Hip pain in a child

Question 1

What is transient synovitis of the hip?

Answer 1

Temporary inflammation of the synovial membrane

Question 2

What are the clinical features of transient synovitis of the hip?

Answer 2

• Acute onset limp
• With or without pain
• No restriction in hip movements
• Cannot weight bear
• Often preceded by viral illness
• Self-limiting

Question 3

What is the management of transient synovitis of the hip?

Answer 3

• Simple analgesia

* Safety net: Attend A&E immediately if symptoms worsen/fever

Question 4

What is perthe’s disease?

Answer 4

Avascular necrosis due to interruption of the blood supply to femoral epiphysis.

Question 5

What are the clinical features of perthe’s disease?

Answer 5

• Gradual onset limp
• Can be painless or painful in hip/groin
• Referred pain to knee
• Restricted hip rotation
• Can cause early-onset OA
• Can be unilateral or bilateral

Question 6

What is seen on XR with Perthe’s disease?

Answer 6

• Widening of joint space

* Decreased femoral head size/flattening

Question 7

What is a slipped upper femoral epiphysis?

Answer 7

Proximal femoral growth plate becomes unstable and epiphysis and diaphysis can slip

Question 8

What are the clinical features of a slipped upper femoral epiphysis?

Answer 8

• Sudden/Gradual onset pain
• Non-weightbearing pain
• Pain referred to the knee and a limp
• Pain disproportionate to trauma
• Prefer to keep hip in external rotation

Question 9

What is developmental dysplasia of the hip?

Answer 9

Abnormal development of the foetal bones causes a structural abnormality

Question 10

What are the clinical features of developmental dysplasia of the hip?

Answer 10

• Asymmetrical skin folds
• Leg length discrepancies
• Bilateral restriction in abduction
• Different in knee level when hips are flexed
• Clunking of hips on special tests (Ortolani and Barlow)

Question 11

What is juvenile idiopathic arthritis?

Answer 11

Arthritis occurring in someone <16yrs

Question 12

What are the features of systemic onset JIA?

Answer 12

• Pyrexia
• Salmon-pink rash
• Lymphadenopathy
• Arthritis
• Uveitis
• Anorexia
• Weight loss

Question 13

What are the red flags of a bone tumour?

Answer 13

• Nocturnal bone pain that responds to NSAIDs

* Bony swelling

Question 14

What is the most common childhood bone tumour?

Answer 14

Ewing sarcoma

Question 15

What most commonly occurs ages 0-3yrs?

Answer 15

• Developmental dysplasia of the hip
• Fracture
• Haematological malignancy

Question 16

What most commonly occurs ages 3-10yrs?

Answer 16

• Transient synovitis

- Perthe’s disease

Question 17

What most commonly occurs ages 10-19yrs?

Answer 17

• Bone tumours

- Slipped upper femoral epiphysis

Question 18

What most commonly occurs at any age?

Answer 18

• Non-accidental injury
• testicular torsion/inguinal hernia/appendicits
• Septic arthritis/osetomyelitis
• Juvelnile idiopathic arthritis