Differential Diagnosis for Pain upon Palpation on Legs

Single Most Likely Diagnosis

• Muscle Strain: This is often the most common cause of pain upon palpation in the legs, resulting from overuse, injury, or excessive physical activity. The pain is typically localized to the affected muscle area.

Other Likely Diagnoses

• Deep Vein Thrombosis (DVT): While not as common as muscle strain, DVT is a significant consideration, especially in patients with risk factors such as recent surgery, immobilization, or cancer. Pain on palpation can be accompanied by swelling and warmth of the affected leg.
• Cellulitis: A bacterial skin infection that can cause pain, redness, and swelling in the affected area. The pain upon palpation is usually accompanied by other signs of infection.
• Tendinitis: Inflammation of the tendons, often due to overuse or repetitive strain, can cause pain upon palpation, especially around the joints.

Do Not Miss Diagnoses

• Compartment Syndrome: A medical emergency characterized by increased pressure within a muscle compartment, leading to pain, especially on palpation, and potentially threatening limb viability. Early diagnosis is crucial.
• Osteomyelitis: A bone infection that can cause severe pain, including pain on palpation, and requires prompt antibiotic treatment to prevent serious complications.
• Peripheral Artery Disease (PAD): While typically presenting with intermittent claudication, severe PAD can cause pain at rest, including pain on palpation, especially in the feet and legs.

Rare Diagnoses

• Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet, which can also include pain upon palpation.
• Complex Regional Pain Syndrome (CRPS): A chronic pain condition that can follow an injury, causing severe, burning pain, and sensitivity, including pain on palpation.
• Neurogenic Pain: Resulting from nerve damage or dysfunction, this can cause a variety of pain sensations, including pain on palpation, often in a dermatomal distribution.

Each of these diagnoses has distinct features and risk factors that can guide further evaluation and management. A thorough history, physical examination, and appropriate diagnostic tests are essential for making an accurate diagnosis.