Hip pain is common in children and adolescents and has a broad range of causes, ranging from the benign to the potentially devastating (table 1) . The evaluation and common causes of hip pain in children are reviewed here. The causes of limp in children, approach to the child with a limp, and radiographic imaging of the hip in children and adolescents are discussed separately. (See "Overview of the causes of limp in children" and "Approach to the child with a limp" and "Radiologic evaluation of the hip in infants, children, and adolescents".)
Overview — The history and examination of the child with hip pain are focused on distinguishing between infectious, inflammatory, orthopedic, and neoplastic etiologies (table 2). This distinction helps to determine the appropriate laboratory and radiographic evaluation. (See 'Common causes of hip pain in children' below.)
- Infectious – Infectious pain is usually acute, localized, and severe (eg, refuses to bear weight); it is generally accompanied by fever, elevated white blood cell count, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
- Inflammatory – Inflammatory pain typically is chronic or has insidious onset (with the exception of transient synovitis, which has acute onset); may be accompanied by other findings (eg, rash, nail pits, uveitis), involve joints other than the hip, and recur; refusal to bear weight is uncommon
- Orthopedic – Pain is usually localized to the hip, but may be referred to the thigh or knee; may have acute or insidious onset; pain increases with activity and decreases with rest; systemic symptoms are absent; ESR and CRP are usually normal
- Neoplastic – Pain is characteristically worse at night and unrelated to activity; may be associated with systemic symptoms and laboratory abnormalities (eg, anemia, leukopenia, thrombocytopenia, elevated lactate dehydrogenase or uric acid)
History — Pain from true hip pathology is typically experienced in the groin, though children and even adults may localize the pain to the thigh or knee. Lateral discomfort, for example around the greater trochanter, typically is caused by pathology outside the joint, and is generally reassuring. Pain that alters function (limp, alteration in activities) should be explored fully, whereas transient or fleeting hip pains are typically of limited significance.
Important aspects of the history in the child with hip pain include the age and sex of the child (table 3); the onset, duration, severity, and location of the pain; associated systemic symptoms; past medical history; family history and social history (table 4).