Differential Diagnosis for Inner Thigh Pain Radiating Down Leg in a Healthy 44-Year-Old Male

Single Most Likely Diagnosis

• Meralgia Paresthetica: This condition is characterized by numbness, tingling, and burning pain in the outer part of the thigh due to compression of the lateral femoral cutaneous nerve. It can sometimes radiate down the leg and is common in healthy individuals, especially those who have recently gained weight or started wearing tight clothing.

Other Likely Diagnoses

• Lumbar Radiculopathy: This refers to damage or irritation of the nerve roots in the lumbar spine, which can cause pain, numbness, or weakness radiating down the leg. Given the age and the presentation, a herniated disc or foraminal stenosis could be contributing factors.
• Piriformis Syndrome: This condition occurs when the piriformis muscle, located in the buttock region, compresses or irritates the sciatic nerve, leading to pain, numbness, and tingling that can radiate down the back of the leg.
• Hamstring Strain: A strain or pull in the hamstring muscles can cause pain in the back of the thigh that may radiate down the leg, especially if the strain is severe.

Do Not Miss Diagnoses

• Deep Vein Thrombosis (DVT): Although less common in healthy individuals without risk factors, DVT can cause leg pain and swelling. It's a critical diagnosis not to miss due to the risk of pulmonary embolism.
• Aortic Aneurysm or Aortic Dissection: These are life-threatening conditions that can cause severe, radiating pain. While rare in a healthy 44-year-old, they are emergencies that cannot be overlooked.
• Spinal Stenosis: Narrowing of the spinal canal can cause pain, numbness, or weakness in the legs, especially with walking or standing. It's more common in older adults but can occur in younger individuals.

Rare Diagnoses

• Neurogenic Tumors: Tumors affecting the nerves, such as schwannomas or neurofibromas, can cause radiating pain but are less common.
• Inflammatory or Infectious Processes: Conditions like osteomyelitis (bone infection) or abscesses in the soft tissues can cause localized pain that may radiate, but these would typically be accompanied by other symptoms such as fever or redness.
• Peripheral Artery Disease (PAD): Although more common in older individuals or those with significant risk factors for vascular disease, PAD can cause leg pain, especially with exertion, due to inadequate blood flow.