Which physical exam findings are characteristic of slipped capital femoral epiphysis (SCFE)?

Updated: Dec 03, 2018
  • Author: Kevin D Walter, MD, FAAP; Chief Editor: Craig C Young, MD  more...
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See the list below:

  • If a patient reports knee pain, always examine the hip, because knee pain may be referred pain from the hip via the obturator nerve.

  • Obesity increases a clinician's index of suspicion for SCFE.

  • Patients often hold their affected hip in passive external rotation.

  • Determine the patient's ability to bear weight (stable vs unstable).

  • If the patient is ambulatory, determine the his or her gait pattern:

    • Antalgic – Shortened stance phase on the affected side

    • Out-toeing

  • Always examine both hips. Assess the active and passive range of motion in both hips. In patients with unilateral complaints, this comparison allows the clinician to compare the affected and unaffected sides for differences. Internal and external rotation are best tested with the patient in the prone position with the knees flexed to 90 º.

    • If SCFE is present, the lower extremity may externally rotate and abduct with gentle passive hip flexion.

    • Internal rotation is decreased in nearly all hips with SCFE. Internal rotation is often painful.

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