HIP ABNORMALITIES AND INJURIES

Hip Abnormalities

Hip Dysplasia, Transient Synovitis, and Septic Arthritis are the most common causes of hip pain in young children. The causes of hip pain in children may be caused by conditions unique to the growing skeleton, including Perthes’ disease, slipped capital femoral epiphysis (SCFE), and apophyseal avulsion fractures of the pelvis.

When hips are in a healthy state, it takes a lot of force to injure them. However, there are a lot of cases of hip injuries in children because their bones aren’t as strong as adults and they like to play with other kids on a daily basis, which increases the potential for injury.

The hip bone serves as a connection between the upper parts of the body and the legs and feet.

It is one of the strongest bones in the body having one very stable ball and socket joint on both sides of the body that link the femur to the hip bone. These joints also allow for a wide range of movement that includes flexion, extension, abduction, adduction, and even circumflexion.

As children are more prone to hip injuries than adults, the doctors at Medical City Children’s Orthopedic and Spine Specialists have made it their passion and goal to see children through these painful injuries and restore them to their playful selves as quickly as possible.

With board certifications and expert training, cultivated with several years of experience, there are no better doctors for the job than doctors  Shyam Kishan, MD, and Kathryn Wiesman, MD,

Diagnosing the Cause of Hip Pain

There are many factors that can cause hip pain in children.  Upon visiting a doctor regarding the pain, the doctor will ask the following important questions.

1. Has there been fever, and how high has it been?
2. Has there been a recent viral illness?
3. Tick exposure?
4. Has there been any trauma?
5. Has there been knee pain?
6. Acute onset is more suggestive of trauma or infection. How long have there been symptoms?
7. Are there any underlying conditions? Sickle cell disease, rickets, SLE, Anorexia Nervosa, and medications such as steroids.
8. Is there a family history of hip disease?
9. Evidence of systemic disease: weight loss, pallor, fatigue, rash, bowel irregularity

Symptoms of Conditions that Cause Hip Pain in Children

In addition to the questionnaire, the doctor will also examine the child and look for bruising, thigh pain, and gate to further the diagnosis.

Bruising

The most common sign of any injury is a bruise. If there are any deep bruises around your child’s hip area, the chances of them having a hip injury or an injury to muscles around the hip are high. This can lead to tenderness or painful muscle spasms.

Referred Thigh Pain

A hip injury doesn’t exactly mean the pain would manifest in the hips. Pain can travel downwards from the point of injury to other parts of the body like the knees and thighs.

So if your child complains of knee pain, excessive thigh soreness, or even upper leg pain after running, he/she may have had a hip injury that needs to get checked.

Abnormal Gait

Hip injuries do not only cause hip pain. They lead to difficulty in maintaining normal posture, especially when walking or running. Children who have a hip injury tend to walk on their tiptoes and shift their balance to the less painful leg while limping.

Medical Conditions that Cause Hip Pain

The following are the different kinds of medical conditions that can cause hip pain.

Transient Synovitis

If your child has this common cause of hip pain, they may limp and tell you their hip hurts after sitting for a long time. They’ll also walk with their toes pointed outward. They may walk on the tips of their toes, have knee or thigh pain, or refuse to walk if the pain is very bad. Your baby will cry when you move their hip joint

This inflammatory problem is most common in preschool and elementary students. Boys get it more often than girls. Doctors don’t know why, but it happens a lot in children who’ve had a virus. It may be a side effect of the body’s fight against it.

Your child’s pediatrician may prescribe anti-inflammatory medicine, sometimes with pain meds. Within a few weeks, they should feel better, without any lingering problems.

Idiopathic Chondrolysis

Idiopathic Chondrolysis of the Hip (ICH) is a rare condition, occurring mostly in black female adolescents. It is characterized by the rapidly progressive destruction of articular cartilage in the hip joint resulting in premature degeneration and subsequent joint arthrosis.

Hip Dysplasia

When developmental hip dysplasia occurs at birth, the abnormality may be detected during a routine physical examination of the newborn. During this examination, the doctor gently flexes the child’s hips in different directions. If the hip appears unstable, the doctor may feel a “clunk” as the hip moves out of alignment.

