Hip pain in a child

Question 1

According to NICE, what are the red flags in a child with a limp?

Answer 1

1. Pain at night that wakes the child
2. Redness, swelling or stiffness
3. Weight loss, anorexia, fever, night sweats, fatigue
4. Unexplained rashes/bruising
5. Limp/stiffness worse on waking
6. Unable to weight bear or painful limitation of movement
7. Severe pain after trauma
8. Palpable mass

Question 2

When do NICE suggest that there should be an urgent referral made for a child with a painful limp?

Answer 2

1. Fever or red flags present
2. Suspicion of maltreatment
3. Younger than 3 years (chance of it being transient synovitis and self limiting in this age group is rare)
4. Older than 9 with painful/restricted movement of the joint

Question 3

Pain at the hip may be referred, in a child with hip pain, where else would you examine?

Answer 3

1. Abdomen
2. Testicles
3. The joint above and below (knee)

Question 4

What is transient synovitis of the hip?

Answer 4

It is also known as irritable hip

Question 5

How does a child present with transient synovitis of the hip?

Answer 5

Acute onset limp with or without pain and reduced hip movements. They will present a few days after a viral illness. Most common in boys ages 4-8 years.

Question 6

What is Perthes Disease?

Answer 6

A gradual onset limp which can be painless. It is most common in boys aged 4-8 years.

Question 7

What is the pathology of Perthes Disease?

Answer 7

Avascular necrosis of the hip joint due to bone remodelling that can result in a deformity.

Question 8

What is a slipped upper femoral epiphysis (SUFE)?

Answer 8

Acute onset pain and non weight-bearing due to slippage of the epiphysis and diaphysis.

Question 9

What are the risk factors for slipped upper femoral epiphysis?

Answer 9

• Being male
• Aged 10<
• Being overweight
• Hypothyroidism