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J Pediatr. 2018 Nov 16. pii: S0022-3476(18)31557-9. doi: 10.1016/j.jpeds.2018.10.050. [Epub ahead of print]

Patterns of Pain in Adolescents with Slipped Capital Femoral Epiphysis.

Author information

1
Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO. Electronic address: muvodich2@kumc.edu.
2
Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO.

Abstract

OBJECTIVE:

To prospectively characterize pain locations in slipped capital femoral epiphysis (SCFE) and evaluate pain locations as predictors of a delay in diagnosis.

STUDY DESIGN:

This was an institutional review board approved prospective study of 110 children who underwent surgery for SCFE at a tertiary children's hospital between 2009 and 2015. Standardized pain diagrams were completed by 107 children. Pain zones were designated via a composite diagram. Hips without hip pain were categorized as atypical; hips with hip pain were typical.

RESULTS:

In total, 122 hips were eligible for pain zone analysis. Seventy hips (57.4%) had hip pain. Atypical pain was present in 52 hips (42.6%), which included groin pain in 17 hips (13.9%), thigh/leg pain in 43 (35.2%), knee pain in 32 (26.2%), and posterolateral pain of the hip and leg in 13 (10.7%). A combination of pain zones was present in 48 hips (39.3%). Forty-nine percent of patients had more than 1 visit until diagnosis. The three most common pain locations for typical hips were hip, hip/thigh, and hip/knee pain (77.2% of typical hips). The 3 most common pain locations for atypical hips were isolated thigh, knee, and groin (65.4% of atypical hips). The least common pain presentations had a longer duration of symptoms (P = .04) and more healthcare visits before diagnosis (P = .04).

CONCLUSIONS:

A combination of pain locations is common in SCFE. Less frequent pain presentations may delay diagnosis. Delays in diagnosis continue despite education efforts.

KEYWORDS:

SCFE; adolescent hip; orthopaedics; slipped capital femoral epiphysis

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