Differential Diagnosis for Sudden Hip Pain on Uneven Ground

• Single most likely diagnosis:
  • Trochanteric bursitis: This condition is characterized by inflammation of the bursa over the trochanter, which can be exacerbated by uneven walking surfaces, leading to sudden hip pain.
• Other Likely diagnoses:
  • Hip strain: Sudden twisting or bending on uneven ground can cause strain to the muscles and tendons surrounding the hip, leading to pain.
  • Osteoarthritis: Pre-existing osteoarthritis of the hip can be aggravated by walking on uneven surfaces, causing sudden pain due to increased stress on the joint.
  • Labral tear: A tear in the labrum, the cartilage that surrounds the socket of the hip joint, can cause sudden hip pain, especially with activities that involve twisting or bending.
• Do Not Miss diagnoses:
  • Hip fracture: Although less common, a hip fracture should not be missed, as it can be life-threatening if not promptly treated. A sudden, severe hip pain after a fall or trauma on uneven ground should raise suspicion for a fracture.
  • Avascular necrosis: This condition, where the blood supply to the bone is interrupted, can cause sudden hip pain and should be considered, especially in patients with risk factors such as long-term steroid use or excessive alcohol consumption.
• Rare diagnoses:
  • Slipped capital femoral epiphysis (SCFE): This condition, more common in adolescents, involves the femoral head slipping off the femoral neck and can cause sudden hip pain, especially after a fall or trauma.
  • Pigmented villonodular synovitis (PVNS): A rare condition characterized by inflammation of the synovium, leading to hip pain and swelling, which can be exacerbated by activities such as walking on uneven ground.