Leg pain and Limp Flashcards
Causes of joint inflammation - child
Diagram
Causes of leg pain and limp in children - diagram
Salient point; organic or non-organic?
Organic if child has a limp, any physical signs or consitutional symptoms.
Non-organic; usually if only leg pain present.
Osteomyelitis
Often overlooked in children.
Diagnosis by radiography, bone scan or MRI
High CRP, WCC
Presentation of swelling, erythema, tenderness maybe later.
What is Perthes disease?
Avascular necrosis of femoral head (femoral epiphysis) leading to BONE INFARCTION.
Affects children aged 4-8 years, 5 times more common in boys.
10% of cases are bilateral.
Symptoms: progressive hip ain that maybe referred to knee (+effusion).
Limb shortening.
Complications: OA, and premature fusion of the growth plates.
Limp that gets worse over a few weeks.
reduction in ROM and >> stiffness.
Muscles wasting as leg isn’t being used.
Roll test: Roll the hip of the affected extremity into external and internal rotation. This test should invoke guarding or spasm, especially with internal rotation.
Trendelenburg gait is seen in the late phase.
Some facts about
It is the most common hip disorder in adolescents. 10/100,000 children
80% of children diagnosed with SCFE are obese.
Chronic (85%): steadily progressive slippage (the most common form).
Acute form (10-15%): slippage occurs suddenly, normally spontaneously.
Stable (90% of cases): the patient is able to walk and osteonecrosis is very rare.
Unstable (10% of cases): the patient is unable to walk (even with crutches) and there is a 50% incidence of osteonecrosis.
Diagnosis is often delayed - and this is associated with a worse prognosis.
Salter-Harris fractures are fractures through a growth plate; peds only.
Most common fracture is type II - through and above.
Compression force causes what kind of fracture?
WHat’s this?
Greenstick fracture - opposite cortex not broken. Bone bends and breaks in children.
Torus or buckling fracture is often caused by a fall on an outstretched arm. Caused by impaction, force acting on the bone’s longitudional axis.
Osgood-Schlatter Disease
Osgood-Schlatter disease is one of the common causes of knee pain in active adolescents who play sports.
(more common in boys).
Usually occurs during the adolescent growth spurt before the tibial tuberosity has finished ossification.
Examination reveals tenderness and swelling at the tibial tuberosity.
Pain is provoked by knee extension against resistance or by hyperflexing the knee with the person lying prone.
Developmental dysplasia of the hip (DDH)
Facts
Developmental dysplasia of the hip (DDH) was formerly referred to as congenital dislocation of the hip (CDH).
it is less common in cultures that carry their children in front of the mother with the hips widely abducted, the straddle or jockey position
About 80% of cases are in girls, probably due to the effect of circulating maternal hormone relaxin on ligamentous laxity.
Asymmetrical gluteal or thigh skin fold.
Limb length discrepancy.
Limitation and asymmetry of hip abduction when the hip is flexed to 90.
Ortolani test (screen for a dislocated hip)
Barlow test (screen for a dislocatable hip)
