Hip pain (peds): Difference between revisions

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== Work-Up ==
{{Peds top}} [[hip pain]].''
#X-ray hip, knee
==Background==
#Consider CBC, ESR
*It can be difficult to differentiate hip from knee pain in children
#Consider US (vs CT)


== DDx ==
==Clinical Features==
*[[Septic Arthritis (Hip)]]
*Hip pain
*[[Slipped Capital Femoral Epiphysis (SCFE)]]
*+/- [[limp (peds)|Limp]]
*[[Legg Calve Perthes Disease]]
*[[Transient (Toxic) Synovitis]]
*Acute rheumatic fever
*[[Juvenile Idiopathic Arthritis]]


== See Also ==
==Differential Diagnosis==
{{Pediatric hip DDX}}
 
==Evaluation==
[[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
 
{{Kocher criteria}}
 
==Management==
*Depends on diagnosis
**[[Transient (toxic) synovitis]] is diagnosis of exclusion
 
==Disposition==
*Depends on diagnosis
**[[Transient (toxic) synovitis]] is diagnosis of exclusion
 
==See Also==
*[[Limp (Peds)]]
*[[Limp (Peds)]]
*[[Hip Pain]]
*[[Hip Pain]]


[[Category:Peds]] [[Category:Ortho]]
==References==
<references/>
[[Category:Pediatrics]]  
[[Category:Orthopedics]]

Latest revision as of 20:49, 11 November 2020

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

Differential Diagnosis

Pediatric hip pain

Evaluation

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