Initial pre-referral workup

Clinical history

Perthes disease typically presents between the ages of four and 10 years.

It may result in variable pain with activity, including thigh, groin or knee pain and is sometimes seen in hyperactive boys.

Physical examination

• variable limp
• hip irritability
• loss of hip motion, especially internal rotation and abduction in flexion

Investigations

plain X-ray (AP and frog leg views)

GP management

Pain management – paracetamol/NSAIDS.

Refer parents to Perthes disease in children (fact sheet).

Indications for specialist referral

Urgent

• refer all patients with confirmed Perthes or possible Perthes