Differential Diagnosis for Lower Back Pain Radiating to Right Side Hip to Knees and Foot

Single Most Likely Diagnosis

• Lumbar Radiculopathy (L4-L5 or L5-S1 Disc Herniation): This condition is the most likely diagnosis due to the radiation of pain from the lower back down to the hip, knee, and foot, which is consistent with the distribution of the sciatic nerve. The dull sensation and sore feeling on the lateral aspect of the leg also align with the typical presentation of lumbar radiculopathy.

Other Likely Diagnoses

• Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain and numbness in the buttock and leg. The symptoms can mimic those of lumbar radiculopathy, making it a plausible alternative diagnosis.
• Lumbar Spondylosis: Degenerative changes in the lumbar spine can cause pain and stiffness, which may radiate to the hip and leg. This condition is common in older adults and could be a contributing factor to the patient's symptoms.
• Trochanteric Bursitis: Inflammation of the bursa over the greater trochanter can cause pain and tenderness on the lateral aspect of the hip, which may radiate down to the knee and foot.

Do Not Miss Diagnoses

• Cauda Equina Syndrome: A rare but serious condition where the nerves in the spinal canal are compressed, leading to severe pain, numbness, and weakness in the legs. It is essential to rule out this condition due to its potential for permanent neurological damage if left untreated.
• Spinal Infection (Abscess or Osteomyelitis): Infections in the spine can cause severe back pain, fever, and neurological deficits. Although less common, these conditions require prompt diagnosis and treatment to prevent serious complications.
• Spinal Tumor: Tumors in the spine can compress nerves, leading to pain, numbness, and weakness. While rare, it is crucial to consider this possibility to ensure timely diagnosis and treatment.

Rare Diagnoses

• Peripheral Artery Disease: Although more common in older adults with risk factors for vascular disease, peripheral artery disease can cause leg pain and numbness, especially with activity.
• Neuropathy (Diabetic or Idiopathic): Certain types of neuropathy can cause pain, numbness, and tingling in the legs, but the pattern of symptoms and the presence of other systemic symptoms would help differentiate these conditions from the more likely diagnoses listed above.