Slipped Capital Femoral Epiphysis Clinical Presentation

Updated: Dec 03, 2018
  • Author: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD  more...
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Presentation

History

See the list below:

  • Slipped capital femoral epiphysis (SCFE) is most common in the adolescent period (ie, boys aged 10-16 y, girls aged 12-14 y). Males have 2.4 times the risk compared with females.

  • The left hip is affected more commonly than the right.

  • Obesity is a risk factor because it places more shear forces around the proximal growth plate in the hip at risk. [22, 23]

    • A study by Perry et al that included BMI data from 597,017 children reported that children 5-6 years of age with severe obesity had almost 6 times the risk for SCFE and children 11-12 years of age with severe obesity had 17 times the risk compared to children with normal BMI. [37]

  • The duration, location, and radiation of pain are important, as is the ability to bear weight.

  • Genetics may play a role in SCFE because the rate of familial involvement is 5-7%, with a large variability in penetrance.

  • In patients younger than 10 years, SCFE is associated with metabolic endocrine disorders (eg, hypothyroidism, panhypopituitarism, hypogonadism, renal osteodystrophy, growth hormone abnormalities). [1, 24, 25] Bilaterality is more common in these younger patients.

  • The chronicity of the condition should be determined.

    • Prodromal symptoms (eg, hip or knee pain, limp, decreased range of motion) for less than 3 weeks are deemed acute.

    • Prodromal symptoms for longer than 3 weeks are deemed chronic.

    • If a patient reports symptoms of greater than 3 weeks' duration but presents with an acute exacerbation of pain, limp, inability to bear weight, or decreased range of motion with or without an associated traumatic episode, the SCFE is categorized as acute on chronic.

    • Determine if a traumatic episode occurred.

  • It is important to determine if the lesion is stable or unstable.

    • "Stable" SCFEs allow the patient to ambulate with or without crutches. [8]

    • "Unstable" SCFEs do not allow the patient to ambulate at all; these cases carry a higher rate of complication, particularly of AVN. [8]

Next:

Physical

See the list below:

  • If a patient reports knee pain, always examine the hip, because knee pain may be referred pain from the hip via the obturator nerve.

  • Obesity increases a clinician's index of suspicion for SCFE.

  • Patients often hold their affected hip in passive external rotation.

  • Determine the patient's ability to bear weight (stable vs unstable).

  • If the patient is ambulatory, determine the his or her gait pattern:

    • Antalgic – Shortened stance phase on the affected side

    • Out-toeing

  • Always examine both hips. Assess the active and passive range of motion in both hips. In patients with unilateral complaints, this comparison allows the clinician to compare the affected and unaffected sides for differences. Internal and external rotation are best tested with the patient in the prone position with the knees flexed to 90 º.

    • If SCFE is present, the lower extremity may externally rotate and abduct with gentle passive hip flexion.

    • Internal rotation is decreased in nearly all hips with SCFE. Internal rotation is often painful.

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