Differential Diagnosis for Left Hip Pain

Given the information provided, here's a structured approach to considering potential diagnoses for the left hip pain:

• 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 stiffness, especially with activities like deadlifts that involve deep hip flexion and rotation. The onset of pain around the time of starting deadlifts and the persistence of symptoms despite physiotherapy suggest a mechanical issue such as FAI.

• Other Likely Diagnoses

  • Tendinopathy (e.g., Iliopsoas or Gluteal Tendinopathy): Overuse or improper form during deadlifts could lead to inflammation and degeneration of the tendons around the hip, causing pain and stiffness.
  • Labral Tear: A tear in the labrum, the cartilage that surrounds the socket of the hip joint, could cause hip pain, stiffness, and limited mobility, especially with activities that involve twisting or pivoting.
  • Piriformis Syndrome: Compression of the sciatic nerve by the piriformis muscle could lead to pain, numbness, and tingling in the hip and thigh, although this typically presents with more neurological symptoms.

• Do Not Miss Diagnoses

  • Avascular Necrosis (AVN) of the Femoral Head: Although less common, AVN is a serious condition that could result from trauma, steroid use, or other factors, leading to the death of bone tissue due to a lack of blood supply. It's crucial to diagnose early to prevent collapse of the femoral head.
  • Infection (e.g., Septic Arthritis or Osteomyelitis): Infection within the joint or bone is a medical emergency that requires prompt diagnosis and treatment to prevent serious complications.
  • Tumor (Benign or Malignant): Although rare, tumors could cause persistent pain and should be considered, especially if there's significant night pain or systemic symptoms like weight loss.

• Rare Diagnoses

  • Slipped Capital Femoral Epiphysis (SCFE): More common in adolescents, SCFE is a condition where the ball at the upper end of the femur (thigh bone) slips out of place, but it can occasionally occur in young adults.
  • Legg-Calve-Perthes Disease: A rare condition in adults, it involves the temporary loss of blood supply to the hip, leading to necrosis of the bone.

Given the chronic nature of the pain and the lack of significant improvement with physiotherapy, reviewing the MRI results would be beneficial to further narrow down the differential diagnosis, especially to assess for structural issues like FAI, labral tears, or signs of early AVN. Consultation with an orthopedic specialist may also be warranted for further evaluation and management.