Question

A 10 year old male presents with a one week history of a limp that seems to be getting worse. The patient describes hip and upper leg pain that is worst when he stands with his full weight on his left foot. The pain started last week, but yesterday it suddenly worsened after he jumped off of a moving swing yesterday. On physical examination, the patient moderately obese and at Tanner stage 2 of sexual development. He walks with a pronounced limp, and refuses to bear weight on the left foot. There is marked limitation of both active and passive range of motion at the hip. Examination of other joints is within normal limits. Which of the following is the most likely diagnosis in this patient?

A. Legg-Calve-Perthes disease
B. Slipped capital femoral epiphysis
C. Transient synovitis
D. Osgood-Schlatter disease
E. Growing pains

Answer 1

The diagnosis most consistent with the symptoms of hip and upper leg pain, pronounced limp, refusal to bear weight, and limitation of range of motion at the hip in an adolescent male is Slipped Capital Femoral Epiphysis (SCFE).

Step-by-step explanation:

The most likely diagnosis for a 10 year old male with a one week history of a limp, hip and upper leg pain that worsens when bearing weight, and a sudden worsening of symptoms after jumping is Slipped Capital Femoral Epiphysis (SCFE). SCFE is a hip condition that occurs in teenagers and pre-teens who are still growing. The patient's symptoms, such as the pronounced limp, refusal to bear weight, and limited range of motion in the hip, align with typical presentations of SCFE. This condition is particularly common in adolescent males, often those who are obese, which matches the patient's profile. The immediate worsening of pain after a physical activity such as jumping off a swing is characteristic of this condition, often because the epiphyseal plate 'slips' further due to trauma.