Hip pain in children Flashcards
Features
Children can suffer from a variety of serious disorders of the hip, e.g.
- developmental dysplasia (DDH)
- Perthes disease
- tuberculosis
- septic arthritis
- slipped capital femoral epiphysis (SCFE),
all of which demand early recognition and management.
Developmental dysplasia of the hip (DDH)
Previously known as congenital dislocation of the hip.
Clinical features
Females:males = 6:1
Asymmetry in 40%; deep thigh crease or extra crease; and short leg
Diagnosed early by:
- Ortolani (IN TEST) and
- Barlow (OUT TEST) tests (abnormal thud or clunk on abduction);
- test usually –ve after 2 mths
US excellent (esp. up to 3–4 mths, ideally 6 wks) and more sensitive than clinical examination
Plain X-ray difficult to interpret up to 3 mths, then helpful
Treatment (guidelines)
DDH must be referred to a specialist.
Placed in an abduction splint or pelvic harness, or other methods if older.
Perthes disease
A juvenile osteochondritis leading to avascular necrosis of femoral head.
Clinical features
Males:females = 4:1
Usual age 4–8 (rarely 2–18)
Sometimes bilateral
Presents as a limp and aching (hip or groin pain)
Characteristic X-ray changes
Requires urgent referral: provide crutches.
Transient synovitis
This common condition is:
- also known as ‘irritable hip’ or observation hip
- the consequence of a self-limiting synovial inflammation.
Clinical features
Children aged 4–8 yrs
Sudden onset of hip pain and a limp: may be referred knee pain
Child can usually walk (some may not)
± history of recent trauma or URTI
Outcome: settles to normal within 7 d, without sequelae.
Treatment is bed rest, crutches and analgesics.
Refer early.
Slipped capital femoral epiphysis
SCFE typically presents in the obese adolescent (10–15 yrs) with anterior hip (groin pain) knee pain and a slight limp.
Diagnosis before major slipping is vital.
X-ray pelvis and ‘frog leg lateral’ of affected hip.
Cease weight-bearing and refer urgently.
Septic arthritis of the hip
should be suspected in all children with acutely painful
- or irritable hip problems
- and referred early.
