An 8-year-old has a painful limp with knee pain medially and hip internal rotation pain. How should the NP manage this?

An 8-year-old has a painful limp with knee pain medially and hip internal rotation pain. How should the NP manage this?

• A. The NP should order a hip X-ray, CBC and ESR
• B. The NP should order a hip and knee X-ray
• C. He should be referred for synovial fluid aspiration
• D. The NP should be immediately referred to orthopedics

Answer: (A)

Focusing on the right first steps for a child with an acute limp and hip involvement is key. When a school-age child has knee pain but the hip is actually the source (indicated by pain with hip internal rotation), the priority is to quickly assess for serious hip conditions such as septic arthritis or Legg-Calvé-Perthes disease and to differentiate infection from other causes. Ordering a hip X-ray gives essential information about the joint and surrounding bone—it can reveal structural issues, early signs of Perthes disease, or fractures that could be driving symptoms. The CBC and ESR are inflammatory and infectious markers that help gauge whether an infection like septic arthritis might be present, which would require urgent action. Together, these tests provide a targeted, noninvasive initial workup to determine the next steps, such as whether further imaging, ultrasound for effusion, or urgent joint aspiration and orthopedic involvement are needed. Knee imaging alone isn’t the priority here because the hip is the likely source of pathology given the hip-specific pain and limited internal rotation. Immediate orthopedic referral or synovial fluid aspiration would follow only if the findings raise strong concern for septic arthritis or if imaging/labs point to another urgent need.

Focusing on the right first steps for a child with an acute limp and hip involvement is key. When a school-age child has knee pain but the hip is actually the source (indicated by pain with hip internal rotation), the priority is to quickly assess for serious hip conditions such as septic arthritis or Legg-Calvé-Perthes disease and to differentiate infection from other causes.

Ordering a hip X-ray gives essential information about the joint and surrounding bone—it can reveal structural issues, early signs of Perthes disease, or fractures that could be driving symptoms. The CBC and ESR are inflammatory and infectious markers that help gauge whether an infection like septic arthritis might be present, which would require urgent action. Together, these tests provide a targeted, noninvasive initial workup to determine the next steps, such as whether further imaging, ultrasound for effusion, or urgent joint aspiration and orthopedic involvement are needed.

Knee imaging alone isn’t the priority here because the hip is the likely source of pathology given the hip-specific pain and limited internal rotation. Immediate orthopedic referral or synovial fluid aspiration would follow only if the findings raise strong concern for septic arthritis or if imaging/labs point to another urgent need.