May Week 4: Common Musculoskeletal Complaints


Legg-Calves-Perthes Disease. William P. Bunnell.  Pediatrics in Review. 

SCFE. David Peck. American Family Physician. 2010.


You are in CYAS clinic on a Friday afternoon and go to see 9 year old Fritz, whose mother tells you he has been complaining of intermittent pain in his right knee for the last 2-3 weeks. She thinks he may need antibiotics. You watch Fritz walk across the room and note a slight right-sided limp, but when you ask him whether he has any pain right now he says no.

What is on your differential at this point? What else should you ask about?

On physical exam, you note full range of motion of both knees and the left hip, and decreased internal rotation of the right hip. He complains of pain when you rotate the right hip internally and externally.

Which diagnostic tests would you like to order? What signs would you expect to see on imaging?

Xray of the right hip shows slipped capital femoral epiphysis on the right, just as you suspected all along.

What is the treatment for SCFE? Should you treat the left side prophylactically?

You look at Fritz’s growth chart and note that he is below the 10th percentile for height and weight. His mother reports that the family recently moved here from Bavaria. She does not have any of his medical records and cannot recall what his growth percentiles have been in the past- she thinks they don’t check that in Germany.

Which other disorders should you test for? What tests will you order?

Case/Questions written by Dr. Alice Kohlmeier