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Differential diagnosis and management of hip pain in childhood
1Department of Rheumatology, Southmead Hospital, Westbury-on-Trym, Bristol.
Insights
Pediatric hip pain requires prompt evaluation to differentiate serious conditions like sepsis from less critical causes. Early diagnosis and management of childhood hip disorders are crucial for preventing long-term damage.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
- Pediatric Infectious Diseases
Background:
- Childhood hip pain can indicate serious underlying conditions requiring urgent attention.
- Differentiation between septic arthritis, irritable hip, and other hip disorders is critical for timely intervention.
Purpose of the Study:
- To outline diagnostic and management protocols for pediatric hip pain.
- To emphasize the importance of distinguishing between acute and chronic hip pain presentations.
Main Methods:
- Review of clinical presentations of various pediatric hip disorders.
- Emphasis on initial radiographic findings and the role of special imaging techniques.
- Clinical assessment including hip movement restriction and physical signs.
Main Results:
- Acute hip pain necessitates distinguishing sepsis from irritable hip; sepsis can rapidly destroy the joint.
- Perthes disease and slipped capital femoral epiphysis are often identifiable on initial radiographs.
- Subacute or chronic hip pain may indicate serious disorders requiring long-term management, with diagnosis often aided by imaging and blood tests.
Conclusions:
- A reliable protocol for acute pediatric hip pain management is available.
- Early recognition of hip disorders, whether infectious, developmental, or inflammatory, is key.
- Exclusion of organic causes is necessary before considering non-organic syndromes presenting as hip pain.
Abstract:
Hip pain in children is always potentially serious. Different specialists see a different spectrum of hip diseases. Acute hip pain is usually referred to the surgeons, and the principal concern is to distinguish sepsis of the hip joint or pelvic bones from irritable hip: untreated sepsis can destroy the hip within days, but its presentation may be atypical or mild and investigations misleading. A reliable protocol for the management of acute hip pain in children is now available. Perthe's disease and slipped capital femoral epiphysis is usually evident on the initial radiograph. Hip disorders with a subacute or chronic presentation are usually referred to the paediatrician or rheumatologist. If examination shows restriction of hip movement or there are radiographic abnormalities, many will have a serious disorder requiring long-term management. The diagnosis is often apparent on the initial radiographs, although special imaging techniques may be needed. In a monoarticular presentation of juvenile arthritis, the hip radiograph will be normal but the diagnosis evident from other clinical features or blood investigations. Recognition of non-organic syndromes presenting with hip pain requires the exclusion of organic causes and an alertness to the incongruity of the physical signs.