Hip pain in children

Infants and children
It is important to recognize bacterial joint inflammation and dysplasia in time.
 * Pain and inflammation – pain when moving, redness, swelling, increased skin temperature, relief position in flexion and abduction, pseudoparesis;
 * infants (vs. hematogenous infection), older children (vs. exogenous infection) → septic and nonspecific arthritis, hematogenous osteomyelitis.
 * Limitation of abduction – asymmetry of skin folds, the difference in the length of the lower limbs, positive Ortolani sign;
 * infants and small children, more often girls → hip dysplasia – congenital dislocation of the hips.
 * Lameness (with unilateral damage), wobbly gait (with bilateral damage), positive Trendelenburg sign;
 * young children without dysplasia at screening, more often girls → hip dysplasia – congenital hip dislocation, transient coxitis.

During the growth period

 * Hip pain often radiates into the thigh/knee – hip pain can be overlooked.
 * Pain and lameness. Localization often uncertain, non-specific, often in the distal end of the thigh and in the knee.
 * Limited mobility for hip pain (relative to the other side) - noticeable relief limp.

Pain and inflammation

 * pain during movement, redness, swelling, increased skin temperature, relief position, pseudoparesis, joint effusion,
 * especially small children (exogenous infection), general signs of infection → septic and non-specific arthritis, hematogenous osteomyelitis,
 * disease of one / more joints / systemic inpairment - the entire period of childhood → chronic juvenile arthritis (subtypes).
 * lameness, hip, knee pain, especially at night, relief position, muscular dystrophy, creeping course
 * children from TB endemic areas; rarely → specific arthritis,


 * pain and swelling of the hip up to the knee (possibly in the thigh and lower leg);
 * younger than 15 years, possibly general symptoms (fever, lack of interest), rarely → Ewing's sarcoma.

Pain with limitation of movement

 * Sudden pains in the hip and knees - with a relief position, after an upper respiratory tract infection, with restriction of movement (especially internal rotation);
 * younger than 10 years (max. 5-6 years), both girls and boys → coxitis fugax, transient coxitis;
 * light pain in the groin (and knee) depending on the load, mainly external rotation and abduction is limited, relief lameness;
 * 3-12 year (with a maximum in the 3rd–6th year), boys significantly more often → Perthes disease,
 * limitation after external rotation, worsened position in external rotation, underestimated knee pain;
 * in puberty (boys 12–16 years, girls 10–14 years), boys 2x more often, eunuchoid appearance with gynecomastia/adiposogenital type/long asthenic individual → osteolysis of femoral head (often chronic form),
 * sudden general collapse, inability to run, positive Drehmann sign,
 * in puberty (boys 12–16 years, girls 10–14 years), boys 2x more often → osteolysis of the femoral head (acute chronic form).

Pain without restriction of movement

 * knee and leg pain before falling asleep (especially in children under 10 years old, both girls and boys), without pathological changes → growing pains.

Changes without pain and without restriction of movement

 * non-specific changes with the absence of disease symptoms (e.g. swelling around the knee) – young (max. in puberty) → suspected osteosarcoma;
 * skipping of the iliotibial tract over the major trochanter - especially young girls; possibly with trochanteric bursitis → popping hip.

Resources

 * GESENHUES, S a R ZIESCHÉ. Vademecum lékaře : Všeobecné praktické lékařství. 1. české vydání. Praha : Galén, 2006. 0 s.  ISBN 80-7262-444-X.