In a smaller percentage of cases, hip dysplasia does not become apparent until later in infancy or early childhood. A later diagnosis may be detected during routine examinations of hip stability in the pediatrician’s office. Signs that may bring undiagnosed developmental hip dysplasia to the attention of parents and doctors include:

• Limb asymmetry including asymmetry in skin folds
• A leg length discrepancy on the affected side
• A limp
• A waddling gait (indicating both legs are affected)
• Restricted range of motion

To confirm a diagnosis of developmental hip joint problems in children up to 4-6 months of age, the orthopedist uses a sonogram. This ultrasound technology offers a significant advantage over the conventional X-ray exam. This is because images with the hip in motion have no risk of radiation. In order to ensure proper development of the bones that make up the hip joint, early intervention should take place.

Arthritis

Elderly people are not the only ones who get arthritis. There are certain kinds of arthritis that can cause hip pain in children. The most common type is juvenile idiopathic arthritis (JIA). If your child has it, they may feel stiffness or have swelling in more than one joint. Their hips may be stiff as well. Your child may also have an unusual gait or run a fever for unknown reasons.

Doctors aren’t sure what causes JIA, but some think it may be linked to a virus. It’s most common in children before they reach puberty. Doctors treat JIA with medicine and physical therapy.

Legg-Calve-Perthes Disease

Perthes Disease is a very unusual childhood hip disorder that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. This can cause your child to limp or have stiffness and pain in the hip, knee, or thigh.  Because without an adequate blood supply, the bone cells die, a process called avascular necrosis. As specialists, we use a treatment that produces positive results.

Doctors don’t know why blood stops flowing to the hip joint in some children. It’s more common among kids up to age 8. Boys are more likely to have it. Doctors usually treat Perthes by surgery, but in some cases, there are nonsurgical treatments that work.

Having Legg-Calve-Perthes disease after age 6 makes someone more likely to have hip problems as an adult.

Slipped Capital Femoral Epiphysis

Slipped Capital Femoral Epiphysis is a fracture along with the growth plate under the ball joint in the hip. The condition causes pain, sometimes in the hip but other times in the thigh or knee. Sometimes, your child may need crutches. Other times, they can’t walk or move their leg because the pain is so severe.

This condition is more common in older children (from age 8 to teenage years) and those who are overweight. Boys get it more often. Surgery is a common treatment. Many children recover fully, but they’re more likely to have arthritis of the hip as adults.

Slipped Capital Femoral Epiphysis is the slipping away of the epiphysis, or head of the femur downwards and backward off the neck of the bone at the growth plate.  It occurs mostly in older children around the ages of 10-16 who have just had a growth spurt although the reason is unknown.

It can be described as stable or unstable SCFE based on whether or not the patient can walk on the affected leg with crutches.  SCFE severely affects the motor skills of kids to the point they may need crutches, or they may be unable to walk at all like in unstable SCFE.

Infections

A number of infections can cause pain in a child’s hip. This may make them limp or give them trouble walking. One condition, called septic arthritis, can cause painful hip swelling and redness. It may be caused by bacteria (like a staph infection), a virus, or even a fungus. Other bacterial infections or Lyme disease (which your child may get from the bite of an infected tick) can also cause hip pain.

Antibiotics may be all that’s needed to treat some infections. Other times, your child may need a procedure to drain the infection from the joint.

Other Rare Causes

Sometimes, in rare cases, the following can cause hip pain

• Tumors
• Leukemia
• Orthopedic birth defects

Types of Injuries that Cause Hip Pain

There are various types of hip injuries and problems in children and can also be associated with a variety of reasons.

The injuries can occur from direct force applied to the hip, a fall on the hip side, or even an abnormal twisting or bending of the leg.

Hip Fractures

A hip fracture is simply a break in one or more bones of the hips, pelvis, or joints such as the femoral neck, the intertrochanteric area, or even the intracapsular fractures.

The part where fractures most commonly occur in a child’s hips is those points where the muscles attach to bone. It’s a weak point in their hip because it isn’t fully formed in children. These fractures usually occur more in children who are a bit older and are used to rough play, cycling accidents, or even automobile accidents compared to very young children.

Fortunately, most hip fractures in children heal easily without a problem. Within 6 weeks of giving up physical activities, the hip should be almost healed although in some cases, the fractures might require surgery to repair.

