Left sided hip pain


• Scene – position of comfort

• En route – Monitor vitals and pain

• Hospital – X-ray, IV


• Response to treatment – no change.

• Disposition – patient transferred for higher level of care.


Eric Boyd, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Left hip pain

Differential Diagnosis

  • Toxic synovitis
  • Septic arthritis
  • Osteomyelitis
  • Fracture
  • Non-accidental trauma

Patient Workup History

  • Mother states patient was normal when she put her in her crib for a nap, but was unable to bear weight on her left leg when she woke up.
  • Normally, patient is standing in her crib when she wakes up from her nap, but today mother found her sitting in her crib.
  • Mother states patient started crying when she tried to walk with assistance.
  • No recent trauma. Patient is being treated for an ear infection but is otherwise very healthy.
  • Patient is normally very active and runs around playing with her older brother.
  • Patient has been walking for ~6 months

Physical Exam

  • Pain when straightening leg
  • Normal neurological reflex
  • No swelling and non-tender to palpation.
  • X-ray by ED found increased fluid in left hip joint.
  • GSC – 15

Editor’s Notes

This child’s symptoms suggest hip pathology, especially with the way her left hip seems to be externally rotated in a position of comfort. Without a fever or toxic appearance, I would suspect synovitis of the hip as high on the list of this differential. Of course, one must consider septic arthritis and non-accidental trauma (fracture) as well.

-Dr. David Spiro

Suggested References

Transient synovitis


• Gender: Female

• Age: 17 months

• Height: Not Available

• Weight: Not Available


• Temperature: Not Available

• Blood Pressure: Not Available

• Heart Rate: 124

• Respiratory Rate: 24

• Pulse Oximetry: 100% RA

Signs and Symptoms

Unable to bear weight on left leg; hip pain

History Medical

• PMH: None

• Dispatch info: Transfer to Doernbecher for hip infection.


• Lives with mom and 6yo sibling


• Amoxicillin

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