Differential Diagnosis for 77 year old male with burning hip, glute, and thigh pain

• Single most likely diagnosis
  • Trochanteric bursitis: This condition is characterized by inflammation of the bursa located on the outer aspect of the hip, leading to pain and tenderness in the hip, glute, and thigh area. The symptoms worsen with walking, which aligns with the patient's presentation. The age and lack of systemic symptoms such as fever also support this diagnosis.
• Other Likely diagnoses
  • Osteoarthritis of the hip: Given the patient's age, osteoarthritis is a common condition that could cause hip, glute, and thigh pain, especially with weight-bearing activities like walking.
  • Lumbar radiculopathy: This condition, often due to a herniated disc or spinal stenosis, can cause pain radiating from the lower back down to the hip, glute, and thigh. The burning nature of the pain could be indicative of nerve involvement.
  • Piriformis syndrome: This condition involves the piriformis muscle compressing the sciatic nerve, leading to pain in the hip, glute, and thigh. Activities like walking can exacerbate the symptoms.
• Do Not Miss diagnoses
  • Avascular necrosis of the hip: Although less common, avascular necrosis is a serious condition that can cause hip pain and is more likely in older adults. It requires prompt diagnosis and treatment to prevent further damage.
  • Infection (e.g., septic arthritis or osteomyelitis): Despite the absence of fever, infection must be considered, especially in older adults who may not always present with typical symptoms. Infection in the hip or surrounding bone could cause severe pain and has significant implications if not treated promptly.
  • Spinal stenosis: This condition can cause neurogenic claudication, leading to pain, numbness, or weakness in the legs and buttocks when walking, which improves with rest. It's a critical diagnosis to consider due to its impact on mobility and quality of life.
• Rare diagnoses
  • Neuropathic pain due to diabetes: Although the patient's history does not mention diabetes, it's a possibility if not previously diagnosed. Neuropathic pain can present as burning pain in the extremities.
  • Tumor (e.g., metastatic disease to the bone): In older adults, the possibility of a tumor, either primary or metastatic, causing bone pain should be considered, especially if there's a history of cancer.
  • Peripheral artery disease (PAD): PAD could cause claudication pain in the legs when walking, which improves with rest. However, the burning nature of the pain and its location might be less typical for PAD.