Differential Diagnosis for Unilateral Upper Buttock Pain
Single Most Likely Diagnosis
- Trochanteric Bursitis: This condition is characterized by inflammation of the bursa over the greater trochanter of the femur, often caused by direct trauma, such as a fall, or repetitive friction from movement. The symptoms of pain over the upper buttock area that worsens with movement are consistent with this diagnosis, especially given the history of a fall and normal X-rays, which would not show soft tissue injuries like bursitis.
Other Likely Diagnoses
- Contusion or Soft Tissue Injury: A direct blow to the area, such as from a fall, can cause bruising and pain in the soft tissues (muscles, tendons, ligaments) of the upper buttock. This would not be visible on an X-ray but could cause significant pain, especially with movement.
- Gluteal Strain: Overstretching or tearing of the gluteal muscles can occur from a fall or sudden contraction of the muscle, leading to pain and stiffness in the buttock area, worsened by movement.
Do Not Miss Diagnoses
- Fracture Not Visible on X-Ray (e.g., Stress Fracture, Occult Fracture): Although the X-rays are reported as normal, some fractures, especially stress fractures or occult fractures, may not be immediately visible. These conditions require further imaging (like an MRI or a follow-up X-ray) for diagnosis and are critical not to miss due to the potential for complications if left untreated.
- Avulsion Fracture: A fragment of bone pulled off by a tendon or ligament, which might not be immediately apparent on an X-ray, especially if the fragment is small or the X-ray views are limited.
Rare Diagnoses
- Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain in the buttock that can radiate down the leg. While it's less common and typically associated with specific activities or anatomical variations, it could be considered in the differential diagnosis, especially if the pain has a radiating component.
- Infection or Abscess: Although rare, an infection in the soft tissues of the buttock could present with pain, swelling, and worsening symptoms with movement. This would be more likely in the context of a compromised immune system, recent injection, or other predisposing factors.