Differential Diagnosis for Hip Pain
The following differential diagnosis is organized into categories to help guide the thought process:
- Single most likely diagnosis
- Hip flexor strain/iliopsoas tear: This is a common injury, especially in athletes who participate in sports that involve sprinting, kicking, or jumping. The iliopsoas muscle is prone to strain or tear due to its anatomy and function.
- Other Likely diagnoses
- Iliopsoas bursitis and tendinitis: Inflammation of the iliopsoas bursa or tendinitis of the iliopsoas tendon can cause hip pain, especially with activities that involve hip flexion.
- Internal snapping pelvis: Also known as coxa saltans, this condition occurs when the iliopsoas tendon snaps over the iliopectineal eminence, causing a snapping sensation in the hip.
- Abductor strain: The gluteus medius and minimus muscles can be strained, leading to hip pain, especially with weight-bearing activities.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hip fracture: Although less common, a hip fracture can occur, especially in older adults or those with osteoporosis. It is essential to consider this diagnosis to avoid missing a potentially life-threatening condition.
- Septic arthritis: Bacterial infection of the hip joint can cause severe pain, swelling, and limited mobility. Prompt diagnosis and treatment are crucial to prevent long-term damage.
- Avulsion fracture: A fracture of the lesser trochanter, where the iliopsoas tendon attaches, can occur, especially in younger athletes.
- Rare diagnoses
- Inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis): These conditions can cause hip pain, stiffness, and limited mobility, although they are less common than other diagnoses.
- Tumors (e.g., osteosarcoma, Ewing's sarcoma): Although rare, tumors can cause hip pain, especially if they involve the bones or soft tissues around the hip joint.
- Piriformis syndrome: Compression of the sciatic nerve by the piriformis muscle can cause hip pain, numbness, and tingling in the leg.