The physical presentation is similar, but the pain is usually worse. The patient is unable to touch the abdomen with the thigh because the hip externally rotates with flexion. Radiologic studies help differentiate SCFE from other hip disorders. In our patient, septic arthritis was quickly ruled out. He appeared healthy, with no fever or other clinical or laboratory signs of sepsis, and the physical exam of his hip did not correlate with the picture of a septic joint.
Patients often have a history of recent injury or infection such as otitis media.
The usually acute onset of septic arthritis is accompanied by fever, apprehension, and loss of appetite. The joint is warm, swollen, and held in flexion. Active and passive range of motion are limited by extreme pain. Physical and laboratory signs of sepsis should prompt quick referral for immediate aspiration of the joint under appropriate conditions. Transient synovitis is the most common cause of hip pain in children under age 10.