Author: Adam Zucconi, DO
Editor: Krystian Bigosinski, MD
5 Year old boy with no significant past medical history presented to the out patient pediatric orthopedic clinic for ER follow up with worsening right hip and leg pain, with an associated fever, chills, and pharyngitis.
This patient reports that approximately 5 days prior to his ER visit, he collided with another student in the school yard. The collision did not stop him from playing the remainder of recess. Over the next few days, he had significant worsening of hip and leg pain. When he developed a fever of 103 with worsening pain his mother went to the ER at the request of his pediatrician. His mother reports that a few days prior to the collision he had been dealing with a "cold" . His pains are worse at night and are relieved with ibuprofen.
Constitutional: Positive for fever 103. well appearing non toxic apearance responsive to ibuprofen and tylenol.
ENT: Erythematous posterior pharynx, with hard palate petechiae, no coryza
Skin: maculopapular rash on the arms and legs involving the trunk which is pruritic.
Musculoskelatal exam: Inspection of the limbs shows no deformity, swelling, or abnormal posturing.
He has tenderness to palpation of the hip and the proximal femur posteriorly.
Range of motion of the hip is markedly diminished, most notably with flexion, abduction, and internal rotation. He has marked pain with IR.
Muscle testing provokes pain but good power.
He has pain with log roll and positive fulcrum testing.
Gait is non-antalgic.
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