Discussion - Musculoskeletal Case Study
Slipped Capital Femoral Epiphysis (SCFE) Case Study:
Joanne is an 11 year old female presenting to the Urgent Care with a 9-day history of right hip
pain. She reports the pain to be 5/10 on a numerical scale and localized to the right hip without
any proximal or distal radiation. The pain is aggravated with activity and relieved with pain
medications and rest. She states she was running during a school party and slipped and fell.
There was no loss of consciousness. Initially she was transported to an outside ED for
evaluation. Her mom states she was advised the X-rays were negative for a right hip fracture.
Mom states Joanne was discharged on Tylenol #3 and advised to follow-up with her pediatrician
within a week. The following week she presented to the office with worsening right hip pain. She
denied fever, night sweats, headaches, abdominal pain, back pain, numbness and tingling in the
right lower extremity. PE: BP 105/49, RR 20, HR 74, O2SAT 100% RA. Joanne is well
developed, well-nourished young female appropriate for her age. She guards her right hip and
she is unable to bear weight without assistance. There is no pain on palpation and full range of
motion (ROM) in all joints of the upper extremities. dorsalis pedis, anterior tibial and posterior
tibial pulses are 2+ bilaterally. Exam of the left lower extremity reveals full ROM. Pain is
elicited with logrolling of the right hip and palpation near the groin. Muscle strength is 5/5 in the
LLE and 3/5 RLE. Assessment: SCFE right hip. Based on this case study:
1. Provide 3 differential diagnoses along with rationale and ICD codes.
2. What are the causes of SCFE?
3. What are the potential complications of SCFE?
4. What diagnostic tests/referrals should be performed?
5. What would be the plan of management and follow-up?
6. What educational information would you provide to the mother at this point?
Slipped Capital Femoral Epiphysis (SCFE) Case Study:
Joanne is an 11 year old female presenting to the Urgent Care with a 9-day history of right hip
pain. She reports the pain to be 5/10 on a numerical scale and localized to the right hip without
any proximal or distal radiation. The pain is aggravated with activity and relieved with pain
medications and rest. She states she was running during a school party and slipped and fell.
There was no loss of consciousness. Initially she was transported to an outside ED for
evaluation. Her mom states she was advised the X-rays were negative for a right hip fracture.
Mom states Joanne was discharged on Tylenol #3 and advised to follow-up with her pediatrician
within a week. The following week she presented to the office with worsening right hip pain. She
denied fever, night sweats, headaches, abdominal pain, back pain, numbness and tingling in the
right lower extremity. PE: BP 105/49, RR 20, HR 74, O2SAT 100% RA. Joanne is well
developed, well-nourished young female appropriate for her age. She guards her right hip and
she is unable to bear weight without assistance. There is no pain on palpation and full range of
motion (ROM) in all joints of the upper extremities. dorsalis pedis, anterior tibial and posterior
tibial pulses are 2+ bilaterally. Exam of the left lower extremity reveals full ROM. Pain is
elicited with logrolling of the right hip and palpation near the groin. Muscle strength is 5/5 in the
LLE and 3/5 RLE. Assessment: SCFE right hip. Based on this case study:
1. Provide 3 differential diagnoses along with rationale and ICD codes.
2. What are the causes of SCFE?
3. What are the potential complications of SCFE?
4. What diagnostic tests/referrals should be performed?
5. What would be the plan of management and follow-up?
6. What educational information would you provide to the mother at this point?
