5.9 Clinical - Pediatric Clinical Consideration Child Limp Flashcards
When it comes to a child presenting with abnormal gait (limp), the sequence of investigations is similar to an adult with limb pain. (history, PE, observe gait, diagnostic tests, labs). When performing a clinical examination what are the main anatomical structures you are examining (first -> last)?
Examination of the back.
Examination bilaterally of hips, knees, lowerlegs and feet.
Know this vaguely. If this doesn’t fall true than it is considered a red flag!
1st yr - many can walk without support.
18 months - most walk, many can run.
2yr - coordination with reciprocal arm swing.
What are some MSK differences between children and adults?
Epiphyseal growth plate present - can impact further growth.
Bones are growing/ heal faster.
Bones are more pliable.
Periosteum thicker and more active.
Abundant blood supply to bone (metastasis?).
Younger the child the faster the healing.
What is the primary type of abnormal gait that children present with? Caused by what? Looks like what?
Antalgic Gait.
Most common type.
Caused by lower extremity or back pain.
Short stepping, child walks slowly.
Why does knee pain occur in pts with hip pathology?
Anterior branch of obturator nerve passes close to the hip joint and can send painful sensation to medial side of knee.
Kid pressents to you with stiffness, swelling, loss of mobility in affected joints, warm to touch without erythema, tender to touch, symptoms increase with stressors, growth retardation.
Diagnosis?
Juvenile Rhuematoid Arthritis.
No definitive diagnostic tests.
What is the most common cause of limping in children? What age group? Onset is (acute/ gradual) (unilateral/bilateral)? Limited ROM of hip joint. Hx of viral illness. No signs of systemic illness, temp. below 38C.
Transient Synovitis.
Most often 3-8yrs old.
Rapid onset with unilateral hip pain.
What are some investigative techniques to perform for Transient Hip Synovitis?
Inspect hip and knee.
Vitals.
CBC, ESR, CRP.
X-ray frog view.
Pt. with limp/ difficulty walking, and fever <5yrs. Joint swollen, erythema, warmth, tenderness on palpation, pain with motion (affected limb immobile).
What is your suspected diagnosis? What tests can you perform?
Septic Arthritis.
FABER - (Flexion, ABduction, Extension, Rotation).
Trendelenburg test - ask patient to stand on one leg, if pelvic drop occurs there is neurological issue and joint problems.
What is Legg-Calve-Perthes? More common in males/females? Peak age? Limited hip motion in which area is classic sign?
Self-limiting disease.
Femoral head loses blood supply.
4x more common in males.
Peak age 4-7yrs.
Limited internal rotation and abduction is classic sign.
Radiographs reveal flattening and fragmentation of the femoral head.
What are 2 common types of childhood fractures?
Childhood Accidental Spiral Tibial Fx (CAST).
Stress Fx.
Caused by twisting ankle, jumping, tripping, etc.
What are the 3 major predictors of infection in punk kids? What is a common type of infection causing limp?
Duration of symptoms - greater than 1 but less than 5 days.
Temp. on admission - greater than 37C.
ESR - greater than mm/hr
Osteomyelitis.
What are 3 types of Developmental Dysplasias of the Hip (DDH)?
Most common in who? How can you spot these out?
Shallow acetabulum, subluxation, dislocations.
Infant usually females.
Shortened limb on affected side, restricted abduction of hip on affected side, unequal gluteal folds when ifant is prone, positive Ortolani/ Barlow tests.
What is the most common spinal deformity in children?
Scoliosis.
If a pt presents with abdominal discomfort what does that suggest about the limp?
Suggestive of an intra-abdominal cause for the limp.
