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25.01.2025 | Review

The Pediatric Hip Physical Exam

verfasst von: Katherine Bach, Sarah Coufal, Nicholas Kelly, Ameera Teal, Ishaan Swarup

Erschienen in: Current Reviews in Musculoskeletal Medicine

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Abstract

Purpose of Review

Atraumatic hip pain in children is one of the most common orthopaedic complaints in this population. This review details the important elements of the pediatric hip physical exam and provides an overview of pertinent clinical exam findings in specific diagnoses of common pediatric hip pathology.

Recent Findings

A thorough physical exam is critical for the diagnosis of pediatric hip pathology, as many conditions have exam findings that are very commonly associated with the pathology, if not pathognomonic for the disorder. Additionally, pediatric hip pathology is strongly age-related, so an understanding of typical exam findings and common hip conditions by age can be invaluable in forming a correct diagnosis.

Summary

Inspection, palpation, range of motion, gait analysis, and provocative tests provide clues about potential diagnoses. Together with history and risk factors, pediatric clinicians can make appropriate diagnosis of pediatric hip disorders.
Literatur
1.
Zurück zum Zitat Yagdiran A, Zarghooni K, Semler JO, Eysel P. Hip Pain in Children. Dtsch Ärztebl Int [Internet]. 2020 Jan 31. Yagdiran A, Zarghooni K, Semler JO, Eysel P. Hip Pain in Children. Dtsch Ärztebl Int [Internet]. 2020 Jan 31.
2.
Zurück zum Zitat Montgomery NI, Epps HR. Pediatric Septic Arthritis. Orthop Clin North Am. 2017;48(2):209–16.PubMedCrossRef Montgomery NI, Epps HR. Pediatric Septic Arthritis. Orthop Clin North Am. 2017;48(2):209–16.PubMedCrossRef
3.
Zurück zum Zitat Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am. 2015;29(3):557–74.PubMedCrossRef Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am. 2015;29(3):557–74.PubMedCrossRef
4.
Zurück zum Zitat Houghton KM. Review for the generalist: evaluation of pediatric hip pain. Pediatr Rheumatol. 2009;7(1):10.CrossRef Houghton KM. Review for the generalist: evaluation of pediatric hip pain. Pediatr Rheumatol. 2009;7(1):10.CrossRef
6.
Zurück zum Zitat Auriemma J, Potisek NM. Developmental Dysplasia of the Hip. Pediatr Rev. 2018;39(11):570-572. Auriemma J, Potisek NM. Developmental Dysplasia of the Hip. Pediatr Rev. 2018;39(11):570-572.
7.
Zurück zum Zitat Sacks H, Pargas-Colina C, Castañeda P. Developmental Dysplasia of the hip: guide for the Pediatric Primary Care Provider. Pediatr Ann. 2022;51(9). Sacks H, Pargas-Colina C, Castañeda P. Developmental Dysplasia of the hip: guide for the Pediatric Primary Care Provider. Pediatr Ann. 2022;51(9).
9.
Zurück zum Zitat Pathy R, Sink EL. Femoroacetabular impingement in children and adolescents. Curr Opin Pediatr. 2016;28(1):68.PubMedCrossRef Pathy R, Sink EL. Femoroacetabular impingement in children and adolescents. Curr Opin Pediatr. 2016;28(1):68.PubMedCrossRef
10.
12.
Zurück zum Zitat Yilmaz AE, Atalar H, Tag T, Bilici M, Kara S. Knee Joint Pain May be an Indicator for a hip joint problem in children: a Case Report. Malays J Med Sci MJMS. 2011;18(1):79–82.PubMed Yilmaz AE, Atalar H, Tag T, Bilici M, Kara S. Knee Joint Pain May be an Indicator for a hip joint problem in children: a Case Report. Malays J Med Sci MJMS. 2011;18(1):79–82.PubMed
13.
Zurück zum Zitat Dibra FF, Prieto HA, Gray CF, Parvataneni HK. Don’t forget the hip! Hip arthritis masquerading as knee pain. Arthroplasty Today. 2018;4(1):118–24.PubMedCrossRef Dibra FF, Prieto HA, Gray CF, Parvataneni HK. Don’t forget the hip! Hip arthritis masquerading as knee pain. Arthroplasty Today. 2018;4(1):118–24.PubMedCrossRef
