Differential Diagnosis for 19-year-old Female with Buttock Pain
Single Most Likely Diagnosis
- Coccydynia: This condition, characterized by pain in the coccyx (tailbone) area, is often caused by falls onto the buttocks, direct blows, or repetitive strain. The patient's complaint of pain at the superior buttock cleft and pain with pressure along the coccygeal bones without other significant symptoms aligns closely with coccydynia.
Other Likely Diagnoses
- Levator Ani Syndrome: A condition that involves pain in the anus or rectum due to spasms of the levator ani muscle. The absence of erythema, swelling, or a pit in the skin, along with the location of the pain, could suggest this diagnosis.
- Piriformis Syndrome: This condition occurs when the piriformis muscle, which runs from the base of the spine to the thighbone, compresses or irritates the sciatic nerve. It can cause pain in the buttocks that may radiate down the back of the leg. The patient's symptoms of pain in the superior buttock cleft could be consistent with piriformis syndrome, especially if there's a history of overuse or trauma to the area.
Do Not Miss Diagnoses
- Cauda Equina Syndrome: A serious condition that requires immediate medical attention, characterized by compression or damage to the cauda equina (a bundle of spinal nerves and spinal nerve roots). Symptoms can include severe low back pain, sciatica, and neurological deficits such as numbness or weakness in the legs. Although the patient does not currently exhibit neurological symptoms, any condition that could potentially lead to cauda equina syndrome must be considered.
- Spinal Infection (e.g., Abscess or Osteomyelitis): Infections of the spine can present with back pain and may not always have accompanying fever or significant swelling, especially in early stages. It's crucial to consider these diagnoses due to their potential severity and need for prompt treatment.
Rare Diagnoses
- Tarlov Cyst: These are rare, fluid-filled sacs that can form on the nerve roots in the spine, potentially causing pain, among other symptoms. While they are not common, they could be considered in the differential diagnosis for buttock pain, especially if other causes are ruled out.
- Chordoma: A rare type of bone cancer that can occur at the base of the spine, including the coccyx. It might cause persistent pain in the area and is a diagnosis that, although unlikely, should not be overlooked due to its serious implications.