Onset is usually insidious, and symptoms of slipped capital femoral epiphysis are associated with stage of slippage. The first symptom SCFE may be hip stiffness that abates with rest; it is followed by a limp, then hip pain that radiates down the anteromedial thigh to the knee. Up to 15% of patients present with knee or thigh pain, and the true problem (hip) may be missed until slippage worsens. Early hip examination may detect neither pain nor limitation of movement.

In more advanced stages, findings may include pain during movement of the affected hip, with limited flexion, abduction, and medial rotation; knee pain without specific knee abnormalities; and a limp or Trendelenburg gait. The affected leg is externally rotated. If blood supply to the area is compromised, avascular necrosis and collapse of the epiphysis may occur.

Because treatment of advanced slippage is difficult, early diagnosis of slipped capital femoral epiphysis is vital. Anteroposterior and frog-leg lateral x-rays of both hips are taken. X-rays show widening of the epiphyseal line or apparent posterior and inferior displacement of the femoral head. Ultrasonography and MRI are also useful, especially if x-rays are normal.

SCFE usually progresses; it requires surgery as soon as it is diagnosed. Patients should not bear weight on the affected leg until SCFE has been ruled out or treated. Surgical treatment consists of screw fixation through the physis.