Differential Diagnosis for 22-year-old Male with Hip and Lumbar Pain
- Single most likely diagnosis:
- Musculoskeletal strain: Given the patient's occupation as a CNA, which involves frequent lifting and turning of patients, musculoskeletal strain is the most likely cause of his left lateral hip pain and left lower lumbar pain. The absence of any specific injury or trauma, and the lack of improvement with heating pad, Tylenol, and medical marijuana, does not rule out this diagnosis.
- Other Likely diagnoses:
- Lumbar disc herniation: The patient's symptoms of hip and lumbar pain could be indicative of a lumbar disc herniation, especially given his occupation, which may involve heavy lifting.
- Trochanteric bursitis: Inflammation of the trochanteric bursa, which is located on the outer aspect of the hip, could cause pain in the left lateral hip area.
- Piriformis syndrome: The piriformis muscle runs from the base of the spine to the thighbone, and irritation of this muscle could cause pain in the hip and lumbar area.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Cauda equina syndrome: Although the patient denies numbness, urinary incontinence, or loss of bowel control, cauda equina syndrome is a medical emergency that requires prompt attention. It is characterized by compression of the nerve roots in the lumbar spine, which could lead to serious complications if left untreated.
- Spinal infection (e.g., osteomyelitis or discitis): Although the patient is afebrile and denies any IV drug use or history of cancer, spinal infection is a potential cause of hip and lumbar pain that requires prompt diagnosis and treatment to prevent serious complications.
- Fracture: Although the patient denies any fall or trauma, a fracture could still be present, especially if it is a stress fracture.
- Rare diagnoses:
- Avascular necrosis of the femoral head: This condition, which is characterized by the death of bone tissue due to lack of blood supply, could cause hip pain.
- Osteonecrosis: Similar to avascular necrosis, osteonecrosis is a rare condition that could cause hip and lumbar pain.