Differential Diagnosis for 47-year-old Female with Hip Pain
Single Most Likely Diagnosis
- Trochanteric Bursitis: This condition is likely given the patient's history of a fall onto her hip, the sharp and shooting nature of the pain, and the exacerbation of pain with activity. The location of the pain in the right hip, where she fell, further supports this diagnosis.
Other Likely Diagnoses
- Osteoarthritis of the Hip: Given the patient's age and the chronic nature of the pain (1.5 months), osteoarthritis is a plausible diagnosis. The pain worsening with activity is consistent with this condition.
- Hip Fracture: Although the patient did not report immediate severe pain after the fall, a stress fracture or an occult fracture could still be present, especially if the fall was significant enough to cause sharp pain.
- Greater Trochanteric Pain Syndrome: This condition involves pain over the greater trochanter due to inflammation of the gluteus medius and minimus tendons and could be related to the fall or overuse.
Do Not Miss Diagnoses
- Avascular Necrosis (AVN) of the Femoral Head: This is a critical diagnosis not to miss, as it can lead to severe and irreversible damage if not treated promptly. The patient's history of diabetes and possibly steroid use for her conditions increase her risk for AVN.
- Infection (Septic Arthritis): Although less likely without fever or systemic symptoms, septic arthritis is a medical emergency that requires immediate attention. The patient's diabetes increases her susceptibility to infections.
- Malignancy (Bone Tumor): While rare, a bone tumor could present with hip pain, especially if the pain is persistent and worsening over time.
Rare Diagnoses
- Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain and possibly numbness or tingling. However, the patient denies radiation, numbness, or tingling, making this less likely.
- Slipped Capital Femoral Epiphysis (SCFE): Typically seen in adolescents, SCFE could be considered in adults with certain risk factors, but it is rare in this age group and usually presents with more systemic symptoms.