Dislocated Hips

Dislocation of the hips is another serious effect that trauma might have on the hips. In this case, the thigh bone or femur may slip out of its socket. Our pediatric orthopedic doctors at Southwest Scoliosis Institute can fix this by putting your child’s hip back in place and then depending on the age of your child, they decide how the healing process proceeds.

Your child’s hips may be put into a cast that keeps the hip from moving for a while, a walking aid or hip brace for an older child. This is left for several weeks or months while the hip heals. Exercise and physiotherapy might also be recommended to help the hips get stronger and aid normal movement.

Avulsion Fractures

Avulsion fractures occur in the hips when a ligament or a tendon is forcibly torn away from the hip bone. This leads to a piece of bone breaking off along with the tendon.

It is usually caused by sudden and forceful movements like harsh falls where the ligaments or tendons that attach to the bones pull away breaking the bone.

Muscle Strain

A strain refers to the overstretching of a tendon or ligament.

Hip muscle strains are mostly associated with intense physical activities like running or jumping especially without adequate preparations or warm-ups.

Muscle sprains manifest as sharp, piercing pains in the affected area and can range from mild to severe. Minor strains can be treated at home but if the pain persists for over ten days, the best option is to get it checked as quickly as possible.

Complications from Hip Injuries

Sometimes, serious complications can result from a hip injury depending on the severity of the injury.

Bleeding

Blood vessels may get injured during fractures, and depending on the accessibility of care and first aid treatments, there might be too much bleeding involved, resulting in hypovolemia.

Bladder Injury

Due to its proximity to the hip or pelvic area, the bladder can get injured during a hip injury. This can be detected by the presence of blood in the urine.

Bladder injuries can also cause pain or difficulty in passing urine, the need to urinate more frequently than before, or even incontinence.

Nerve Injury

One of the earliest complications of hip fracture is nerve damage with the most commonly damaged nerve being the sciatic nerve. The sciatic nerve is the longest in the body that passes along the back of the thigh and sends branches into the lower leg.

Symptoms of sciatic nerve injury vary and include weakness of the foot and ankle, pain or numbness in the foot, calf, or thigh, or even inability to move the leg.

Some other nerves can also get damaged, resulting in similar symptoms in the parts of the leg they supply. Although recovery from nerve injuries can take a long time to completely recover from, having no recovery at all is unusual.

Femoral Vascular Necrosis

As a result of some fractures, mostly those of the femoral neck, blood supply to the hip joint may be cut off leading to necrosis.

This complication depends on the type of fracture and the specific anatomy of a person’s blood supply to the head of the femur bone.

Other complications that may occur include:

• Pulmonary Embolism
• Muscle Atrophy
• Improper Union or Non-Union of bones

Treatments for Hip Injuries and Hip Pain

Treatment for hip injuries may include:

Rest

One of the most effective ways to recuperate after an injury to the body is rest. Children will always be children and may want to ignore the pain and play regardless leading to more damage to the healing process.

It is important to restrict the number of physical activities they do to aid their recovery. They would only have to give up the very stressful activities for a while depending on the severity of their injuries.

Medicines

Having a hip injury does not mean that your child is sick. However, depending on the type of injury, certain medications can aid their recovery including specially prescribed painkillers to deal with the pain.

Our highly skilled team of doctors is expertly trained to treat hip injuries and prescribe only the right medications for your child’s injury.

Physical Therapy

Your child might benefit from physical therapy to help improve overall functional mobility. In addition, the doctors might prescribe physical therapy programs which focus on reducing or eliminating pain and restoring mobility and range of movement of the hip.

The physical therapist may prescribe some exercises that help with this and you might have to assist your child with performing some of them each day.

Surgery

Depending on the type, location, and severity of your child’s hip injury, surgery might be an option to repair the damage. It’s nothing to worry about as our highly skilled pediatric doctors will fix the problem and your child will be back playing ASAP.

Preventing Hip Injuries

Finally, precautions to prevent hip injuries in children include:

• Encouraging your kids to exercise often helps to make them stronger.
• Healthy diets with calcium and other nutrients while cutting out unhealthy fat.
• Monitoring your kid’s activities to minimize the risk of accidents and excessive use of muscles.
• Planning regular check-ups to ensure everything is alright.