Differential Diagnosis for Hip Pain Relieved by Activity but Worsens at Night in Older Adult
- Single Most Likely Diagnosis
- Osteoarthritis: This condition is common in older adults and can cause hip pain that worsens at night due to prolonged periods of inactivity, which can lead to stiffness. Activity can help relieve this stiffness, explaining the improvement in pain during the day.
- Other Likely Diagnoses
- Trochanteric bursitis: Inflammation of the bursa over the trochanter can cause hip pain that may worsen at night, especially if the individual sleeps on the affected side. Activity can help reduce the inflammation and relieve pain.
- Hip flexor strain or tendinitis: These conditions can cause pain that worsens with rest and improves with activity, as movement can help reduce stiffness in the affected muscles or tendons.
- Stress fractures: Although more common in athletes, stress fractures can occur in older adults, especially those with osteoporosis. Pain from stress fractures can worsen at night and improve with activity.
- Do Not Miss Diagnoses
- Avascular necrosis of the femoral head: This condition, often associated with long-term steroid use, trauma, or excessive alcohol consumption, can cause hip pain that worsens at night. It is crucial to diagnose early to prevent collapse of the femoral head.
- Malignancy (e.g., metastatic bone disease): Night pain that improves with activity can be a red flag for malignancy. It's essential to consider this diagnosis, especially in patients with a history of cancer.
- Infection (e.g., septic arthritis or osteomyelitis): Although less common, infections can cause hip pain that worsens at night. These conditions are medical emergencies and require prompt diagnosis and treatment.
- Rare Diagnoses
- Paget's disease of bone: A chronic condition that can cause enlarged and misshapen bones, leading to pain that may worsen at night.
- Osteonecrosis due to other causes (e.g., sickle cell disease, Gaucher's disease): These conditions can lead to avascular necrosis and hip pain with similar characteristics.
- Inflammatory arthropathies (e.g., rheumatoid arthritis, ankylosing spondylitis): Although these conditions are more systemic, they can cause hip pain that worsens at night and improves with activity.