Approach to hip pain in childhood
- Peter A Nigrovic, MD
Peter A Nigrovic, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- William Phillips, MD
William Phillips, MD
- Section Editor — Pediatric Orthopedics
- Professor of Pediatrics and Orthopedics
- Baylor College of Medicine
- Robert Sundel, MD
Robert Sundel, MD
- Section Editor — Pediatric Rheumatology
- Associate Professor of Pediatrics
- Harvard Medical School
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 (WBC) 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
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- Laboratory evaluation
- - Plain radiographs
- - Ultrasonography
- - MRI
- - Bone scan
- COMMON CAUSES OF HIP PAIN IN CHILDREN
- - Septic arthritis
- - Osteomyelitis
- - Other infections
- - Transient synovitis
- - Systemic rheumatologic disease
- - Idiopathic chondrolysis of the hip
- - Legg-Calvé-Perthes and secondary avascular necrosis
- - Slipped capital femoral epiphysis
- - Stress fracture
- - Osteoid osteoma
- - Other neoplasms