What is the hallmark presentation of slipped capital femoral epiphysis?

The hallmark presentation of slipped capital femoral epiphysis (SCFE) is a painful limp accompanied by an inability to bear weight. This condition occurs in adolescents when the ball at the head of the femur (the capital femoral epiphysis) slips off the neck of the femur due to weakness of the growth plate.

The pain typically originates in the hip or groin and can often be referred to the knee, which might lead to some confusion. However, the primary symptom is a painful limp, which is often exacerbated by activity and results in difficulty or inability to bear weight on the affected leg.

In contrast, other presentations such as a painless limp with thigh muscle atrophy would suggest a different etiology, such as muscular or neurological issues rather than SCFE. Severe knee pain with swelling may point toward an acute injury or other knee pathology, while dull hip pain with no movement restriction could imply a chronic condition or a less acute injury. Therefore, the key manifestation of SCFE that correlates with its pathophysiology is the painful limp combined with the inability to bear weight, making it the most distinct and defining symptom of this condition.