An 11 year old 70 kg. Child presents with limitation of abduction and internal rotation. There is tenderness in scarpas triangle. On flexing the hip the limb is abducted. The diagnosis is :
Ans. is 'b' i.e., Slipped capital femoral epiphysis Let's see each option one by oneSlipped capital femoral epiphysis :It is the displacement of the proximal femoral epiphysis (or described simply as displacement of the femoral head on the femoral neck). The direction of the slip is always posterior and often medial.The displacement could be chronic displacement or acute displacement.Clinical picture :Age group usually affects adolescents age 11- 13 years. The typical patient is overweight often markedly. Rarely the patient is tall, asthenic and rapidly growing.symptoms and signs :The onset of SCFE is usually insidious (90% is chronic form of SCFE), with a h/o a painful limp for 1 to several month of prior. The pain is characteristically aching and located in the thigh or knee rather than the hip.The change in hip range of motion is usually diagnostic. There is loss of abduction and internal rotation of the hip, although these may be difficult to identify in the grossly overweight childThere is almost always a characteristic obligatory external rotation of the hip when it is flexed because of the distorted hip anatomy caused by the disorder. The femoral head is post to its normal position, so the flexed hip must externally rotate to keep the head within the acetabulum.Legg-Calve - Perthes Disease: (Osteochondritis of head of femur)is a serious but self-limited pediatric hip disorder. Cause is unknown. The disease is thought to be related to avascular necrosis of the hip (Femur head )Clinical Presentation: A child 4 -10 years of age presents usually with a painless limp. If pain is present it may be mild and referred to the thigh or knee. The child is usually small for their age and have retarded bone age. Physical examination discloses atrophy of the thigh on the affected side and usually limited hip motion. The typical patients have a flexion contracture of 0 -30 degrees, loss of abduction compared with the opposite side and loss of internal rotation of hip.Observation Hip ( Transient synovitis of the hip):It is benign, nontraumatic, self-limited disorder that mimics septic hip in clinical presentation. Septic hip must be excluded before making its diagnosis.Synovial fluid rapidly accumulates under pressure in the hip joint, and there may be severe pain from capsular distention. The fluid is resorbed within 3 -7 days, with no long term sequelae. Although, the cause of transient synovitis is unclear, evidence suggest it is associated with immune responses to viral or bacterial antigen mediated through the synovial membrane.Clinical Picture:Age group 4-5 years. As with septic hip URTI often proceeds transient synovitis by a few days to two weeks. The hip contains excess synovial fluid and is held in flexion, abduction and external rotation because this is the joint position of maximum capacity. The joint is sore and resistant to movementTuberculosis of the hip :Disease is insidious in onset and runs a chronic course .The child may be apathetic and pale with loss of appetite before definite symptoms pertaining to the hip appear.Stiffness of hip night cries pain referred to knee, limpingSwelling around the hip because of cold abcess.Deformity : Stage I*- Flexion, abduction & external rotation (FABER)Stage II * - Flexion, adduction & internal rotation (FADIR)Stage III* - Exaggeration of Stage II.
Perthes disease
slipped capital femoral epiphyses
Observation hip
Tuberculosis hip
Hip, Spine, Neck, and Shoulder Problems