Differential Diagnosis for Right Hip Pain

The patient presents with right hip pain that wraps around to the mid buttock area, with a normal hip X-ray. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Piriformis Syndrome: This condition is characterized by pain in the hip and buttock area due to compression of the sciatic nerve by the piriformis muscle. The normal hip X-ray and the specific location of the pain make this a likely diagnosis.
• Other Likely Diagnoses
  • Trochanteric Bursitis: Inflammation of the bursa over the greater trochanter can cause hip pain that radiates to the buttock area. Normal X-ray findings do not rule out this condition.
  • Gluteus Medius Tendinopathy: Similar to trochanteric bursitis, issues with the gluteus medius tendon can cause pain in the hip and buttock area without abnormal X-ray findings.
  • Lumbar Radiculopathy: Although the primary complaint is hip pain, lumbar radiculopathy (especially involving the L4-S1 nerve roots) can cause pain that radiates to the hip and buttock area.
• Do Not Miss Diagnoses
  • Avascular Necrosis (AVN) of the Femoral Head: Although the X-ray is normal, early AVN might not be visible on initial X-rays. This condition is critical to diagnose early due to its potential for severe and irreversible damage.
  • Infection (Septic Arthritis or Osteomyelitis): Infections in the hip joint or bone can present with pain and normal initial X-rays. These conditions are medical emergencies.
  • Tumor: Both benign and malignant tumors can cause hip pain. While less common, missing a tumor could have significant consequences.
• Rare Diagnoses
  • Stress Fracture: Although more common in athletes or individuals with osteoporosis, stress fractures can occur in anyone and might not be visible on initial X-rays.
  • Osteitis Pubis: Inflammation of the pubic bone and its surrounding structures, often seen in athletes, can cause hip and groin pain.
  • Sacroiliac Joint Dysfunction: While more commonly associated with lower back pain, sacroiliac joint issues can sometimes cause pain that radiates to the hip and buttock area.

Each of these diagnoses has a different set of implications for treatment and prognosis, highlighting the importance of a thorough diagnostic workup.