PT Classroom - A Review Of Various Conditions At The Hip In The Pediatric Patient ׀ by  Bill Lyon, PT, DPT, OCS, CSCS, USAW-L1


Bill Lyon, PT, DPT, OCS, CSCS, USAW-L1 received his doctor of physical therapy degree from the University of Wisconsin - Milwaukee. He has more than 11 years of experience in performance training and strength & conditioning and is a Certified Strength and Conditioning Specialist through the NSCA as well as a Level one Olympic lifting coach through United States Weightlifting. Bill is a physical therapist with United Hospital System in Kenosha where he works primarily in an outpatient physical therapy setting.


A Review Of Various Conditions At The Hip In The Pediatric Patient


When working in a clinic that sees orthopedic conditions of children, it’s important to be able to work through differential diagnoses of pediatric hip conditions and be able to rule them out from more routine strains, sprains, etc. Ability to recognize differential Dx and know when to refer a patient on for imaging or orthopedic consult can be critical to the patient’s treatment and prognosis. Three distinct conditions that one would want to understand would be Transient Synovitis, Slipped Capital Femoral Epiphysis, and Legg-Calve-Perthes’ Disease.

Transient Synovitis:
Transient Synovitis is the most common cause of acute hip pain in younger children (3-10). Pain is caused by a transient inflammation of the synovial membrane. Most commonly unilateral hip or groin pain is reported, however patients may report medial thigh or knee pain as well. Recent history of an upper respiratory infection, pharyngitis, bronchitis, or otitis media is seen in around half of patient’s diagnoses with transient synovitis. Boys are affected twice as often as girls. Common complaint is “just woke up and started hurting.” Condition will typically resolve in 7-10 days. Blood work and presence of fever are commonly used to differentially diagnose from septic arthritis of the hip, which is a true medical emergency that requires prompt care. X-ray used to rule out Slipped Capital Femoral Epiphysis and Legg-Calve-Perthes Disease.

Clinical presentation:
-Age 3-10, boys:girls 2:1
-Pain complaint is pain in hip joint
-Often antalgic gait due to pain
-Can have recent history of respiratory infection
-May have low grade fever

Slipped capital femoral epiphysis:
Slipped capital Femoral Epiphysis is a fracture of the growth plate of the femoral head that resulting in a slip of the physis resulting in a malalignment of the head of the femur compared to the rest of the femur. Cause is not known, but can be linked to falls/trauma. It is commonly seen right after periods of fast growth such as near puberty. Most common in males (2-3:1), ages 10-17. The condition is also much more common in obese individuals. Patients will present with pain in the thigh, as well as the knee (often primary pain complaint), typically eliciting an antalgic limp. Decreased hip range of motions are common, particularly being limited into internal rotation due to the now off shape of the joint complex. This condition requires surgical intervention and has a 20% probability of occurrence in contralateral hip within 18 months. If suspected, make patient NWB and refer for further work up!

Clinical Presentation:
-Age 10-17
-Males:females, 2-3:1
-More common in obese individuals
-Waddling gait
-Hip range of motion loss, especially internal rotation
-Shortening of limb
-Externally rotated limb
-Often vague pain in anterior supra-patellar knee
-Adductor spasm

Legg-Calve-Perthes’ Disease:
LCPD is an avascular necrosis of the proximal femoral head due to decreased blood supply in the area. The disease comes on insidiously and may have link after injury to hip. Most commonly it is seen unilaterally (Bilateral presentation is less than 10% of cases) and in children aged 4-10. When the disease is diagnosed prior to age 6, prognosis is good. It is much more common in males (4-5:1) and rare in African Americans. An increased incidence is noted with family history.

Clinical presentation:
- age 4-10
-Male:Female, 4-5:1
-Antalgic gait
-Limited internal rotation when in both flexed and extended positions, decreased abduction
-Trendelenburg gait
-Weak and painful hip musculature

Hopefully these descriptions and presentation bullet points will aid clinicians in knowing when to refer on for optimal patient care!

Last revised: 6, 17 2016
by Bill Lyon, PT, DPT, OCS, CSCS, USAW-L1


3) Placzek, J., Boyce, D. 2006. Orthopaedic Physical Therapy SECRETS. Second Edition. St. Louis, MO: Mosby Elsevier

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