Clin skills - Gait and Limp Flashcards
What is the limp
Abnormal gait
Examples of abnormal gait
Antalgic Short leg Trendelenburg Stiff knee Spastic
Things to note in the HPC of the limping child
Acute/chronic
Pain – SOCRATES, beware knee/ thigh pain
Trauma
Systemic symptoms – fever, malaise, anorexia
Joint swelling(s) (not hip!)
Any previous episodes
Recent viral/ bacterial infections
Things to ask in the PMH of a limping child
Incl perinatal hx
- DDH risk factors – breech, oligohydramnios
- Birth complications
- SCBU
Things to ask in the developmental history of a limping child
Milestones - how long walking
Things to ask in the family history of a limping child
DDH
Infl arthritides
Autoimmune condns
General examination of a limping child
Well or unwell?
Comfortable at rest?
Temp
Pulse
Well presented?
Rashes
Bruises/ bites/ burns …
ENT
Apley’s examination - look
Posture of limb Joints held flexed? External signs of injury? Joints swollen Limb length discrepancy Gait
Apley’s examination - feel
Erythema
Tenderness
Joint effusion
Tone of muscles
Apley’s examination - move
Active/ passive ROM
Neurological/ developmental examination
Investigations done for a limping child
FBC
Infl markers
Autoimmune markers
Blood cultures
Imaging for limping children
Plain radiographs
Ultrasound
MRI
Radiographs for limping children
Fractures and dislocations
Bony pathology
Ultrasound for limping children
Good for looking for effusions
MRI for limping children
Gold standard
Detailed imaging of joint, soft tissues
Difficult for kids <5yrs
The ‘irritable hip’
Painful hip
Joint stiffness
Limp
Ddx for irritable hip
Infection Transient synovitis JIA Perthes Tumour
Main ddx of septic arthritis
Transient synovitis
Septic arthritis in children
Infection within joint space
ROM reduced
Effusion
Erythema
OM in children
Infection within the bone
Hx of trauma
ROM usually less affected
Localised tenderness
Key Kocher criteria for infection or transient synovitis
Refusal to WB
Fever > 38.5
Key Caird criteria for infection or transient synovitis
T > 38.5
Refusal to WB
When does OM require surgery
Subperiosteal abscess
Large intraosseous collection (>2cm)
PVL staph
Spectrum of abnormality for DDH
Dysplasia
Sublaxation
Dislocation
Instability