Slipped capital femoral epiphysis or SCFE is often not diagnosed until weeks or months after its onset . Its symptoms of vague pain in the groin or hip, or the thigh or knee, may be shared with many other hip disorders. Some of the more important differential diagnoses are discussed briefly below:
Avascular Necrosis of the Hip
Avascular necrosis of the hip is a condition typically seen in the age bracket of 30-50 years, often with a history of another predisposing disorder such as Cushing disease or systemic lupus erythematosis ( SLE). It can also be a consequence of SCFE over the long term or following surgical correction in some cases. It is differentiated by MRI imaging which shows reduced intensity on T1 and T2-weighted images.
Hip fracture is always preceded by a history of trauma, findings of soft tissue shadowing and visible displacement of the fractured bone .
The clinical features of Legg-Calve-Perthes disease include pain, limping and restricted range of movement, similar to SCFE. The age group affected is usually under 10 years old. The X-rays reveal collapse of the femoral head, and MRI findings in the subchondral area are characteristic of hyperintense T2-weighted images and hypointense T1-weighted images.
Hip dysplasia is caused by a loss of articulation within the hip joint. In some cases, is so mild as to produce no symptoms , but may also result in hip dislocation as a result of severe dysplasia. The latter may lead to early onset of osteoarthritis, hip impingement, or labral cartilaginous tearing. X-rays show that the acetabulum is directed in an abnormally vertical orientation and is shallower than normal.
The presentation of osteomyelitis is usually chronic but may occur as acute symptoms following a period of chronic pain, which may include pain at night or at rest . Blood tests give evidence of inflammation, and blood cultures may show the presence of bacteria. MRI i shows hyperintense T2-weighted images and abscesses in the intraosseous or subperiosteal space.
The patient with septic arthritis suffers severe pain and weight-bearing is impossible. Systemic features such as fever, chills and a sense of malaise are often present. On physical examination, the hip is held in flexion, abduction and external rotation which is the least painful because it is the position that offers the most space to the joint. Passive movement of the joint is extremely painful. Plain X-rays show that joint space is widened by inflammation and infection. Ultrasound is positive for joint effusion, and joint aspiration is often positive for infectious organisms.
Groin Muscle Pull
When the groin muscle is pulled, t he groin adductor tendons are tender and the hip is painful when adducted. The limb is in normal position.
Ankylosing spondylitis is seen in an older age group, from young to middle-aged males. It often involves both hip joints and the symptoms are worse in the morning, waning as the day progresses. Other joints affected include the sacroiliac and low back joints. X-rays are helpful in visualizing the irregularities in the bone with other typical sclerotic or erosive changes. The spine is seen as a ‘bamboo-spine’ on plain radiography.
Stress fractures occur in patients with a history of rough use or overuse of the limb, and X-rays show the femoral neck to be edematous or to display a typical stress reaction.
Reviewed by Catherine Shaffer, M.Sc.
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