Paediatrics – Hip

Musculoskeletal (MSK) Therapy Services

There are several conditions that can affect hips during childhood and adolescence, most commonly it is nothing to worry about but occasionally it can be the result of a condition that requires immediate Orthopaedic intervention.

If you are concerned about hip pain you should make an appointment with your GP in the first instance and they will be able to ensure you are appropriately screened.

If you would like a more in depth understanding of the anatomy of the spine, check out – AnatomyZone – Your Guide to Human Anatomy and search ‘hip’.

Snapping Hip syndrome

What is it?

Snapping hip syndrome is a commonly seen condition in children and adolescence and in most cases can be treated with basic care and exercises. It is an umbrella term for a variety of causes of hip pain and/or clicking. It can be associated with a feeling of the hip snapping or popping out of place.

Would an X-ray help?

Following an assessment an x-ray may be recommended to rule out other hip conditions dependent on symptoms and age but for snapping hip syndrome an x-ray is not required to make the diagnosis and begin treatment.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation x-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the x-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an x-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about X-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

  1. Physiotherapy – If you have hip pain, this is normally the first port of call. Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation.
  2. Advanced Practitioner – If your hip pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  3. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).
  4. Pain Management Programme – Although not provided by ESHT. A referral into the Evelina Hospital in London’s Pain management programme may help for pain that is not resolving or does not have a specific medical cause.

Perthes

What is it?

Perthes is a rare childhood condition involving the hip which affects approximately 1 in 9,000 children. Perthes typically occurs in children who are between 4 to 10 years old and is five times more common in boys than girls.

Perthes occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die in a process called avascular necrosis. The reason for the blood supply disruption is still not fully understood however over time (approximately 18 to 24months) the blood supply to the head of the femur returns and the bone re grows. Most children return to daily activities without any major limitations. The long-term prognosis for children who have had Perthes is good.

Would an X-ray help?

In the case of perthes an X-ray is required to determine the stage of the disease and this will allow for the medical team to determine the best course of treatment. The treatment will be decided on by on Orthopaedic Consultant. Depending on age treatment may include bracing, surgery or monitoring with physiotherapy.

X-rays work by passing a low level radiation through the body to produce an image.

For more information about x-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

You will either see a specialist physiotherapist or advanced practice physiotherapist who will assess you and request an x-ray if there are concerns of perthes following assessment. Based on the results of the x-ray you will either continue with physiotherapy or be referred to the Paediatric Orthopaedic team for further management.

Additional info

Slipped Capital Femoral Epiphysis (SCFE/SUFE)

What is it?

SCFE (slipped capital femoral epiphysis) or SUFE (slipped upper femoral epiphysis) is one of the most common hip disorders affecting adolescents. It is more common in boys than girls and is more prevalent in obese children. The typical age on onset is 11 to 12 in girls and 12 to 13 in boys and it is often associated with a growth spurt. SCFE is a fracture to the growth plate of the thigh bone that results in the ball at the end slightly slipping off the rest of the bone. It requires surgical repair with a long screw to allow it to properly heal and the outcomes of this are very good.

Would an x-ray help?

In the case of SCFE/SUFE an X-ray is required to determine the severity of the slip and this will allow for the medical team to determine the best course of treatment. The treatment will be decided on by on Orthopaedic Consultant. Normally surgery is required to correct the slip.

X-rays work by passing a low level radiation through the body to produce an image.

For more information about x-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

You will either see a specialist physiotherapist or advanced practice physiotherapist who will assess you and request an x-ray if there are concerns of SCFE/SUFE following assessment. Based on the results of the x-ray you will either continue with physiotherapy or be referred to the Paediatric Orthopaedic team for further management.

Additional information