Differential Diagnosis for Point Tenderness at the Greater Trochanter and Lower Back Pain

Single Most Likely Diagnosis

• Trochanteric Bursitis: This condition is characterized by inflammation of the bursa located at the greater trochanter, leading to point tenderness and pain in the area, which can also radiate to the lower back. The proximity of the greater trochanter to the lower back and the referral patterns of pain make this a highly plausible diagnosis.

Other Likely Diagnoses

• Gluteus Medius Tendinopathy: Similar to trochanteric bursitis, this condition affects the tendons of the gluteus medius muscle, which is near the greater trochanter. It can cause pain and tenderness in the same area and is often associated with lower back pain due to altered gait mechanics or referred pain.
• Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain in the buttocks and lower back. While the primary pain location might not be directly at the greater trochanter, the syndrome can cause referred pain in this area.
• Lumbar Radiculopathy: This refers to nerve root irritation or damage in the lumbar spine, which can cause pain radiating down the back and into the buttocks or legs. The pain pattern can sometimes be localized near the greater trochanter, especially if the L4 or L5 nerve roots are involved.

Do Not Miss Diagnoses

• Avascular Necrosis of the Femoral Head: Although less common, avascular necrosis can cause hip and lower back pain. It is crucial to diagnose early to prevent further damage to the femoral head.
• Infection (Osteomyelitis or Septic Bursitis): Infections in the bone or bursae around the greater trochanter can present with pain and point tenderness. These conditions require prompt diagnosis and treatment to avoid serious complications.
• Malignancy (Bone or Soft Tissue Tumors): Tumors in the bone or soft tissues near the greater trochanter can cause localized pain and tenderness. While rare, missing a diagnosis of malignancy could have severe consequences.

Rare Diagnoses

• Greater Trochanteric Fracture: Stress fractures or acute fractures of the greater trochanter can cause point tenderness and pain, but these are less common than other conditions listed here.
• Fascia Iliaca Compartment Syndrome: This is a rare condition involving increased pressure within the fascia iliaca compartment, which can cause pain in the lower back and hip area.