Limp

Last updated 20.09.12

 

Index

 

Definition

-  Uneven, jerky or labourious gait typically secondary to pain, deformity or weakness

 

Features

-  Boys > girls

 

Causes

-  Developmental Dysplasia of Hip (DDH)

-  Transient synovitis

-  Perthes disease

-  Slipped capital femoral epiphysis

-  Septic arthritis

-  Osteomyelitis

-  Juvenille idiopathic arthritis

-  Sickle cell disease

-  Fracture

-  Osgood-Schlatter disease

-  Tumours

-  Discitis

 

Associated S/S

-  Painful in 80% (Antalgia)

-  Hip 34%

-  Knee 19%

-  Constant severe, localized & reproducible: fracture, septic arthritis, osteomyelitis, sickle cell disease

-  Intermittent: juvenile idiopathic arthritis

-  Night pain: neoplasia

-  Bilateral: myositis

-  Improves w activity: rheumatoid, CRPS

-  Worsens w activity: fracture, overuse injury, hypermobility

-  Fever: osteomyelitis, septic arthritis, transient synovitis

-  Viral prodrome: transient synovitis

-  Trauma

-  Swollen, inflamed joint

 

Likely Dx by age

-  0 – 2 years = Developmental Dysplasia of Hip (DDH)

-  2 – 5 years = Transient synovitis

-  5 – 10 years = Perthes disease

-  10 – 15 years = Slipped capital femoral epiphysis (SCFE)

-  Must DDx septic arthritis & osteomyelitis

 

Ix

-  Gait assessment if possible

-  Infants: hip exam

-  +/- Knee exam

-  +/- Ankle exam

-  +/- X-Rays

-  Indicated in osteomyelitis, fracture, Perthes disease, SCFE, neoplasms, DDH

-  Hip

-  AP + Lateral or Frog Leg view

-  Bilateral films needed to exclude SCFE

-  Knee X-ray

-  +/- Hip US: effusion

-  Effusion: transient synovitis, septic arthritis

-  Bilateral: systemic disorder

-  +/- FBE, BC, ESR, CRP

-  Fever >37.5o + elevated ESR >20mm/hr 93% sens for infectious or autoimmune process

-  Fever >38.5o + elevated CRP 100% sens, 87% spec for septic arthritis

-  Elevated WBC poor correlation with Dx

-  +/- Hip joint aspiration

-  If US or x-ray demonstrate effusion or if considering septic arthritis

-  Synovial fluid: WBC, Gram Stain, cultures, protein, glucose

-  +/- MRI

-  Osteomyelitis, early avascular necrosis, stress fracture

-  Spinal pathology suspected

 

 

 

 

Referenes

 

Upto Date – Approach to the Child with a Limp – 2010