5 y/o M initially w/ a cold 1wk ago now presents w/ a limp & effusion in the hip. X-rays are normal and ESR is 35 (?), T = 99.8, WBCs = 10K - Next best step?

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02-03-2024
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High School

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5 y/o M initially w/ a cold 1wk ago now presents w/ a limp & effusion in the hip. X-rays are normal and ESR is 35 (?), T = 99.8, WBCs = 10K - Next best step?

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monikaT monikaT · Answer 1 · 2023-07-30T08:47:14-04:00

Final answer:

The next best step is to refer the child to a pediatric orthopedic specialist or pediatric rheumatologist and consider getting a hip ultrasound, starting NSAIDs for pain relief, and additional laboratory tests like CRP.

Explanation:

The clinical presentation of a 5-year-old male with a history of a cold, now presenting with a limp and effusion in the hip, normal X-rays, an elevated ESR, a slightly increased temperature, and normal WBC count suggests a possible transient synovitis or early septic arthritis.

The next best step in management should be prompt referral to a pediatric orthopedic specialist or a pediatric rheumatologist for further evaluation. In the meantime, obtaining a hip ultrasound to assess for effusion, starting nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, and considering further laboratory tests such as a C-reactive protein (CRP) might be advised.

Given that X-rays are normal, this step is unlikely to reveal osseous abnormalities but can exclude other conditions such as fractures. A normal WBC count does not rule out infection, and hip effusions in children can be due to various causes, including infectious, inflammatory, and traumatic.