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Hip Pain Symptoms

Pediatric Symptoms

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Updated February 20, 2008

Hip pain is surprisingly common in kids, and most often, it is caused by injuries. These injuries -- while fairly easy to detect in older children and adolescents -- are much harder to detect when infants, toddlers, or preschoolers get hurt. These younger children may not be able to explain that they were injured, and may take time to complain of hip pain, may not want to walk, or may have a limp.

Other things that cause hip pain in kids include:

  • transient synovitis - a very common cause of hip pain in preschool and younger school age children, in which children often have symptoms of limping, hip pain, refusal to walk, but no fever or other symptoms. Although it often follows a viral infection, the actual cause is unknown, and the symptoms go away in a few days without any treatment.
  • septic arthritis - one of the more serious causes of hip pain in children, in which an infection in the hip joint is causing the hip pain and associated symptoms, such as fever and refusal to walk.
  • other infections - in addition to septic arthritis, infections of the bone (osteomyelitis) and muscles near the hip joint can cause hip pain.
  • other causes - hip pain can also sometimes be caused by juvenile rheumatoid arthritis, bone cysts, and malignant neoplasms, including osteosarcoma and Ewing's sarcoma.

Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease typically occurs in children between the ages of four and eight years old and is more common in boys, especially boys who are very active and who are short for their age. These children often have a painless limp, but then develop other symptoms, including hip pain and decreased range of motion or stiffness of the hip joint. They may also have pain in their groin or knee.

Legg-Calvé-Perthes disease is a form of osteonecrosis or avascular necrosis of the femoral head, which is the top of the leg bone that fits into the hip joint, and which can usually be seen on a routine x-ray. It occurs when the blood flow to this bone is temporarily interrupted for some still unknown reason.

Treatment may include physical therapy for mild cases, restriction of vigorous activities, and surgery for more severe cases.

Slipped Capital Femoral Epiphysis

Slipped capital femoral epiphysis usually affects boys between the ages of 10 and 16, typically those who are overweight. It occurs when the neck of the femur slips along the growth plate away from the femoral head that is still in the hip joint. This can usually be seen on an x-ray, which is the typical way to diagnosis this condition.

Symptoms of slipped capital femoral epiphysis can include knee, groin, thigh, or hip pain, hip stiffness, limping, and as it gets worse, a child may not be able to walk at all.

Slipped capital femoral epiphysis is treated with surgery, which holds the femur in place and keeps it from slipping any more.

Tests for Hip Pain

When a child has hip pain, even though there are many benign causes that are not harmful, others can be much more serious, especially if they are not diagnosed quickly.

To help aid in the diagnosis, tests can include:

  • hip (pelvis) x-rays
  • complete blood count (CBC) with differential
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • rheumatoid panel (rheumatoid factor, ANA)
  • blood culture

Other tests for hip pain might include an ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) of the hip or a bone scan. When septic arthritis is suspected, hip aspiration may also be done to see if the doctor can get pus from the infection out of the hip joint with a needle.



Sources:

Evaluation of the child who has hip pain. Frick SL - Orthop Clin North Am - 01-APR-2006; 37(2): 133-40

Long: Principles and Practice of Pediatric Infectious Diseases

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