A 12-year-old male with hip pain presents to the NP clinic. Hip pain has occurred with activity for the past 4-6 weeks, but his pain is worse and now involves the knee. There is no history of trauma. How should the workup be initiated?

A 12-year-old male with hip pain presents to the NP clinic. Hip pain has occurred with activity for the past 4-6 weeks, but his pain is worse and now involves the knee. There is no history of trauma. How should the workup be initiated?

• A. Order a hip and knee X-ray
• B. Order a hip X-ray and a sed rate
• C. Perform Trendelenburg's test in the office
• D. Have the child squat in the office to assess the hips

Answer: (C)

Start with a focused hip exam to screen for hip pathology before jumping to tests. The Trendelenburg sign is a quick, reliable bedside test you use in a child with hip pain. Have the patient stand on one leg and look at the pelvis: if the pelvis drops on the opposite side, that indicates weakness of the hip abductors (gluteus medius/minimus) and points to a problem in or around the hip, such as SCFE or Perthes disease. This finding helps distinguish hip-origin pain from purely knee issues and guides the next steps toward targeted imaging. If the Trendelenburg test is abnormal, proceed with hip imaging (and consider knee imaging only if symptoms remain or there’s a mismatch between exam and symptoms). The other options—immediately ordering imaging without a focused exam, or relying on labs like a sed rate, or using a squat test in lieu of a standard hip-specific screen—do not efficiently identify hip pathology first in a child with hip pain and knee referral.

Start with a focused hip exam to screen for hip pathology before jumping to tests. The Trendelenburg sign is a quick, reliable bedside test you use in a child with hip pain. Have the patient stand on one leg and look at the pelvis: if the pelvis drops on the opposite side, that indicates weakness of the hip abductors (gluteus medius/minimus) and points to a problem in or around the hip, such as SCFE or Perthes disease. This finding helps distinguish hip-origin pain from purely knee issues and guides the next steps toward targeted imaging.

If the Trendelenburg test is abnormal, proceed with hip imaging (and consider knee imaging only if symptoms remain or there’s a mismatch between exam and symptoms). The other options—immediately ordering imaging without a focused exam, or relying on labs like a sed rate, or using a squat test in lieu of a standard hip-specific screen—do not efficiently identify hip pathology first in a child with hip pain and knee referral.