Differential Diagnosis for Lateral Hip Pain
- Single most likely diagnosis
- Greater Trochanteric Bursitis/Pain Syndrome: This condition is characterized by pain on the outer aspect of the hip, tenderness to palpation over the greater trochanter, and pain with flexion, adduction, and internal rotation of the hip. The patient's symptoms, including pain on the outer area of the left hip after exercise and tenderness on palpation of the lateral aspect, align closely with this diagnosis.
- Other Likely diagnoses
- Gluteus Medius Tendinopathy: This condition involves inflammation or degeneration of the gluteus medius tendon, which can cause lateral hip pain, especially with activities that involve hip abduction or external rotation. The patient's pain with flexion to 70° could be related to the involvement of the gluteus medius tendon.
- Iliotibial (IT) Band Syndrome: The IT band runs down the outside of the thigh from the hip to the knee. Friction or inflammation of this band, especially where it crosses the lateral femoral condyle, can cause lateral hip pain, particularly in runners or cyclists. The patient's history of pain after exercise supports this possibility.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Avascular Necrosis of the Femoral Head: Although less common, avascular necrosis can present with hip pain and should be considered, especially if the patient has risk factors such as steroid use, excessive alcohol consumption, or a history of hip trauma. Early diagnosis is crucial for effective treatment.
- Stress Fracture: A stress fracture of the femoral neck or greater trochanter could present with lateral hip pain, especially after an increase in physical activity. Missing this diagnosis could lead to a complete fracture, which has significant implications for treatment and recovery.
- Rare diagnoses
- Osteoid Osteoma: A benign bone tumor that can cause nocturnal pain, which is relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). While rare, it should be considered in the differential diagnosis of hip pain, especially if the pain is persistent and atypical.
- Synovial Chondromatosis: A rare condition characterized by the growth of cartilage in the synovial membrane of the joint, leading to joint pain and swelling. It is less likely but could be considered if other diagnoses are ruled out and the patient presents with unusual or persistent symptoms.