Hip Pain in a Child Flashcards
What are red flags for a child with a limp?
- Pain waking them up at night
- Redness, swelling or stiffness of the joint or limb
- Weight loss, anorexia, fever, night sweats or fatigue
- Unexplained rash or bruising
- Limp and stiffness worse in the morning
- Unable to weight bear or painful limitation of range of motion
- Severe pain, anxiety and agitation after traumatic injury
- Palpable mass
What would you examine if there is pain in the hip?
- Abdomen - hernia orifices and testicles
- Knee
- The knee
What is transient synovitis of the hip?
- Irritable hip. More common in boys, typically between 4-8 yrs.
- Acute onset limp, with or without pain, with reduced hip movements
- The child is systemically well and it is self limiting
- Often preceded by a viral illness, either URTI or gastroenteritis
What is septic arthritis/osteomyelitis?
- Occurs at any age.
- Associated with fever, inconsolable and systemic upset, acute onset pain, non-weightbearing and extreme pain on movement
- Local signs, redness and heat may be present
- Red flag condition
What is Perthes disease?
- More common in boys, typically 4-8 yrs
- Gradual onset limp, can be painless, usually bilateral
- Occurs as result of avascular necrosis due to interruption of blood supply to the femoral epiphysis
- Remodelling occurs and can result in deformity and can cause early onset OA
What are the clinical signs of Perthes disease?
Minor, slight restriction of hip movements, especially internal rotation with some spasm.
What is Slipped Upper Femoral Epiphysis (SUFE)?
- More common in boys, typicall >/=10yrs
- Risk factors: overweight, hypothyroidism
- Can present acutely with sudden onset pain and non-weight-bearing or gradual onset vague pain that may be referred to the knee and a limp
- Caused by proximal femoral growth plate becoming unstable and the epiphysis and diaphysis can slip
- Requires urgent surgical stabilisation with pins to prevent further slippage of the epiphysis.
What is Developmental Dysplasia of the Hip (DDH)?
- More common girls
- Usually detected at birth, but can present later
- Signs include asymmetrical skin folds, leg length discrepancies, buttock flattening and walking with the affected leg in external rotation
- Older children may present with a gradual onset of a painless limp
What is Juvenile Idiopathic Arthritis (JIA)?
- Presents at any age
- Important to determine whether hx suggests inflammatory pathology
- Pain or limping can be caused by knee or ankle swelling
How would a bone tumour present?
- Red flag symptoms
- Nocturnal bone pain which responds to NSAIDs
- Bony swelling may be evident
What are the types of JIA?
- Oligoarthritis: <5 joints affected
- Polyarthritis: >5 joints affected - 1 type +ve for RF and the other -ve for RF
- Enthesitis related arthritis (ERA): inflammation where tendons attach to bone
- Psoriatic arthritis: any joints affected
- Systemic onset JIA: fever or rash beginning of illness
- Undifferentiated arthritis: any that doesn’t fit in with the others
What is synovitis treatment?
- Advice on rest and simple analgesia
- Straight to A+E if symptoms worsen, fever develops or child cannot weightbear
- If symptoms improving within 48 hours, the child should be reviewed in 1 week to confirm complete resolution
What is the treatment for Perthes disease?
Put in a position of abduction and internal rotation which can be done by traction in bed or an abduction frame. Or without traction in abduction plasters or braces.