14.
Zurück zum Zitat Wilson JJ, Furukawa M. Evaluation of the patient with Hip Pain. Am Fam Physician. 2014;89(1):27–34.PubMed Wilson JJ, Furukawa M. Evaluation of the patient with Hip Pain. Am Fam Physician. 2014;89(1):27–34.PubMed
15.
Zurück zum Zitat Byrd JWT. Evaluation of the hip: history and physical examination. North Am J Sports Phys Ther NAJSPT. 2007;2(4):231–40. Byrd JWT. Evaluation of the hip: history and physical examination. North Am J Sports Phys Ther NAJSPT. 2007;2(4):231–40.
17.
Zurück zum Zitat Behera P, Gopinathan NR. Examination of Gait in a Child. In: Clinical Orthopedic Examination of a Child. 1st ed. 2021. pp. 18–28. Behera P, Gopinathan NR. Examination of Gait in a Child. In: Clinical Orthopedic Examination of a Child. 1st ed. 2021. pp. 18–28.
18.
Zurück zum Zitat Sutherland D. The development of mature gait. Gait Posture. 1997;6(2):163–70.CrossRef Sutherland D. The development of mature gait. Gait Posture. 1997;6(2):163–70.CrossRef
19.
Zurück zum Zitat Sawyer JR, Kapoor M. The limping child: a systemic Approach to diagnosis. Am Fam Physician. 2009;79(3):215–24.PubMed Sawyer JR, Kapoor M. The limping child: a systemic Approach to diagnosis. Am Fam Physician. 2009;79(3):215–24.PubMed
20.
Zurück zum Zitat Gibson ME, Stork N. Gait disorders. Prim Care Clin off Pract. 2021;48(3):395–415.CrossRef Gibson ME, Stork N. Gait disorders. Prim Care Clin off Pract. 2021;48(3):395–415.CrossRef
21.
Zurück zum Zitat Mashabi A, Abdallat R, Alghamdi MS, Al-Amri M. Gait compensation among children with non-operative Legg–Calvé–Perthes Disease: a systematic review. Healthcare. 2024;12(9):895.PubMedPubMedCentralCrossRef Mashabi A, Abdallat R, Alghamdi MS, Al-Amri M. Gait compensation among children with non-operative Legg–Calvé–Perthes Disease: a systematic review. Healthcare. 2024;12(9):895.PubMedPubMedCentralCrossRef
22.
Zurück zum Zitat Costa MDC, Natour J, Oliveira HAV, Terreri MT, Len CA. Gait in children and adolescents with idiopathic musculoskeletal pain. Adv Rheumatol. 2019;59(1):7.PubMedCrossRef Costa MDC, Natour J, Oliveira HAV, Terreri MT, Len CA. Gait in children and adolescents with idiopathic musculoskeletal pain. Adv Rheumatol. 2019;59(1):7.PubMedCrossRef
23.
Zurück zum Zitat Hadgaonkar S, Mehta N. Analysis of Limp, Lurch, and list in spinal afflictions– what is the Root cause? J Orthop Case Rep. 2023;13(6):149–52.PubMedPubMedCentralCrossRef Hadgaonkar S, Mehta N. Analysis of Limp, Lurch, and list in spinal afflictions– what is the Root cause? J Orthop Case Rep. 2023;13(6):149–52.PubMedPubMedCentralCrossRef
24.
Zurück zum Zitat Anable NR, Luginsland LA, Carlos C, Stevens WR Jr, Loewen AM, Jeans KA, et al. Investigating pelvic drop gait abnormality in adolescent hip pathology patients. Gait Posture. 2024;110:65–70.PubMedCrossRef Anable NR, Luginsland LA, Carlos C, Stevens WR Jr, Loewen AM, Jeans KA, et al. Investigating pelvic drop gait abnormality in adolescent hip pathology patients. Gait Posture. 2024;110:65–70.PubMedCrossRef
25.
Zurück zum Zitat Brown BD, Hood Watson KL. Cellulitis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Brown BD, Hood Watson KL. Cellulitis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
26.
Zurück zum Zitat Wong SE, Cogan CJ, Zhang AL. Physical examination of the hip: Assessment of Femoroacetabular Impingement, Labral Pathology, and microinstability. Curr Rev Musculoskelet Med. 2022;15(2):38–52.PubMedPubMedCentralCrossRef Wong SE, Cogan CJ, Zhang AL. Physical examination of the hip: Assessment of Femoroacetabular Impingement, Labral Pathology, and microinstability. Curr Rev Musculoskelet Med. 2022;15(2):38–52.PubMedPubMedCentralCrossRef
