Irritable hip

Question 1

How does hip pain present in a child?

Answer 1

Limp
Refusal to use affected leg
Refusal to weigh tbear
inabitlity to walk
Pain
Swollen or tender joint

Question 2

What would be likely causes of hip pain from 0-4 years old?

Answer 2

Septic arthritis
Developmental dysplasia of the hip - DDH
Transient synovitis

Question 3

Likely causes hip pain 5-10 years

Answer 3

Septic arthritis
Transietn synovitis
Perthes disease

Question 4

Likley causes hip pain 10-16 yeras

Answer 4

Septic arthritis
Slipped upper femoral epiphysis (SUFE)
Juvenile idiopathic arthritis

Question 5

Red flags for hip pain

Answer 5

Child under 3
Fever
WAKING at night with pain
Weight loss
Anorexia
Night sweats
Fatigue
Persistent pain
Stiffness in the morning
Swollen or red joint

Question 6

Urgent referral for limping child criteria

Answer 6

Child under 3 years
Child older than 9 with restricted or painful hip
Evidence of neurovascular compromise
Severe pain or agitation
Red flags for serious pathologu
Suspicion of abuse

Question 7

Investigations for painful hip

Answer 7

US - effusion in joint
Joint aspiration used to diangose or exclude septic arthritis
MRI - osteomyelitis

Question 8

What is developmental dysplasia of the hip?

Answer 8

Structural abnormality in hips -> abnormal development of foetal bones in prefnancy
Instability -> subluxation or dislocation, abnormal gait, early degenerative changes

Question 9

When is DDH picked up>

Answer 9

NIPE or later when present with asymmetry, reduced ROM in hip or a limp

Question 10

Findings suggestive of DDH in NIPE?

Answer 10

Different leg lengths
Restricted hip abduction on one side
Significant bilateral restriction in abduction
Difference in knee level when hips are flexed
Clunking of hips on special tests

Question 11

What are the two special tests for DDH?

Answer 11

Ortolani
BIarlow

Question 12

What is the ortolani test?

Answer 12

is done with the baby on their back with the hips and knees flexed. Palms are placed on the baby’s knees with thumbs on the inner thigh and four fingers on the outer thigh. Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly.

Question 13

What is the barlow test

Answer 13

is done with the baby on their back with the hips adducted and flexed at 90 degrees and knees bent at 90 degrees. Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly.

Question 14

What noises from hip exam require US?

Answer 14

Click - isolated normally dont
Clunk - yes

Question 15

Investigation for DDH

Answer 15

US hios
Xrays - older infants

Question 16

Treatment for <6 months DDH

Answer 16

Pavlik harness

Question 17

What is the aim of a pavlik harness and how does it hold baby?

Answer 17

Hold femoral head to allow acetabulum -> normal shape
Keeps hips flexed and abducted
Harness removed after 6-8 weeks

Question 18

What is Perthes disease?

Answer 18

Disruption of blood flow to femoral head -> avascular necrosis of bone, affecting epiphysis of femur distal to growth plate

Question 19

What children does Perthes disease most commonly occur in?

Answer 19

4-12 years, mostly between 5-8
More commmon in boys
Idiopathic

Question 20

What is the main complciation fo perthes disease?

Answer 20

Osteoarthritis

Question 21

What causes osteoarthritiis as a complication of Perthes disease?

Answer 21

Revascularisation or neovascularisation and healing of femoral head - remodelling. Soft and deformed femoral head

Question 22

Presentation of Perthes disease

Answer 22

Pain in hip or groin ‘Limp
Restricted hip movements
Referred pain to the knee
No trauma history

Question 23

What to think as differential if hip pain trigerred by minor trauma?

Answer 23

Slipped upper femoral epiphysis

Question 24

Investigation for Perthes disease

Answer 24

Xray - but may be normal
Blood tests - inflam markers
Technetium bone scan
MRI

Question 25

Aims of management of Perthes disease

Answer 25

Conservative
Maintain healthy position + alignment joint _- reduce risk of damage or deformity to the femoral head

Question 26

Management of Perthes disease

Answer 26

Bed rest
Traction
Crutches
Analgesia
Physiotherpay
Regular X rays assess healing
Surgery in most severe cases

Question 27

Why do physiotheraoy

Answer 27

Retain ROM in muscles and joints without putting excess stress on bone

Question 28

What is transient synovitis?

Answer 28

Irritable hip caused by temporary irritation and irritation of synocial membrane

Question 29

Who is transient synovitis most common in

Answer 29

children aged 3-10

Question 30

What is TS ass with?

Answer 30

viral URTI - happens a few weeks after
Typically dont have fever

Question 31

Presentation of transient synovitis

Answer 31

Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature
No systemic illness

Question 32

Mangemetn for transient synovitiss

Answer 32

Symptomatic - simple analgesia
Exclude more worrying conditions

Question 33

Who can be managed in primary care with hip paun?

Answer 33

Children aged 3-9 with symptoms suggestive of transient synovitis if limp present for less than 48 hours and child otherwise well
SAFETY NET TO A+E- worse sympotms or fever

Question 34

How long does it take for transeint synovitis to improve?

Answer 34

24-48 hours
Fully resolve 1-2 weeks no lasting problems
Recur in 20% of patients

Question 35

irritable hip on x ray

Answer 35

moth eaten sign

Question 36

SUFE on x ray

Answer 36

ice cream fallen off cone

Question 37

SUFE

Answer 37

Slipped sepiphysis
Acute - trauma
Chronic - obese
Teenagers and boys