Hip pain

Question 1

Hip pain in children presents with?

Answer 1

Joint pain is a common paediatric presentation, particularly an acute limp.

Hip pain will present differently depending on the developmental age of the child. They may present with:

Limp
Refusal to use the affected leg
Refusal to weight bear
Inability to walk
Pain
Swollen or tender joint

TOM TIP: Examiners like to test your knowledge about the causes of hip pain in a child. It is worth being familiar with the differential diagnosis and distinguishing features of each cause.

Question 2

Causes of joint pain in children?

Answer 2

It is helpful to remember the differential diagnosis in the context of the age of the child. There is some overlap in ages.

0 – 4 years:

Septic arthritis
Developmental dysplasia of the hip (DDH)
Transient sinovitis

5 – 10 years:

Septic arthritis
Transient sinovitis
Perthes disease

10 – 16 years:

Septic arthritis
Slipped upper femoral epiphysis (SUFE)
Juvenile idiopathic arthritis

Question 3

Red flags for hip pain?

Answer 3

Suspect serious pathology if there are red flags:

Child under 3 years
Fever
Waking at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Stiffness in the morning
Swollen or red joint

Question 4

Management of hip pain?

Answer 4

Criteria for urgent referral for assessment in a limping child:

Child under 3 years
Child older than 9 with a restricted or painful hip
Not able to weight bear
Evidence of neurovascular compromise
Severe pain or agitation
Red flags for serious pathology
Suspicion of abuse

Management will focus on identifying the underlying cause. Investigations that can be useful include:

Blood tests including inflammatory markers (CRP and ESR) for JIA and septic arthritis
Xrays are used to diagnose fractures, SUFE and other boney pathology
Ultrasound can establish an effusion (fluid) in the joint
Joint aspiration is used to diagnose or exclude septic arthritis
MRI is used to diagnose osteomyelitis