ABC of Rheumatology: PAIN IN THE HIP AND KNEE

Hip disease in adults is usually associated with pain on walking or on rolling over in bed, limited movement of the joint, a limping or waddling gait, and shortening of the affected leg. It may be difficult to put on socks and to get up from a low chair. Perthes' disease of right hip. This is a non-specific term for pain in the groin, a limp, and limited movement of the hip joint in all directions in a child. The child should be kept in bed and investigated immediately by general physical examination, plain x ray pictures of the hips, full blood count, and measurement of erythrocyte sedimentation rate, with further investigations as necessary to establish a specific diagnosis. Perthes' disease—Osteochondritis of the epiphysis of the femoral head occurs in boys aged 4–10 years. Plain x ray pictures reveal widening of the joint space, narrowing of the epiphysis, and, later, fragmentation of the femoral head. Further deformity of the femoral head may be limited by use of abduction braces or casts. Infection of the hip joint in a child usually follows bony infection and is rapidly destructive. The child refuses to bear weight on the leg and appears ill. In neonates there are few signs, and the diagnosis is easily missed. x Ray changes are late, so if there is clinical suspicion ultrasonography should be carried out to detect an effusion, and any fluid should be aspirated and cultured. An infected hip should be surgically drained and treated with high dose intravenous antibiotics and bed rest. Slipped epiphysis most often occurs in overweight adolescents. A combination of shearing forces and inherent epiphysial weakness leads to the superior epiphysial plate slipping downward and backward, either suddenly or gradually. There is pain after exertion, and the hip may be held in external …