Hip pain (peds): Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Hip Effusion Subramaniam.gif|thumbnail|Left hip effusion<ref>http://www.thepocusatlas.com/pediatrics/</ref>]] | [[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=== | ===Workup=== | ||
*X-ray hip (AP & bilateral Frog leg), femur, knee | *X-ray hip (AP & bilateral Frog leg), femur, knee | ||
Revision as of 19:10, 8 August 2019
This page is for pediatric patients; for adult patients see hip pain
Background
- It can be difficult to differentiate hip from knee pain in children
Clinical Features
- Hip pain
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
Left hip effusion[1]
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
- Depends on diagnosis
- Transient (toxic) synovitis is diagnosis of exclusion
Disposition
- Depends on diagnosis
- Transient (toxic) synovitis is diagnosis of exclusion