Differential Diagnosis for Hip Pain with Increased Pain with Axial Load of the Femoral Head into the Acetabulum with Rotation

• Single Most Likely Diagnosis
  • Femoroacetabular Impingement (FAI): This condition is characterized by abnormal contact between the femoral head and the acetabulum, leading to pain and limited mobility, especially with activities that involve flexion, rotation, and axial loading of the hip.
• Other Likely Diagnoses
  • Labral Tears: Tears in the labrum, the cartilage that surrounds the socket of the hip joint, can cause pain, especially with rotational movements and axial loading.
  • Osteoarthritis: Wear and tear of the joint cartilage can lead to pain with weight-bearing activities and movements that involve axial loading and rotation.
  • Piriformis Syndrome: Irritation of the piriformis muscle, which runs from the base of the spine to the thighbone, can cause pain in the hip and buttock, especially with activities that involve rotation and axial loading.
• Do Not Miss Diagnoses
  • Avascular Necrosis (AVN): A condition where the blood supply to the bone is disrupted, leading to bone death. It can cause severe pain and is a medical emergency if not promptly treated.
  • Septic Arthritis: A bacterial infection within the joint, which is a medical emergency requiring immediate attention to prevent joint destruction and systemic complications.
  • Fracture: Any fracture involving the hip or femur can cause significant pain with movement and weight-bearing and requires prompt diagnosis and treatment.
• Rare Diagnoses
  • Slipped Capital Femoral Epiphysis (SCFE): A condition in adolescents where the ball at the upper end of the femur (thigh bone) slips out of place, causing pain and limited mobility.
  • Synovial Chondromatosis: A rare condition where cartilage grows in the synovium, the lining of the joint, leading to pain, swelling, and limited mobility.
  • Intra-articular Tumors: Rare tumors that occur within the joint can cause pain, swelling, and limited mobility, and their diagnosis is crucial for appropriate management.