Differential Diagnosis for Bilateral Buttock Pain upon Standing
- Single most likely diagnosis
- Musculoskeletal strain: This is the most common cause of buttock pain, especially when it occurs bilaterally upon standing. Prolonged sitting or standing, poor posture, and overuse can lead to strain in the muscles of the buttocks and lower back.
- Other Likely diagnoses
- Piriformis syndrome: The piriformis muscle runs from the base of the spine to the thighbone, and when it compresses the sciatic nerve, it can cause pain in the buttocks that worsens with standing or walking.
- Trochanteric bursitis: Inflammation of the bursae at the outer aspect of the hip can cause buttock pain, especially when standing or lying on the affected side.
- Lower back strain: Strain in the lower back muscles can radiate pain to the buttocks, particularly when standing or changing positions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cauda equina syndrome: A serious condition where the nerves in the spinal canal are compressed, leading to severe pain, numbness, and potentially permanent nerve damage if not promptly treated.
- Spinal stenosis: Narrowing of the spinal canal can compress nerves, leading to pain, numbness, and weakness in the legs and buttocks, which worsens with standing or walking.
- Osteonecrosis of the femoral head: A condition where the blood supply to the hip joint is interrupted, leading to bone death and potentially severe, debilitating pain.
- Rare diagnoses
- Inflammatory arthritis (e.g., ankylosing spondylitis): Chronic inflammatory conditions that can cause pain and stiffness in the buttocks and lower back.
- Neoplastic processes (e.g., tumors): Although rare, tumors in the spine, pelvis, or soft tissues can cause buttock pain, especially if they compress nerves or invade surrounding structures.
- Infectious processes (e.g., osteomyelitis, abscesses): Infections in the bone or soft tissues can cause severe pain, redness, and swelling in the affected area, including the buttocks.