Investigating hip pain in a well child

doi:10.1136/bmj.39188.515741.47

BMJ 2007;334:1216-1217 (9 June), doi:10.1136/bmj.39188.515741.47

Practice

Rational imaging

Investigating hip pain in a well child

A Gough-Palmer, radiology specialist registrar, K McHugh, consultant paediatric radiologist

Great Ormond St Hospital for Children NHS Trust, London WC1N 3JH

Correspondence to: A Gough-Palmer agoughpalmer@yahoo.com

The first 150 words of the full text of this article appear below.

The patient

A 9 year old girl with a history of conservatively managed leftsided Perthes' (Legg-Calvé-Perthes) disease presentedto her orthopaedic team via her general practitioner with onsetof right hip pain and subsequent limp. She was otherwise well.On clinical examination she had a limp with moderate pain andsome limitation of abduction and internal rotation. She didnot have a fever, and routine haematology and biochemistry gavenormal results.

Differential diagnosis and prognosis

Assuming the disease can confidently be localised to the hip(rather than knee, pelvis, or lower back), a presumptive diagnosisof the painful hip is reasonable, based on age and presentation.

In a younger, febrile, or unwell child, septic arthritis needsto be excluded urgently.
Perthes' disease typically affectschildren aged between 3 and10 years (peaking between 5 and7 years); it affects about fourboys for each girl affected;and it occurs bilaterally in about10% of cases¹. . . [Full text of this article]