Differential Diagnosis for Hip Pain
Single most likely diagnosis
- Greater Trochanteric Bursitis: This condition is characterized by inflammation of the bursa over the greater trochanter, leading to pain on the outer aspect of the hip. The pain is typically exacerbated by activities that involve adduction of the hip, such as walking forward, and relieved by lateral steps, which reduce the pressure on the affected bursa.
Other Likely diagnoses
- Gluteus Medius Tendinopathy: Similar to greater trochanteric bursitis, gluteus medius tendinopathy involves inflammation of the tendon surrounding the hip, causing pain that worsens with forward walking and improves with lateral steps.
- Iliotibial (IT) Band Syndrome: This condition involves inflammation of the iliotibial band, a ligament that runs down the outside of the thigh from the hip to the knee. IT band syndrome can cause hip pain that is worse with forward walking and may improve with lateral steps, depending on the specific area of inflammation.
- Osteoarthritis of the Hip: While osteoarthritis typically causes pain with both forward and lateral movements, some patients may experience more pain with weight-bearing activities like walking forward, potentially showing some relief with lateral steps due to altered biomechanics.
Do Not Miss diagnoses
- Avascular Necrosis (AVN) of the Femoral Head: AVN is a serious condition that occurs when the blood supply to the femoral head is disrupted, leading to necrosis of the bone tissue. It can cause hip pain that worsens with weight-bearing activities. Early diagnosis is crucial to prevent collapse of the femoral head and the need for more extensive surgical interventions.
- Infection or Septic Arthritis: Infections within the hip joint can cause severe pain, especially with movement. While the pattern of pain may not specifically worsen with forward walking and improve with lateral steps, any suspicion of infection warrants immediate medical attention due to the potential for rapid joint destruction.
- Malignancy: Tumors, either primary or metastatic, can cause hip pain. The pain pattern may vary, but any persistent or worsening pain, especially in the absence of a clear traumatic or overuse cause, should prompt an evaluation for malignancy.
Rare diagnoses
- Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain in the hip and buttock area. While it can cause pain with certain movements, the specific pattern of worsening with forward walking and improving with lateral steps is less typical.
- Slipped Capital Femoral Epiphysis (SCFE): SCFE is a condition seen in adolescents where the femoral head slips off the femoral neck. It can cause hip pain that worsens with weight-bearing activities, but the diagnosis is more specific to the pediatric population and may not exactly fit the described pain pattern.