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Important aspects of the history in the evaluation of a child with hip pain unrelated to acute trauma or fracture

Important aspects of the history in the evaluation of a child with hip pain unrelated to acute trauma or fracture
Historical feature Potential clinical significance
Age
  Typical age for:
  • Bacterial arthritis: 0 to 6 years
  • Transient synovitis: 3 to 8 years
  • SCFE: Early adolescence
  • Idiopathic chondrolysis: 10 to 20 years
Sex
 

More common in males: Legg-Calvé-Perthes disease, septic arthritis, transient synovitis, SCFE

More common in females: Idiopathic chondrolysis, chronic recurrent multifocal osteomyelitis

Pain
Onset

Acute: Infectious, transient synovitis, acute trauma

Insidious: SCFE, Legg-Calvé-Perthes disease, spondyloarthritis

Severity

Refusal to bear weight: Septic arthritis, osteomyelitis (femur or pelvis), malignancy, trauma, transient synovitis; also may be due to discitis or secondary avascular necrosis

Willing to bear weight with limp or antalgic gait: Transient synovitis, systemic JIA, SCFE, Legg-Calvé-Perthes disease, or secondary avascular necrosis

Location

Isolated hip pain (which may be localized to the thigh or knee): Septic arthritis, osteomyelitis, Legg-Calvé-Perthes disease, SCFE

Pain in other joints (uncommon): Viral/postviral, JIA

Associated systemic symptoms
Fever Infection, systemic JIA, IBD-associated arthritis, neoplasm
Other constitutional (eg, fatigue, weight loss) or gastrointestinal symptoms (eg, change in bowel pattern) Systemic JIA, IBD-associated arthritis, neoplasm
Rash Systemic JIA, viral/postviral
Past medical history
Previous episodes of hip pain Systemic JIA, transient synovitis, mechanical
Kidney failure SCFE
Endocrine disorder (hypothyroidism, growth hormone deficiency) SCFE
Recent infection Postinfectious or reactive arthritis, septic arthritis (if bacterial), osteomyelitis (if bacterial)
Recent antibiotics May alter the presentation of septic arthritis or osteomyelitis
Systemic glucocorticoid use May be associated with secondary avascular necrosis
Tick exposure Lyme arthritis
Family history
  Family history of inflammatory arthritis, psoriasis, IBD, or uveitis may be associated with JIA
Social history
Sports participation, particularly endurance sports or dance Stress fracture, iliac apophysitis, snapping iliopsoas tendon, trochanteric bursitis; acetabular labral tear, femoroacetabular impingement
Sexually active Infectious (eg, disseminated gonococcal) or reactive (Chlamydia trachomatis) arthritis
IBD: inflammatory bowel disease; JIA: juvenile idiopathic arthritis; SCFE: slipped capital femoral epiphysis.
Graphic 63566 Version 8.0