Initial pre-referral workup

Clinical history

Common causes not to be missed:

All ages

• trauma
• infection – septic arthritis, osteomyelitis
• tumour
• referred pain

One to four years

• developmental dysplasia of the hip
• irritable hip (transient synovitis)

Four to 10 years

• Perthes disease
• irritable hip (transient synovitis)
• juvenile idiopathic arthritis

10 to 16 years

• slipped upper femoral epiphysis

Investigations

Depending on clinical presentation, consider:

• FBE, ESR,CRP
• hip X-rays (AP and lateral)
• hip ultrasound

GP management

Refer parents to Limping Child (fact sheet).

Indications for specialist referral

Emergency

• red flag signs – unwell, flushed, lethargic, fever, flat, anorexic
• joint is irritable and stiff
• not improving