Differential Diagnosis for Hip Pain

The patient presents with pain during hip abduction and extension and flexion. Here's a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Trochanteric Bursitis: This condition is characterized by inflammation of the bursa over the greater trochanter of the femur, leading to pain during hip abduction, extension, and sometimes flexion. The pain is typically localized to the lateral aspect of the hip and can be exacerbated by activities that involve these movements.

• Other Likely Diagnoses

  • Gluteus Medius Tendinopathy: Inflammation or degeneration of the gluteus medius tendon can cause pain during hip abduction and sometimes during extension and flexion, due to the tendon's role in stabilizing the hip joint.
  • Piriformis Syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain in the hip and buttock area, which can be exacerbated by movements such as hip flexion, extension, and abduction.
  • Hip Osteoarthritis: While more commonly associated with pain during weight-bearing activities, advanced hip osteoarthritis can cause pain with a wide range of hip movements, including abduction, extension, and flexion.

• Do Not Miss Diagnoses

  • Septic Arthritis of the Hip: Although less common, septic arthritis is a medical emergency that requires prompt diagnosis and treatment. It can present with acute onset of hip pain, especially with movement, and is accompanied by systemic symptoms such as fever.
  • Avascular Necrosis (AVN) of the Femoral Head: AVN can cause hip pain that worsens with weight-bearing and movement. It's crucial to diagnose early to prevent collapse of the femoral head and subsequent arthritis.
  • Stress Fracture: Stress fractures around the hip can cause pain that is exacerbated by weight-bearing and certain movements. They are more common in athletes or individuals with osteoporosis.

• Rare Diagnoses

  • Synovial Chondromatosis: A rare condition characterized by the growth of cartilage in the synovial membrane of the joint, leading to pain and mechanical symptoms.
  • Inflammatory Arthropathies (e.g., Rheumatoid Arthritis, Ankylosing Spondylitis): These conditions can cause hip pain and stiffness, although they are less common causes of hip pain compared to other joints.
  • Tumors (Benign or Malignant): Although rare, tumors around the hip can cause pain that is exacerbated by movement. They often present with a mass or night pain.