Differential Diagnosis for 78 yo man with R hip pain radiating to thigh and numbness in lower right ankle and foot

• Single most likely diagnosis
  • Lumbar spinal stenosis: This condition is common in older adults and can cause hip pain that radiates to the thigh, as well as numbness in the lower extremities. The improvement of pain with movement is also consistent with this diagnosis, as walking or moving can help to reduce the compression on the spinal nerves.
• Other Likely diagnoses
  • Osteoarthritis of the hip: This is a common condition in older adults that can cause hip pain, especially with weight-bearing activities. However, the radiation of pain to the thigh and numbness in the lower extremities could suggest a referred pain pattern or associated lumbar spine disease.
  • Trochanteric bursitis: This condition can cause hip pain that radiates to the thigh, but it is less likely to cause numbness in the lower extremities.
  • Peripheral neuropathy: This condition can cause numbness in the lower extremities, but it is less likely to cause hip pain that radiates to the thigh.
• Do Not Miss diagnoses
  • Aortic aneurysm or dissection: Although less likely, these conditions can cause hip or lower back pain and should be considered in the differential diagnosis, especially if there are associated symptoms such as abdominal pain or a palpable abdominal mass.
  • Spinal epidural abscess or hematoma: These conditions can cause severe back pain, numbness, and weakness in the lower extremities, and can be life-threatening if not promptly diagnosed and treated.
  • Hip fracture: Although the patient's pain improves with movement, a hip fracture should still be considered, especially if there was a recent fall or trauma.
• Rare diagnoses
  • Piriformis syndrome: This condition can cause hip pain that radiates to the thigh and numbness in the lower extremities, but it is relatively rare and usually associated with specific activities or postures.
  • Cauda equina syndrome: This is a rare condition that can cause severe back pain, numbness, and weakness in the lower extremities, as well as bowel and bladder dysfunction. It is usually associated with a herniated disk or other spinal lesion.