27.
Zurück zum Zitat Vigotsky AD, Lehman GJ, Beardsley C, Contreras B, Chung B, Feser EH. The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ. 2016;4:e2325.PubMedPubMedCentralCrossRef Vigotsky AD, Lehman GJ, Beardsley C, Contreras B, Chung B, Feser EH. The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled. PeerJ. 2016;4:e2325.PubMedPubMedCentralCrossRef
28.
Zurück zum Zitat Sankar WN, Laird CT, Baldwin KD. Hip range of motion in children: what is the norm? J Pediatr Orthop. 2012;32(4):399–405.PubMedCrossRef Sankar WN, Laird CT, Baldwin KD. Hip range of motion in children: what is the norm? J Pediatr Orthop. 2012;32(4):399–405.PubMedCrossRef
29.
Zurück zum Zitat Tijssen M, van Cingel R, Willemsen L, de Visser E. Diagnostics of Femoroacetabular Impingement and Labral Pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthrosc J Arthrosc Relat Surg. 2012;28(6):860–71.CrossRef Tijssen M, van Cingel R, Willemsen L, de Visser E. Diagnostics of Femoroacetabular Impingement and Labral Pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthrosc J Arthrosc Relat Surg. 2012;28(6):860–71.CrossRef
30.
Zurück zum Zitat Frangiamore S, Mannava S, Geeslin AG, Chahla J, Cinque ME, Philippon MJ. Comprehensive clinical evaluation of Femoroacetabular Impingement: part 1, physical examination. Arthrosc Tech. 2017;6(5):e1993–2001.PubMedPubMedCentralCrossRef Frangiamore S, Mannava S, Geeslin AG, Chahla J, Cinque ME, Philippon MJ. Comprehensive clinical evaluation of Femoroacetabular Impingement: part 1, physical examination. Arthrosc Tech. 2017;6(5):e1993–2001.PubMedPubMedCentralCrossRef
31.
Zurück zum Zitat Safran MR. Microinstability of the hip-gaining Acceptance. J Am Acad Orthop Surg. 2019;27(1):12–22.PubMedCrossRef Safran MR. Microinstability of the hip-gaining Acceptance. J Am Acad Orthop Surg. 2019;27(1):12–22.PubMedCrossRef
32.
Zurück zum Zitat Hoppe DJ, Truntzer JN, Shapiro LM, Abrams GD, Safran MR. Diagnostic accuracy of 3 physical examination tests in the Assessment of Hip Microinstability. Orthop J Sports Med. 2017;5(11):2325967117740121.PubMedPubMedCentralCrossRef Hoppe DJ, Truntzer JN, Shapiro LM, Abrams GD, Safran MR. Diagnostic accuracy of 3 physical examination tests in the Assessment of Hip Microinstability. Orthop J Sports Med. 2017;5(11):2325967117740121.PubMedPubMedCentralCrossRef
33.
Zurück zum Zitat Spiker AM, Fabricant PD, Wong AC, Suryavanshi JR, Sink EL. Radiographic and clinical characteristics associated with a positive PART (Prone Apprehension Relocation Test): a new provocative exam to elicit hip instability. J Hip Preserv Surg. 2020;7(2):288–97.PubMedPubMedCentralCrossRef Spiker AM, Fabricant PD, Wong AC, Suryavanshi JR, Sink EL. Radiographic and clinical characteristics associated with a positive PART (Prone Apprehension Relocation Test): a new provocative exam to elicit hip instability. J Hip Preserv Surg. 2020;7(2):288–97.PubMedPubMedCentralCrossRef
34.
Zurück zum Zitat Gebhardt S, Lerch S, Sobau C, Miehlke W, Wassilew GI, Zimmerer A. Prone Apprehension Relocation Test significantly correlates with radiological instability scores of the hip. J Hip Preserv Surg. 2022;9(2):78–83.PubMedPubMedCentralCrossRef Gebhardt S, Lerch S, Sobau C, Miehlke W, Wassilew GI, Zimmerer A. Prone Apprehension Relocation Test significantly correlates with radiological instability scores of the hip. J Hip Preserv Surg. 2022;9(2):78–83.PubMedPubMedCentralCrossRef
35.
Zurück zum Zitat Thomas GE, Palmer AJ, Andrade AJ, Pollard TC, Fary C, Singh PJ, et al. Diagnosis and management of femoroacetabular impingement. Br J Gen Pract. 2013;63(612):e513–5.PubMedPubMedCentralCrossRef Thomas GE, Palmer AJ, Andrade AJ, Pollard TC, Fary C, Singh PJ, et al. Diagnosis and management of femoroacetabular impingement. Br J Gen Pract. 2013;63(612):e513–5.PubMedPubMedCentralCrossRef
