Medical Mystery: Sudden thigh pain sidelines young athlete
Like almost 70 percent of children who live in the neighborhoods around St. Christopher's Hospital for Children in North Philadelphia, my 12-year-old patient was struggling with her weight. It had been steadily increasing for the last eight years and now that she was starting to go through puberty, her weight jumped to 158 pounds.
That meant she weighed more than 98 percent of all kids her age and height and was getting close to being considered morbidly obese.
Childhood obesity in impoverished areas is a complex phenomenon of poor access to healthy food, food insecurity, a lack of safe areas to play, household stress, and culture. Because several of the girl's family members have type 2 diabetes, we were fighting against the clock to prevent this devastating disease in my young patient.
To her credit, she became active and even started to play basketball for her school team. But then persistent pain in her right thigh stopped her from playing. She was diagnosed with muscle strain at another facility, given ibuprofen, and told to follow up with her physician in a few weeks.
A week later, her father hurriedly pushed her into our office in a wheelchair, as she couldn't walk. I examined her and found she couldn't bear any weight on her right leg. Moving the leg at all caused pain. I immediately obtained X-rays of her hips. A call from our radiologist confirmed my suspicions and she was scheduled for surgery the next day.
The top part of her femur, or thighbone, was slipping off the shaft of the femur and putting my patient at risk of severe complications, such as early osteoarthritis, which would limit her ability to be active for a lifetime.
The X-ray confirmed the diagnosis, slipped capital femoral epiphysis. This is an unusual disorder that affects children shortly after the onset of puberty, while their growth plate - wedged between the femoral head and femur - is still present. The head of the femur slips off in a backward direction, which can cause various symptoms, such as hip, thigh, or knee pain and a limp.
The risk of this condition is higher among kids who are overweight, and also among boys. Many times, diagnosis is delayed because pain is referred to the knee or thigh (as in my patient). As time goes on, the femoral head slips more and more, like a scoop of ice cream slowly slipping off the cone on a hot day.
The goal of treatment is to prevent additional slippage. Surgery, which requires placing screws through the femur to secure the femoral head, should be immediate. My patient had surgery the next day and needed to use crutches for more than a month.
Still, at a follow-up visit two months later, I was excited to see she could walk without pain, and she had even lost 10 pounds. She told me fear of the same thing happening to her left hip had motivated her - and her whole family - to adopt healthier habits.
Daniel R. Taylor, D.O., is an associate professor at the Drexel University College of Medicine and director of community pediatrics and child advocacy at St. Christopher's Hospital for Children.
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