Abstract
Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. Hip pain may also be referred from low back or pelvic pathology. Evaluation and management requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of hip and pelvic musculoskeletal pain in the pediatric population.
Highlights
Children who have hip pathology may present with a variety of non-specific symptoms
Untreated intra-articular infection can lead to a permanent loss of hip function making it extremely important to differentiate possible infection from benign cases of transient synovitis
Hip pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphyses and apophyseal avulsion fractures of the pelvis
Summary
Children who have hip pathology may present with a variety of non-specific symptoms. Transient synovitis and septic arthritis have similar early symptoms with the spontaneous onset of progressive hip, groin, or thigh pain; limp or inability to bear weight; fever; and irritability. Slipped Capital Femoral Epiphyses (SCFE) SCFE, displacement of the proximal femoral epiphysis off the femoral neck, usually affects 11 to 14 year olds, is more common in obese children and boys and is bilateral in 20–40%.[13] Adolescents usually present with a limp and may have hip, groin or knee pain. Osteomyelitis Proximal femur or pelvic osteomyelitis presents similar to septic arthritis of the hip with fever and pain but children may have some passive range of motion if there is not extension of the infection into the joint. Stress fractures Stress fractures of the femur are uncommon in children, but they can occur in athletes engaged in repetitive loading of the lower extremities such as endurance running.[31] Children present with activity related hip, groin or anterior thigh pain that can typically be reproduced by asking the patient to hop on the affected leg. Referral to a sports medicine physician may help expedite appropriate diagnosis and management
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