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What causes sudden intense hip pain in a child?

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Posted on Tue, 22 Dec 2015
Question: My son is 14 years old. Normally extremely fit and healthy - no previous illness AT ALL and doesn't complain and it quiet a stoic, brave kid who plays lots of sport etc. 7 days ago he was struck down by intense hip pain - so bad that he has been crying and screaming at any movement that involves his hip joint and it continues to ache on rest. He is most comfortable lying flat (pain remains at a 4-5/10), but any movement takes it straight to a 10. He has been in hospital since last Wednesday, still with no diagnosis. He has had MRI, X-rays and CT scan - all 'normal' for his hip although they found mesenteric adonitis on the right side, enlarged liver and a slight infection in his right lung. We returned from a holiday in Bali 10 days prior to the symptoms starting, but he was not unwell at all during the trip or up until it began last week. He is afebrile and has normal blood pressure etc. He has had some sweats, but these have coincided with severe pain on movement to the toilet etc. He has been on Ketamine, Morphine, Celebrex and several other medications - nothing has helped. He had 3 days of IV antibiotics, but this was ceased after bloods were clear, apart from raised liver enzymes. He had a nerve block injection in the hip, but again, no relief. He is getting very frustrated that they are unable to find a cause and his symptoms are not subsiding. He has very little appetite, but is trying to eat and drink a bit - often causing nausea and vomitting. Any ideas would be great!!!!! Thank you.
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Answered by Dr. Diptanshu Das (1 hour later)
Brief Answer:
Morphine or pethidine should be the mainstay of treatment.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through the query and understand your concerns. Sicne MRI or CT scan does not reveal anything conclusive, bone tumors and other similar causes can perhaps be ruled out. There are two broad possibilities to consider. The most likely cause is some sort of muscle spasm although it is hard to comment definitively without clinical examination. Hot compress and muscle relaxants should be given along with the current line of pain medication. I understand that the response is inadequate but all that can be done is to see which medicine ultimately provides relief. Although addiction forming on long term, on short term morphine or pethidine are very safe and should be the mainstay of treatment. The nausea can be a side effect of such medication and antiemetics should provide relief.

The possibility that needs to be ruled out is some inflammatory cause. In that case the CRP (c-reactive protein) or the ESR would be raised. If this has not been checked, please get it done. Negative results will rule out inflammatory cause.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Diptanshu Das

Pediatrician

Practicing since :2005

Answered : 3871 Questions

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What causes sudden intense hip pain in a child?

Brief Answer: Morphine or pethidine should be the mainstay of treatment. Detailed Answer: Thanks for asking on HealthcareMagic. I have gone carefully through the query and understand your concerns. Sicne MRI or CT scan does not reveal anything conclusive, bone tumors and other similar causes can perhaps be ruled out. There are two broad possibilities to consider. The most likely cause is some sort of muscle spasm although it is hard to comment definitively without clinical examination. Hot compress and muscle relaxants should be given along with the current line of pain medication. I understand that the response is inadequate but all that can be done is to see which medicine ultimately provides relief. Although addiction forming on long term, on short term morphine or pethidine are very safe and should be the mainstay of treatment. The nausea can be a side effect of such medication and antiemetics should provide relief. The possibility that needs to be ruled out is some inflammatory cause. In that case the CRP (c-reactive protein) or the ESR would be raised. If this has not been checked, please get it done. Negative results will rule out inflammatory cause. Regards