Isotope scanning in the ?irritable hip syndrome?

Abstract

A study of isotope scanning in children with irritable hip syndrome has demonstrated its role as a discriminator between Perthes disease and transient synovitis. Three children with normal radiographs had Perthes changes on scanning and went on to develop X-ray changes. An anatomical and pathological basis for the scan abnormalities is suggested.

Management of irritable hip: a review of hospital admission policy.

“…Where outpatient 'observation' has been proposed, specialised investigations have been usedfor example, ultrasoundalong with frequent review.17 Although imaging using ultrasound or tomography is useful in showing an effusion, this is not diagnostic as various hip disorders give rise to this, and osteomyelitis may not.17 [18][19][20][21][22] Bone scintigraphy may help in identifying osteomyelitis, but it is not 100% specific and neither is it a practical proposition for the large number of patients referred with mild symptoms. [23][24][25][26] The admission and treatment of irritable hip with traction/bed rest has never been shown to be prognostically beneficial, although until the 1960s such patients were often kept in hospital for many weeks.' 2 7 Several workers have measured intracapsular pressures on children in traction and have expressed concern over increases in pressure with skin traction in extension, potentially harmful to the epiphysis.…”

Scintigraphy of Benign Bone Disease

“…LCPD accounted for 23 to 44% of children presenting with an irritable hip. [67][68][69] The abnormality is best shown by pinhole imaging with the hip in maximum medial rotation, and SPECT is unlikely to be required. Conventional planar imaging has a reported sensitivity of 98% and a specificity of 95% compared with 97% and 78%, respectively, for radiography, 69 with scintigraphic changes antedating radiological alterations.…”

Radionuclide bone scanning.

“…Pinhole views of the hips and anterior and posterior views of the lumbar spine and pelvis must be done routinely to exclude spinal, sacroiliac, or pelvic pathology causing referred hip pain. 69 Scintigraphy is a highly sensitive method of distinguishing Perthes' disease from other conditions. In the acute phase of Perthes' disease, the femoral head is photopenic in its lateral two thirds.…”