Differential Diagnosis for Low Back/Buttock Pain Radiating Down Thigh Worse with Straight Leg Raise
- Single Most Likely Diagnosis
- Lumbar Disc Herniation: This is the most likely diagnosis given the symptoms. The pain radiating down the thigh, especially when worsened by straight leg raise (a test often used to assess for sciatic nerve irritation), is highly suggestive of a herniated disc compressing or irritating the sciatic nerve.
- Other Likely Diagnoses
- Lumbar Spondylosis: This condition involves wear and tear on the spine, which can lead to similar symptoms by compressing or irritating nerves.
- Piriformis Syndrome: The piriformis muscle can compress the sciatic nerve, leading to pain in the buttock and thigh, especially with activities that involve pivoting or bending.
- Sacroiliac Joint Dysfunction: This can cause pain in the lower back and buttock area, sometimes radiating down the thigh, and can be exacerbated by movements that stress the sacroiliac joint.
- Do Not Miss Diagnoses
- Cauda Equina Syndrome: Although less common, this is a serious condition where the nerves in the spinal canal are compressed, leading to severe pain, numbness, and potentially bladder and bowel dysfunction. It requires immediate medical attention.
- Spinal Infection (e.g., Abscess or Osteomyelitis): Infections in the spine can cause severe back pain and neurological symptoms, including radiating pain, and are medical emergencies.
- Spinal Tumor: Tumors in the spine can compress nerves, leading to pain and neurological symptoms. Early diagnosis is crucial for effective treatment.
- Rare Diagnoses
- Arterial Disease (e.g., Atherosclerosis of the iliac arteries): While less common as a cause for these specific symptoms, severe arterial disease can lead to claudication pain in the buttocks and thighs, especially with exercise.
- Osteonecrosis of the Femoral Head: This condition can cause hip and buttock pain, sometimes radiating down the thigh, but it's less directly associated with straight leg raise worsening of symptoms.