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

  • Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain, stiffness, and sometimes numbness in the hip and thigh. The symptoms of front thigh stiffness and hip pain could be consistent with piriformis syndrome, especially if the physiotherapy has focused on hip strengthening without addressing potential soft tissue issues.
  • Tendinopathy (e.g., Gluteal or Iliopsoas Tendinopathy): Overuse or improper form during deadlifts could lead to tendon inflammation or degeneration around the hip, causing pain and stiffness. The fact that physiotherapy has not fully resolved the symptoms suggests that the issue might be related to overuse or repetitive strain.
  • Hip Flexor Strain: Given the history of starting a new exercise regimen, a strain to the hip flexor muscles could be a contributing factor, especially if the exercises involved significant hip flexion.

• Do Not Miss Diagnoses

  • Avascular Necrosis (AVN) of the Femoral Head: Although less likely, AVN is a serious condition that can 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 consider AVN, especially with persistent hip pain and a history of recent onset, as it requires prompt treatment to prevent further damage.
  • Infection (e.g., Septic Arthritis): Infection within the hip joint is a medical emergency. While the chronic nature of the symptoms makes this less likely, any signs of infection (fever, redness, swelling, etc.) would necessitate immediate medical attention.
  • Tumor: Bone or soft tissue tumors around the hip could cause persistent pain and stiffness. Although rare, this possibility should be considered, especially if there's a significant discrepancy between the severity of symptoms and the expected outcome from physiotherapy and exercise modification.

• Rare Diagnoses

  • Slipped Capital Femoral Epiphysis (SCFE): Typically seen in adolescents, SCFE involves the femoral head slipping off the femoral neck through the growth plate. While rare in a 30-year-old, it could be considered if there were any predisposing factors or if the MRI suggested an abnormality of the femoral head or neck.
  • Osteonecrosis of the Femoral Head due to Other Causes: Besides AVN, other forms of osteonecrosis (e.g., due to sickle cell disease, Gaucher's disease) could present with hip pain and stiffness, though these would be rare and typically associated with other systemic symptoms or known conditions.

Attaching the MRI results for further review could provide valuable insights, especially for conditions like FAI, tendinopathy, or AVN, which may have characteristic findings on imaging. The concern about inflammation is valid and should be further investigated, potentially with additional imaging or laboratory tests if necessary.