Hip pain (peds): Difference between revisions
 
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==Work-Up==
{{Peds top}} [[hip pain]].''
==Background==
{{Hip anatomy background images}}
*It can be difficult to differentiate hip from knee pain in children


==Clinical Features==
*Hip pain
*+/- [[limp (peds)|Limp]]


1)  Xray knee-hip
==Differential Diagnosis==
{{Pediatric hip DDX}}


2) Consider CBC, Sed rate
==Evaluation==
[[File:Iliopectineal line, ilioischial line, tear drop, acetabular fossa, and anterior and posterior wall of the acetabulumi.jpg|thumb|AP hip x-ray.]]
[[File:Hip Effusion Subramaniam.gif|thumbnail|Left hip effusion<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
[[File:Epilys.jpg|thumb|X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.]]
[[File:PMC4063129 ISRN.ORTHOPEDICS2011-486512.001.png|thumb| A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).]]
===Workup===
*X-ray hip (AP & bilateral Frog leg), femur, knee
*Consider CBC, ESR, CRP
*Consider:
**[[Ultrasound]] to evaluate for effusion
**CT or MRI to evaluate for abscess


3)  Consider US (vs. CT)
{{Kocher criteria}}


==Management==
*Depends on diagnosis
**[[Transient (toxic) synovitis]] is diagnosis of exclusion


==DDx==
==Disposition==
 
*Depends on diagnosis
 
**[[Transient (toxic) synovitis]] is diagnosis of exclusion
SEPTIC ARTHRITIS
 
Age - 6 mo to 8 yrs
 
Pres - Pain, Pseudoparalysis
 
Labs - ESR > 20 after 1-2 d, WBC >
 
Xrays - possible effusion
 
 
SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)
 
Age - 9 to 16 yrs
 
Present - mild to severe pain, limp
 
Labs - normal
 
Xray - Anterior displacement of femoral neck to head
 
 
LEGG-CALVE-PERTHES DISEASE
 
Age - 4 to 9 yrs
 
Present - Painless Limp
 
Labs - normal
 
Xrays - Compression, collapse, fragmentation
 
 
ACUTE TRANSIENT SYNOVITIS
 
Diagnosis of Exclusion
 
- Age 3 to 8 yrs
 
- Present - Pain. Limp, refusal to bear weight
 
- Labs nl
 
- Xray normal
 


==See Also==
==See Also==
*[[Limp (Peds)]]
*[[Hip Pain]]


 
==References==
Peds: Acute Transient Synovitis
<references/>
 
[[Category:Pediatrics]]
Peds: Legg Calve Perthes Disease
[[Category:Orthopedics]]
 
Peds: Slipped Capital Femoral Epiphysis (SCFE)
 
Peds: Septic Arthritis
 
 
==Source==
 
 
Resident & Staff Physician, July 02
 
 
 
 
[[Category:Peds]]

Latest revision as of 20:25, 26 February 2025

This page is for pediatric patients. For adult patients, see: hip pain.

Background

Hip anatomy.
Extracapsular ligaments (anterior right hip).
Extracapsular ligaments (posterior right hip).
  • It can be difficult to differentiate hip from knee pain in children

Clinical Features

Differential Diagnosis

Pediatric limp

Hip Related

Other Causes of Limping

Evaluation

AP hip x-ray.
Left hip effusion[1]
X-ray showing a slipped capital femoral epiphysis, before and after surgical fixation.
A normal and abnormal epiphyseal line as described by Klein et al. in an 11 year 6 month old boy with a left SCFE. Proximal prolongation of the superior neck line transects the epiphysis in the normal hip (right) but either lies flush with or does not transect the epiphysis in SCFE (left hip).

Workup

  • X-ray hip (AP & bilateral Frog leg), femur, knee
  • Consider CBC, ESR, CRP
  • Consider:
    • Ultrasound to evaluate for effusion
    • CT or MRI to evaluate for abscess

Kocher Criteria for septic arthritis of the hip

  • ESR > 40 mm/hr
  • WBC > 12,000/microliter
  • Refusal or inability to weight bear on affected joint
  • Fever 38.5° C or greater
Number of Kocher Criteria Chance of Septic Joint
1 3%
2 40%
3 93%
4 99%

Management

Disposition

See Also

References

  1. ↑ http://www.thepocusatlas.com/pediatrics/
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