Irritable Hip

Your child gets up and falls to the ground. Stands up again - back on the ground. They can't bear any weight through their leg.

They limp about and walk wonky.

You are worried - what's going on?

I've personally experienced this exact scenario with one of my children - and yes I still freaked out! I was in a complete panic even though I knew the likely diagnosis from watching him.

What is Irritable Hip?

Irritable Hip is the most common cause of non-traumatic limping in children (Tu et al. 2023). Just because it's common, doesn't mean that's what's going on with your child so please do get an assessment first and foremost.

• Other cause of limping in toddlers

Irritable Hip, or Transient Synovitis, is inflammation and irritation of the inside of the hip joint. This inner layer is called the synovium and hence inflammation of it is synovitis. The synovium consists of the lining around the ball and socket bones of the hip (and other synovial joints) as well synovial fluid to lubricate the joint. Synovitis involves:

• Increased joint (synovial) fluid

• Increased pressure in the synovial joint capsule

Symptoms of Irritable Hip

How do kids develop irritable hip?

It's unknown how it develops but it's thought that some kids have events in the lead up including (Whitelaw & Varacallo 2022):

What Tests are done for Irritable Hip?

This will depend on the age of your child but may include:

• Chat - What are the symptoms? Has there been an illness prior?
  

• Low back, hip, knee, ankle and foot tests - range of motion and orthopaedic testing

• Hip x-ray, ultrasound and / or blood tests - rule out other causes of hip pain

Treatment for Irritable Hip

Rest

Easier said that done but rest. Without rest, the inflammation may persist and prolong the condition which otherwise tends to improve within days (particularly pain) and the limp within 1-2 weeks.  It may also lead to re-occurrences of irritable hip.

How to get a Toddler to Rest their Irritable Hip

Do what you need to do. It is hard!

• Pram - go to the zoo or some adventure that will entertain but keep them strapped in

• Movie

• Reading - go to the library and pick some new books to read together

• Arts & crafts - sitting down doing drawing and arts & crafts

• Carry them - watch your own back though!

• Sleeping Logs - play games like "sleeping logs" where the kids lie still and if they move, they are out

• Talk to them - depending on their language skills, chat to them to remind them about their leg and the importance of rest

• Feed them - It fun and different to keep them at the table for longer. It might be as simple as a grazing plate instead of regular meat-&-veg dinner; eat out at a cafe or a picnic in the backyard (avoid a park where they'll want to run around).

Movement as Comfortable

Kids will naturally move in a way that's comfortable for them. For example, instead of walking, they may crawl.

Only return to strenuous activities until fully resolved.

Pain Relief

Anti-inflammatory pain relief might be considered. This might be herbal or medication such as ibuprofen.

Chiropractic

Paediatric chiropractic through the hip, back and leg to release muscle spasm, reduce inflammation and improve compensation patterns. This does not replace rest that is the first and foremost important part of managing Irritable Hip.

When to Seek Medical Help for Irritable Hip?

• Fever or generally unwell

• Pain not relieved by rest or medication

• Not improving within three days or fully resolved by 2 weeks

• Swelling and redness around the hip or leg

What are the Long Term Complications of Irritable Hip?

• Recurrence - 1 in 4-5 will experience another episode of irritable hip, most commonly within six months of the first incidence.

• Hip Joint Deformation - the ball of the hip joint (called the femoral head & neck) may become misshapen. This is called coxa magna.

• Other hip diseases - Legg-Calve-Perthes disease where the blood supply to the hip joint is disrupted