A 11 year old 70kg child presents with limitation of abduction and internal rotation. Tenderness in scarpas triangle. On flexing hip, limb is abducted. Diagnosis is
**Question:** A 11 year old 70kg child presents with limitation of abduction and internal rotation. Tenderness in scapular triangle. On flexing hip, limb is abducted. Diagnosis is
A. Osteomyelitis
B. Acetabular labrum tear
C. Femoral neck fracture
D. Trochanteric bursitis
**Correct Answer:** .
**Core Concept:**
The scapular triangle refers to a triangular space formed by the inferior angle of the scapula, the subscapularis muscle, and the coracohumeral ligament. It is associated with the greater tubercle of the humerus, which is a common site for various pathologies. In this case, the patient presents with limitation of abduction and internal rotation, as well as tenderness in the scapular triangle.
**Why the Correct Answer is Right:**
The correct answer is **D** Trochanteric bursitis, also known as Greater Trochanteric Pain Syndrome (GTPS). GTPS is characterized by pain and tenderness over the greater trochanter, often caused by repetitive stress on the trochanteric bursa due to excessive hip abduction or external rotation. In this case, the patient's symptoms align with GTPS, as flexing the hip causes the limb to abduct.
**Why Each Wrong Option is Incorrect:**
A. Osteomyelitis (Option A) typically presents with fever, systemic symptoms, and involvement of other adjacent structures, making it less likely in this case.
B. Acetabular labrum tear (Option B) usually presents with hip pain and limited range of motion, not the described symptoms.
C. Femoral neck fracture (Option C) usually presents with hip pain, limping, and inability to bear weight, differing from the presented symptoms.
**Core Concept (Clinical Pearls and Pitfalls):**
Clinically, it is essential to consider the patient's age, weight, and the specific symptoms described when formulating a diagnosis. In the case of a young child, the differential diagnosis should focus on regional pathologies rather than systemic conditions. Trochanteric bursitis is a common cause of referred pain from the hip to the gluteal region in children.
**Why Each Wrong Option is Incorrect:**
A. Osteomyelitis in a child may present with fever and systemic symptoms, which are not present in this case.
B. Acetabular labrum tears are not common in children and typically present with pain and limited range of motion, which differs from the described symptoms.
C. Femoral neck fractures commonly involve a child's ability to bear weight and present with limping, which are not present in this case.
**Clinical Pearls:**
1. When assessing a pediatric patient with referred pain, consider regional pathologies like trochanteric bursitis, particularly in young children. Assess symptoms, weight, and age when formulating a differential diagnosis.
2. Pain and limited range of motion are more commonly associated with acetabular labrum tears or femoral