Hip pain in a child

Question 1

Child hip pain red flags

Answer 1

Wakes child at night
- malignancy
Redness, swelling, stiffness
- infection or inflam joint disease
Weight loss, anorexia fever, night sweats, fatigue
- malignany, infection, inflammation
Unexplained rash or bruising
- haematological or inflam joint disease, NAI
Severe pain, anxiety, agitation after traumatic injury
- compartment syndrome

Question 2

Transient synovitis of the hip, demographic

Answer 2

Boys 4-8 years

Question 3

Transient synovitis of the hip, presentation

Answer 3

Acute onset limp
With or without pain
Reduced hip movements
Systemically well
Often preceded by viral illness (URTI or gastroenteritis)

Question 4

Manage transient synovitis of the hip

Answer 4

Self limiting
Ibuprofen and paracetamol for pain
Follow up in a few days
Safety net eg if they get febrile

Question 5

Septic arthritis/osteomyelitis presentation

Answer 5

Any age
Fever, inconsolable, systemically unwell
Non-weightbearing, extreme pain on movement
Redness/heat

Question 6

Perthes disease, demographic

Answer 6

Boys 4-8 years

Question 7

Perthes disease presentation

Answer 7

Gradual onset hip pain
Limp
Stiffness, reduced range of hip movement
Can be painless
Can be bilateral

Question 8

Slipped upper femoral epiphysis (SUFE) demographic

Answer 8

Boys, 10-15

Question 9

SUFE risk factors

Answer 9

Overweight

Hypothyroidism

Question 10

SUFE presentation

Answer 10

Acute with sudden onset pain

OR gradual onset vague pain, limp
may be referred to the knee

Knee or distal thigh pain common
Loss of internal rotation of leg in flexion

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

Question 11

Developmental dysplasia of the hip, demographic

Answer 11

Girls, usually detected at birth

Question 12

DDH features

Answer 12

Asymmetrical skin folds
Leg length discrepancies
Buttock flattening
Walking with affected leg in external rotation
Gradual onset painless limp

Barlow’s and Ortolani’s positive

Question 13

Bone tumour, haematological malignancy

Answer 13

Red flags
- nocturnal bone pain etc
Bony swelling may be seen

Haem malignancy more typically younger children. abdo mass with splenomegaly may be present

Question 14

Outside the box reasons for hip pain

Answer 14

Testicular torsion
Inguinal hernia
Appendicitis

Question 15

Juvenile idiopathic arthritis demographic

Answer 15

Any age, <16

Question 16

JIA features

Answer 16

Signs of inflammatory disease - stiffness, swelling, worse in morning etc

ANA may be positive - assoc with anterior uveitis

Question 17

Types of JIA (6)

Answer 17

Oligoarthritis (less than 5 joints in fist 6 months)
Polyarthritis (5+)
Enthesistis related (eg pain in feet and back)
Psoriatic arthritis (dactylitis, psoriasis, family member with psoriasis or nail changes)
Systemic onset JIA
Undifferentiated