Question of the Week

For October 25, 2016

An 11-year-old girl who plays soccer and basketball reports a limp that is worse after she plays, is associated with what she describes as “an achy feeling” in the right hip, and improves with rest. She has no mechanical symptoms and cannot recall any injury, illnesses, fever, or weight loss. She takes occasional ibuprofen for the hip pain.

She is currently afebrile and has a BMI of 19 (71st percentile). She has mild tenderness over the right anterior–superior iliac spine but no swelling, bruising, or erythema of the hip or bony pelvis. She has full passive range of motion of the right hip. No pain is elicited when the leg is gently rolled internally and externally with the hip in extension. Her back and knees are normal.

What is the most appropriate next step for this patient?

Reassure her that the symptoms are likely to resolve spontaneously without active management
Obtain anteroposterior and frog-leg lateral radiographs of the hip
Measure a complete blood count with differential and a C-reactive protein level
Obtain an ultrasound of the hip
Recommend scheduled ibuprofen for one week, and instruct her to return if she has not improved