The superficial muscles of the hip and pelvis region can be grouped into four quadrants based on their position and function: anterior flexor group (iliopsoas, sartorius, rectus femoris), medial adductor group (gracilis, pectineus, adductor muscles), posterior extensor group (hamstring muscles, gluteus maximus) and lateral abductor group (gluteus medius and minimus). Maximal intracapsular volume of the hip is possible with the hip in a position of flexion, abduction, and external rotation this is the position of comfort in children with hip effusions. The pubic symphysis and SI joint are very stable joints with limited motion whereas the hip joint is mobile in multiple planes. It also contains numerous ridges and depressions, indicative of its function for stability more than motion. The SI joint is a diarthrodial joint with hyaline cartilage on the sacral side and fibrocartilage on the iliac side. The hip joint is a ball and socket articular joint and the pubic symphysis is a fibrous joint. The hip joint (acetabulofemoral joint), sacroiliac (SI) joint and pubic symphysis make up the pelvic girdle. The basic anatomy of the hip with muscle attachments is shown in Figure 1. The clinical history should include a thorough description of the pain characteristics (location, character, onset, duration, change with activity or rest, aggravating and alleviating factors, night pain) trauma (acute macrotrauma, repetitive microtrauma, recent/remote) mechanical symptoms (catching, clicking, snapping, worse during or after activity) systemic symptoms (fever, irritability) inflammatory symptoms (morning stiffness) neurological symptoms (weakness, altered sensation) gait (limp, altered weight bearing) effects of previous treatments (including antibiotics, analgesics, anti-inflammatories, physiotherapy) and the current level of function of the child.Ī history of previous injury or surgery, neurological disorder, chronic inflammatory joint disease or bleeding diathesis, as well as diseases associated with spodyloarthropathies including psoriasis, acute uveitis and inflammatory bowel disease is significant. Diagnostic imaging is then useful to confirm the diagnosis.

Once the pain is localized to the hip region, there is a limited differential diagnosis based on age and presentation. Intra-articular hip pathology is usually localized to the groin. If pain is present it is important to determine where it is coming from, as pelvis and low back pathology may refer pain to the hip region and hip pathology commonly presents with referred thigh or knee pain. Clinical historyĬhildren who have hip pathology may present with pain, refusal to bear weight, limp, or decreased movement of the lower extremity. This article will review common musculoskeletal causes of hip and pelvis pain in the pediatric population. An awareness of developmental anomalies as well as variation in skeletal maturation will aid the physician in evaluation and management. Other causes of hip pathology are often related to skeletal maturity and are fairly specific to the age of the child.

Untreated intra-articular infection can lead to a permanent loss of hip function making it extremely important to differentiate possible infection from benign cases of transient synovitis. Transient synovitis and septic arthritis have similar early symptoms with the spontaneous onset of progressive hip, groin, or thigh pain limp or inability to bear weight fever and irritability. Children who have hip pathology may present with a variety of non-specific symptoms.

Normal hip xray frog leg