Differential Diagnosis
The patient's symptoms of right-sided abdominal pain radiating to the right groin and leg, worsening with movement and walking, suggest a possible musculoskeletal or neurological origin. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Lumbar disc herniation or radiculopathy: The patient's symptoms of pain radiating to the leg, worsening with movement, and a cramping sensation are consistent with nerve root irritation, which can be caused by a herniated disc.
- Other Likely diagnoses
- Piriformis syndrome: This condition, where the piriformis muscle compresses the sciatic nerve, can cause pain in the buttock and leg, which may worsen with movement.
- Trochanteric bursitis: Inflammation of the bursa over the hip can cause pain in the groin and leg, especially with movement.
- Osteoarthritis of the hip or spine: Degenerative joint disease can cause pain in the hip, groin, and leg, which may worsen with movement.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Abdominal aortic aneurysm: Although less likely, a ruptured abdominal aortic aneurysm can cause severe abdominal and back pain, which may radiate to the leg.
- Spinal cord compression or cauda equina syndrome: These conditions can cause severe neurological symptoms, including pain, numbness, and weakness in the legs, and require urgent medical attention.
- Rare diagnoses
- Neoplastic processes (e.g., spinal or pelvic tumors): Although rare, tumors in the spine or pelvis can cause pain and neurological symptoms.
- Inflammatory conditions (e.g., ankylosing spondylitis): Chronic inflammatory conditions can cause pain and stiffness in the spine and hips.
Management
The management of the patient's condition will depend on the underlying diagnosis. Initial steps may include:
- Imaging studies (e.g., MRI or CT scans) to evaluate the spine, hips, and pelvis
- Electromyography (EMG) or nerve conduction studies (NCS) to assess nerve function
- Physical therapy to improve mobility and strengthen the muscles
- Pain management with medications (e.g., NSAIDs, muscle relaxants) or interventional procedures (e.g., injections)
- Referral to a specialist (e.g., orthopedic surgeon, neurologist) for further evaluation and treatment.