CCP: limping child Flashcards
normal gait
Walk without support by 12-15 months
Coordination with reciprocal arm swing by 2 years
Adult gait pattern attained by 8-10 years of age
antalgic gait
from pain, less time in stance phase
trendelenburg limp
stance phase body sway away from the weak hip abductor and swing phase droop on the weak side
waddling gait
seen in b/l hip involvement or neuro problem
stiff legged gait
knee extension and circumduction w/ pelvic elevation on affected side
toe walking
habitual or due to muscle contractures, spasticity or (puncture wound on heel)
steappage
difficulties w/ dorsiflexion of foot usu. Assoc. w/ peroneal neuropathies
stooped gait
might indicate abdominal pathology
developmental hip dysplasia
do Barlow: push back to move the femoral head out of the acetabulum
ortolani: Abduct the thigh, see if there is a substantial clunk back into the joint space
Age: 0-4 yrs.
Abnormal formation of hip joint
Cause: unknown - femoral head unstable w/in acetabulum
Incidence: 3-4 per 1,000
5-9X more common in females
-risk factors-genetic component, anything causing crowding of the fetus—large birth, oligohydraminos; female, first born, breech (esp. feet up)
Toddler’s fracture
Def: Spiral fracture of tibia under age of 5 years
Common childhood fx
Sudden twisting of tibia
Often difficult to visualize on x-ray
Sx: pain, refusal to walk, minor swelling/warmth over site, pain with palpation
Tx: long-leg cast; heal within 3-4 wks
Physeal fracture
“growth plate injury”
Age: 0-16 yrs girls; 0-18 yrs boys
Weakest area of growing bone
15% of all childhood fractures
Boys>girls
Salter-Harris classification: II is most common!
stress fractures
Small crack in bone
Often from overuse, high impact sports
Weight bearing bones
2nd/3rd metatarsal most common
Age: 10-18 years
Sx: pain that increases with weight bearing activities, reduced with rest, tenderness to touch
Tx: rest, possible surgery depending on site
which salter harris needs ORIF?
3-5
osteomyelitis
Inflammation of bone marrow & adjacent bone
Age: all
Children: hematogenous spread
Location: metaphysis of long bones
Sx: local inflammation & fever, irritability, lethargy, bone tenderness & dec. ROM
Adults: subacute/chronic forms, secondary to open wounds
Tx: IV antibiotics (4-6 wks min.)
NOTE: staph aureus implicated in most pts. w/ hematogenous spread
septic arthritis
Infection with the joint space (long bones don’t give you the swollen red joint, this will give you a swollen red joint)
Age: all
Bacterial, viral, (fungi or parasite)
Intense synovitis is the result of the inflammatory response
pathology: pathogen enters joint space through hematogenous spread or cut in the skin - leukocytes are released causing cytokine infiltration and destruction of cartilage –> acute monoarticular joint swelling
Sx: monoarticular, erythema, swelling, pain, dec. ROM
Knee most common
- however Septic arthritis of hip associated with highest risk of avascular necrosis
Ddx: aspiration and culture of synovial fluid
Tx: IV/PO antibiotics (4-6 wks) - Cefotaxamine
transient/toxic synovitis
Sx: “irritable hip syndrome”: acute hip pain, dec. ROM
Hip in flexion/abduction & ext. rotation (relieves pressure on the capsule)
Age 0-10 yrs
Dx of exclusion
Cause: ? Infectious - no firm cause, findings of preceding URI
- about 30% of all non-traumatic childhood limps
- often post viral and goes to the hip
Tx: self limited (5-7 days), NSAIDS
Legg-Calve-Perthes disease - LCPD
- insidious onset, happens more often in thin, active boys
aka Perthes disease or idiopathic osteonecrosis of the femoral head
Age 4-10 years
Lack of blood flow to femoral head=necrosis
Bone collapses—flattens
Blood supply returns after several months
New bone replaces old
Sx: slight limp, pain in knee, thigh or groin, limited ROM, leg length discrepancy
Tx: meds/reduce activity to dec. pain (children under 6); splinting or surgery to keep hip stable
slipped capital femoral epiphysis - SCFE
Noninflammatory condition; femoral head displaced from femoral neck
presents w/ pain and inability to walk
Initially bilateral 20-40%, if unilateral, the other side slips in 30-60%
Age: 10-14 years
** Typically overweight boys: shear stress
***Association with endocrine disorders, 1° hypothyroid and HGH deficiency
Sx: insidious, complaint of pain in hip and limp
Tx: surgical stabilization w/ cntral screw or bone graft
juvenile idiopathic arthritis - JIA
its hot red swollen joint
Chronic joint pain for min. of 6 wks & age onset t look sick
lyme arthritis
2nd most frequent presenting sx (rash #1; erythema migrans)
May occur months or years after infection
Sx: Episodic initially
- 2/3 monoarthritis of knee
Age: 10-18 yrs.
Cause: Borrelia burgdorferi transmitted by tick
Prevalence: US–northeast, midwest, south & west costal areas
Boys=girls
Tx: IV/PO antibiotics, NSAIDs
GIVES clue of something you need to pay att’n to outside of the joint
Gonococcal arthritis
Septic arthritis of the joint caused by gonococcus
Age: 10-18 yrs (sexually active) – only shows up if they are sexually active!!!! not that common, though will be on bugs
Sx: same as septic arthritis
Dx/Tx: aspiration of joint fluid; IV/PO antibiotics (at least 1 week)
Growing pains
Intermittent nonarticular pains in childhood
Diagnosis of exclusion
Sx: Typically pain at night & limited to calf, thigh or shin
- pain is short-lived and resolved with heat, massage, or mild analgesics
- Pain free during the day
Cause: unknown
Tx: reassurance to parents/child
organisms involved in septic arthritis
The most common causative organism is Staphylococcus aureus then nongroup A beta-hemolytic streptococci
Neonate
Group B Streptococcus, Staphlococcus aureus, gram-negative bacilli
Infant (1-3 m.o.)
Streptococcus sp., Staphlococcus sp., Haemophilius influenza
Child
S. aureus, S. pneumoniae, group A Streptococcus
Adolescent
As above plus Neisseria gonorrhoeae
Sickle cell disease
As above plus Salmonella
Puncture wound
As above plus Pseudomonas
