Differential Diagnosis for a 14-year-old Boy with Right Hip Pain
Single most likely diagnosis
- Slipped Capital Femoral Epiphysis (SCFE): This condition is a common cause of hip pain in adolescents, especially during periods of rapid growth. The gradual worsening of pain, particularly with weight-bearing activities like playing football, and the absence of trauma, make SCFE a strong consideration.
Other Likely diagnoses
- Apophysitis (e.g., iliac apophysitis): Overuse injuries can lead to inflammation of the growth plates (apophyses) in the hip area, causing pain that worsens with activity.
- Stress fracture: Although less common in the hip, stress fractures can occur, especially in young athletes who participate in high-impact sports, leading to gradual onset of pain.
- Osteochondritis dissecans: A condition where a piece of cartilage and bone in the joint becomes damaged, leading to pain and potentially locking or catching sensations in the joint.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Septic arthritis: An infection within the joint, which is a medical emergency requiring prompt treatment to prevent long-term damage.
- Bone tumor (e.g., osteosarcoma, Ewing's sarcoma): Although rare, bone tumors can present with gradual onset of pain and must be considered to ensure early diagnosis and treatment.
- Avascular necrosis: A condition where the blood supply to the bone is interrupted, leading to bone death. This can be caused by various factors, including trauma, steroids, or sickle cell disease.
Rare diagnoses
- Legg-Calve-Perthes disease: A condition characterized by avascular necrosis of the femoral head, more common in younger children but can occur in early teens.
- Synovitis: Inflammation of the synovial membrane, which can be caused by various factors, including infection, trauma, or autoimmune diseases.
- Inflammatory conditions (e.g., juvenile idiopathic arthritis): Chronic conditions that can cause hip pain, stiffness, and swelling, often accompanied by systemic symptoms.