Childhood limp

Question 1

What questions should be asked in a paediatric limp history?

Answer 1

Acute vs chronic
Injury or illness association
Impact on child - staying still, unhappy
Systemic features

Question 2

What are the red flags for hip pain in a child?

Answer 2

Nocturnal pain, night sweats, weight loss - ALL
High fever, holding leg abducted - septic arthritis
High fever, not weight-bearing - osteomyelitis
Changeable, unusual history - NAI

Question 3

What are the features of Perthes disease?

Answer 3

4-8 year old boys
Gradual painless limp
Results in deformity and early onset arthritis

Question 4

What are the features of slipped upper femoral epiphysis?

Answer 4

10 years and older boys
Risk: BMI, hypothyroidism
Sudden onset pain not weight bearing or gradual vague pain

Question 5

What are the features of developmental dysplasia of the hip?

Answer 5

Babies
Asymmetrical skin folds, leg length discrepancy, buttock flattening
Older children may present with painless limp

Question 6

What are the features of juvenile idiopathic arthritis?

Answer 6

Any age, multiple joints

7 types

Question 7

What are the seven types of JIA?

Answer 7

Oligoarthritis 
Polyarthritis 
Enthesitis related 
Psoriatic arthritis 
Systemic onset 
Undifferentiated

Question 8

What are the features of hip pain due to abdominal pathology?

Answer 8

Abdominal pain
Not weight bearing
Nausea
Reduced appetitie

Appendicitis, torsion, inguinal hernia

Question 9

What are the features of transient synovitis?

Answer 9

4-8 year old boys 
Acute onset limp 
Often preceded by viral illness
Reduced hip movements 
Child is systemically well

Question 10

How is transient synovitis treated?

Answer 10

Ibuprofen and paracetamol

Question 11

What safe-netting should be done for transient synovitis?

Answer 11

Attend A&E if child is febrile with limp or non weight bearing limb