Approach to Child with Limping

Posted by e-Medical PPT Tuesday, November 13, 2012
Limp is defined as an uneven, jerky, or laborious gait, usually caused by pain, weakness, or deformity .Limp can be caused by both benign and life-threatening conditions, the management varies from reassurance to major surgery depending upon the cause .

EPIDEMIOLOGY
The incidence was 4 per thousand.
Male:female ratio was 2:1.
Median age was 4 years.
Eighty percent of patients had pain; pain localized to the hip, knee, and other areas of the leg in 34, 19, and 18 percent, respectively.
12 percent of patients were admitted to the hospital.

DIFFERENTIAL DIAGNOSIS
Bone:
     Fractures.
     Legg-CalvĂ©-Perthes.
     Slipped capital femoral epiphysis.
     Tumors.
     Vasoocclusive crisis of sickle cell disease
Joints:
     Transient synovitis
     Septic arthritis
     Acute rheumatic fever
     Juvenile rheumatoid arthritis
     Henoch-Schönlein purpura
     Developmental dysplasia of the hip
     Hemarthrosis: traumatic, hemophilia
     Lyme disease
     Systemic lupus erythematosis.
Soft tissue:
   Viral myositis.
   Intramuscular vaccination.
   Cellulitis.
   Myositis.
Neurological:
   Cerebral palsy
   Peripheral neuropathy
   Meningitis.
   Epidural abscess of the spine.

HISTORY
Duration and course of the limp?
History of trauma ?
Associated symptoms (e.g., fever, weight loss, anorexia, back pain, arthralgia, voiding or stooling problems)
If pain is present, where is it located, when does it occur, and what its severity?
Does the limp improve or worsen with activity?
Recent history of viral illness or streptococcal infection (post infectious arthritis).
Recent history of new or increased sports activity
Recent history of intramuscular injection (can cause muscle inflammation or sterile abscess)
History of endocrine dysfunction (may predispose to slipped capital femoral epiphysis)
Family history of connective tissue disorder, inflammatory bowel disease, hemoglobinopathy, bleeding disorder, or neuromuscular disorder...
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