Differential Diagnosis for Lateral Hip Pain

The differential diagnosis for lateral hip pain can be categorized into several groups based on the likelihood and potential impact of missing a diagnosis.

• Single Most Likely Diagnosis

  • Greater Trochanteric Bursitis/Pain Syndrome: This condition is characterized by inflammation of the bursa located at the lateral aspect of the hip, leading to pain and tenderness. It's often related to repetitive friction or direct trauma to the area, making it a common cause of lateral hip pain.

• Other Likely Diagnoses

  • Gluteus Medius Tendinopathy: Similar to the rotator cuff in the shoulder, the gluteus medius tendon can become inflamed or torn, leading to lateral hip pain, especially with activities like climbing stairs or standing from a seated position.
  • 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 can cause lateral hip and thigh pain, commonly seen in runners or cyclists.
  • Piriformis Syndrome: Although more commonly associated with posterior hip and thigh pain, piriformis syndrome can sometimes present with lateral hip pain due to the proximity of the piriformis muscle to the lateral hip structures.

• Do Not Miss Diagnoses

  • Hip Fracture: While less common, a fracture of the hip, particularly an intertrochanteric or femoral neck fracture, can present with lateral hip pain and must be ruled out, especially in older adults or those with significant trauma.
  • Avascular Necrosis (AVN) of the Femoral Head: AVN can cause hip pain that may initially be localized to the lateral aspect of the hip. It's a critical diagnosis to consider due to its potential for significant morbidity if not addressed promptly.
  • Malignancy: Although rare, tumors such as osteosarcoma or metastatic disease to the bone can cause hip pain. Given the potential severity of these conditions, they must be considered in the differential diagnosis.

• Rare Diagnoses

  • Osteonecrosis of the Trochanter: A rare condition where the bone of the greater trochanter dies due to lack of blood supply, leading to pain and potentially a fracture.
  • Inflammatory Arthropathies: Conditions like rheumatoid arthritis or ankylosing spondylitis can cause hip pain, including lateral hip pain, though they are less common causes compared to other forms of arthritis or musculoskeletal issues.