and radiate to the lower back, especially when walking.
- Osteoarthritis of the Hip or Lumbar Spine: Degenerative changes in the hip or lumbar spine can cause pain that worsens with activity, including ambulation.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition that requires immediate medical attention, cauda equina syndrome is characterized by low back pain, sciatica, and potentially bladder and bowel dysfunction. Although less likely, missing this diagnosis could have severe consequences.
- Abdominal Aortic Aneurysm: Although the pain profile might not perfectly match, an abdominal aortic aneurysm can cause back pain that radiates to the hip, especially if it is expanding or leaking. This is a life-threatening condition that must not be overlooked.
- Spinal Infection (Osteomyelitis, Discitis): Infections of the spine can cause severe back pain that worsens with movement and can radiate to the hip. These conditions require prompt diagnosis and treatment to prevent serious complications.
Rare Diagnoses
- Piriformis Syndrome: Although it can cause sciatica-like symptoms, piriformis syndrome is less common and involves the piriformis muscle compressing the sciatic nerve.
- Sacroiliac Joint Dysfunction: This condition can cause pain in the lower back and hip but is less frequently considered as a primary diagnosis for the described symptoms.
- Neoplastic Processes (Metastatic Disease): Although rare, metastatic disease to the spine or hip can cause pain that radiates from the back to the hip, especially if the cancer involves the lumbar spine or pelvic bones.