Table 2 Pathoanatomic approach; within the greater trochanter triangle (paediatric) (diagnoses appear in order of frequency in an athletic population)
Define and AlignPathologyListen and LocalisePalpate and RecreateAlleviate and InvestigateDefine and Align
Within the triangle (Paediatric)Acute transient synovitisMale. Refusal to weight bear. Poorly localised pain. Viral precipitant.3–6 yearsWell, non-toxic, variable range of motion.Diagnosis of exclusion, to be monitored to exclude septic arthritis.22
Apophysitis/avulsion fractureAssociated injury/event.<18 years23Point tenderness.24Plain film x-ray,25 computerised tomography (CT).26
Perthes’ diseaseMale, associated knee pain.4–9 yearsDecreased range of movement of hip, abduction and internal rotation ↓Plain film x-ray, antero/posterior (AP), lateral, and comparative views.27
Joint effusion.27
Slipped capital femoral epiphysisOverweight, male, 30% cases bilateral.2812–15 yearsDecreased range of motion of hip, abduction and internal rotation ↓.Plain film x-ray, antero/posterior (AP), lateral, and comparative views.
Limb shortening, external rotation of hip.29
Septic arthritisRefusal to weight bear. Systemically unwell.AllUnwell, toxic, variable range of motion.Temp >38.5, CRP >20, ESR >40, refusal to weight bear, leucocytosis >12.22
Plain film x-ray, joint aspiration, isotope bone scan.
Congenital dysplasiaDelayed mobilising/limp, walking on tip-toe.30AllLimb length discrepancy, unilateral symptoms, limitation of abduction.30Ultrasound, x-ray.
TumourNight pain, systemic “red flags”, absence of appropriate physical stressors.20All agesSystemic features, may mimic stress fracture.20Plain film x-ray, magnetic resonance imaging.21