Hip pain in children

Question 1

What are red flags symptoms in acute leg limping in child?

Answer 1

Nocturnal pain, night sweats, weight loss = acute lymphoblastic leukaemia

Fever, holding leg abducted (to prevent internal rotation due to pain), non-weight bearing limp = septic arthritis or osteomyelitis of femur/pelvis

Changeable history/unusual history regarding mechanism of injury = non-accidental injury

Question 2

What movement is helpful in assessing loss of movement and pain and pathology in the hip joint?

Answer 2

Internal rotation

Question 3

What is transient synovitis and how is it treated?

Answer 3

It is irritable hip in 2-10 year olds
It is most common cause of hip pain in children

Presentation:
Acute hip pain
Limp
Reduced hip movements
Low grade fever
Often preceded by viral infection 

Treatment:
Self-limiting
Rest
Analgesia (paracetamol and ibuprofen)

Question 4

What is Perthe’s disease?

What symptoms occur in this disease?

Answer 4

Affects hip joints of 4-8yr olds, more common in boys
It is caused due to avascular necrosis of the femoral head (femoral epiphysis)

Symptoms:
Progressive hip pain
Limp
Stiffness and reduced ROM in hips

X-ray:
widening of joint space
later changes may show decreased femoral head size

Question 5

What is slipped upper femoral epiphysis?
What are the symptoms?
How is it treated?

Answer 5

This is classical seen in obese boys and 10-15yr olds
Displacement of femoral head epiphysis postero-inferiorly

Symptoms:
Hip, groin, medial thigh or knee pain
Loss of internal rotation of leg in flexion

Investigations:
AP and lateral X-ray show typical ‘frog-leg’

Treatment:
Internal fixation

Question 6

What is developmental dysplasia of the hip (DDH)?
What is the clinical presentation?
What tests can be done to diagnose DDH?

Answer 6

Here, hip joint does not form properly

More common in female and in babies born in breech presentation

Presentation:
Asymmetrical skin folds
Let length differences
Buttock flattening
Walking with affected leg in external rotation

Investigations:
Barlow’s test and Ortolani’s test are +ve

Question 7

What symptoms are present in juvenile idiopathic arthritis (JIA)?

Answer 7

Oligoarticular disease:
Joint pain and swelling in medium sized joints e.g. knees, ankles, elbows
Limp
ANA +ve in JIA - associated with anterior uveitis