36.
Zurück zum Zitat Gogu S, Gandbhir VN. Trendelenburg Sign. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Gogu S, Gandbhir VN. Trendelenburg Sign. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
37.
Zurück zum Zitat Hardcastle P, Nade S. The significance of the Trendelenburg test. J Bone Joint Surg Br. 1985;67(5):741–6.PubMedCrossRef Hardcastle P, Nade S. The significance of the Trendelenburg test. J Bone Joint Surg Br. 1985;67(5):741–6.PubMedCrossRef
38.
Zurück zum Zitat Bailey R, Selfe J, Richards J. The role of the Trendelenburg Test in the examination of gait. Phys Ther Rev. 2009;14(3):190–7.CrossRef Bailey R, Selfe J, Richards J. The role of the Trendelenburg Test in the examination of gait. Phys Ther Rev. 2009;14(3):190–7.CrossRef
39.
Zurück zum Zitat Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-Leg Squat Task indicates hip abductor muscle function. Am J Sports Med. 2011;39(4):866–73.PubMedCrossRef Crossley KM, Zhang WJ, Schache AG, Bryant A, Cowan SM. Performance on the single-Leg Squat Task indicates hip abductor muscle function. Am J Sports Med. 2011;39(4):866–73.PubMedCrossRef
40.
Zurück zum Zitat Fludder CJ, Keil BG. Routine screening for developmental dysplasia of the hip by chiropractors: a case report of late diagnosis in an infant. J Can Chiropr Assoc. 2020;64(2):144–54.PubMedPubMedCentral Fludder CJ, Keil BG. Routine screening for developmental dysplasia of the hip by chiropractors: a case report of late diagnosis in an infant. J Can Chiropr Assoc. 2020;64(2):144–54.PubMedPubMedCentral
41.
Zurück zum Zitat Camino Willhuber GO, Piuzzi NS. Straight Leg raise test. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Camino Willhuber GO, Piuzzi NS. Straight Leg raise test. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
42.
Zurück zum Zitat Nandhagopal T, Tiwari V, De Cicco FL. Developmental Dysplasia of the hip. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Nandhagopal T, Tiwari V, De Cicco FL. Developmental Dysplasia of the hip. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
43.
Zurück zum Zitat Storer SK, Skaggs DL. Developmental Dysplasia of the hip. Am Fam Physician. 2006;74(8):1310–6.PubMed Storer SK, Skaggs DL. Developmental Dysplasia of the hip. Am Fam Physician. 2006;74(8):1310–6.PubMed
44.
Zurück zum Zitat Shaw BA, Segal LS, Otsuka NY, Schwend RM, Ganley TJ, et al. Evaluation and referral for Developmental Dysplasia of the hip in infants. Pediatrics. 2016;138(6):e20163107.PubMedCrossRef Shaw BA, Segal LS, Otsuka NY, Schwend RM, Ganley TJ, et al. Evaluation and referral for Developmental Dysplasia of the hip in infants. Pediatrics. 2016;138(6):e20163107.PubMedCrossRef
45.
46.
Zurück zum Zitat Mazloumi SM. Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. NUMBER. 2014;2(2). Mazloumi SM. Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. NUMBER. 2014;2(2).
48.
Zurück zum Zitat Thatayatikom A, Modica R, De Leucio A. Juvenile idiopathic arthritis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Thatayatikom A, Modica R, De Leucio A. Juvenile idiopathic arthritis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
Metadaten
Titel
The Pediatric Hip Physical Exam
verfasst von
Katherine Bach
Sarah Coufal
Nicholas Kelly
Ameera Teal
Ishaan Swarup
Publikationsdatum
25.01.2025
Verlag
Springer US
Erschienen in
Current Reviews in Musculoskeletal Medicine
Elektronische ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-025-09945-y

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