Back and Hip Pain Differential Diagnosis
Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five spinal nerve roots that form the sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.
Although sciatica is a relatively common form of low back and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain.
A cramping sensation of the thigh
Shooting pains from the buttock, down the leg
Tingling, or pins-and-needles sensations in the legs and thighs
A burning sensation in the thigh.
Vertebral Instability is abnormal movement between a bone in the spine and the one next to it. As a disc degenerates it loses tension which allows the disc to bulge and permits increasing movements to take place between the vertebrae. The loss of disc height causes the joints in the back to displace and override beyond their correct normal alignment. This overriding and abnormal slipping of the joints causes increased wear and tear and the production of bone spurs around the joint.
Catching pain when standing from sitting position
Sudden pain when bending forward or backwards
Pain on lifting
Spasm in back muscles.
Spondylolysis is a defect of a vertebra. It is typically caused by stress fracture of the bone, and is especially common in adolescents who overtrain in activities such as rowing, tennis, diving, martial arts and gymnastics.
Lower back pain that is worsened with activity
Lower back pain that is worsened with bending back of the spine
FAI (femoral acetabular impingement) – common in cyclists
FAI is a condition affecting the hip joint in young and middle-aged adults. Impingement occurs when the ball shaped femoral head rubs abnormally or doesn’t have full range of motion in the acetabular socket. Damage in the hip joint can occur to the articular cartilage or the labral cartilage (soft tissue bumper of the socket). Treatment options vary from conservative treatment to arthroscopic and open surgery.
Dull ache around groin, lower back and generally around the hip
Increased pain when in hip flexion.
Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two surfaces. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. As patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful.
Tenderness over the bony prominence of the upper/outer thigh
Swelling over the bursa.
Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending down the lower thigh and into the leg.
Radiating pain into the buttock, posterior thigh and lower leg
Tenderness over sciatic notch
Increased pain with prolonged sitting or walking.