Limp Flashcards
What is the most common cause of atraumatic acute limp?
Transient synovitis
Preceded by a recent URI or GI illness M:F 2:1 3-10 years (incidence peaks at age 6) Unilateral pain to hip, thigh or knee Painful passive ROM Looks well Hip held abducted and externally rotated
One clinical feature and one Ix that differentiates between transient synovitis and septic arthritis
Ability to weight bear
CRP (odds ratio 82, if > 2.0 - 74% chance of septic arthritis)
Describe DDH (Developmental dysplasia of the hip)
Newborn-toddler
More common in breech positioning
F:M 9:1
Spectrum of acetabular dysplasia, hip subluxation and hip dislocation
Physiologic and mechanical factors
Positive result on Barlow maneuver in a newborn
OR
Painless limp with hip contracture in a toddler - waddling gait if bilateral
Best test - Hip US
Describe LCP (Legg-Calve-Perthes)
Early school age M:F 5:1 Avascular necrosis of the femoral head Cause unknown Associated with delayed bone age Hip or knee pain Insidious limp With limitation of flexion and internal hip rotation Best test - MRI of the hips (early), plain XR (later)
Describe SCFE (Slipped Capital Femoral Epiphysis)
Early adolescence
Obesity
Common in African-americans
M:F 3:2
Weakness of the femoral head physis
Cause unknown (? endocrine role)
Can be acute (sudden severe hip pain) or chronic (gradually worsening, mildly antalgic, externally rotated limp)
Can be bilateral in younger patients (<12years) or those with genetic/endocrine disorders
Can be associated with hypothyroidism (esp if < 10 years), acromegaly, excess GH, hypopituitarism, hypogonadism, especially obesity and sometimes trisomy 21
Best test - Plain hip XR (AP and frog leg)
What line do you use to check for SCFE?
Klein’s line
Drawn along the superior edge of the femoral neck toward the head, should pass through some of it
Name a screening test for LLD (leg length discrepancy)
Galeazzi
Patient supine, hips and knees are flexed
Positive if knees are at different heights
What noninfectious, atraumatic, non-rheumatologic pathology can cause nighttime limb pain?
ALL (leukemia)
Define osteochonditis dissecans
A portion of articular cartilage and unknown subchondral bone gradually separates from the surrounding tissue
Unknown cause
Commonly involves the knee - the lateral aspect of the medial femoral condyle or posterior aspect of the lateral femoral condyle
Intermittent pain that worsens with activity
Sometimes has clicking or locking
XR may show delineated, dense fragments of subchondral bone separated from the rest of the affected bone by a radiolucent crescent line
Other sites
Talus
Elbow
Patella
Young adolescents that present with chronically painful flat feet - likely cause is?
Tarsal coalition.
A coalition is a congenital fibrous band between the talus and calcaneus bones, or occasionally between the calcaneus and the navicular bone.
CT can show narrowing of the subtalar joint, or complete absence of the joint space.
“Beaking” of the talus on plain films is a clue. Can have pain in the posterior ankle, over the plantar aspect of the foot or dorsally.
Name some benign and malignant bone lesions
BENIGN - usually not painful
Bone cysts (unicameral or aneurysmal)
Osteochondromas
Osteoid osteomas (can be painful)
MALIGNANT
Osteosarcoma
Ewing’s sarcoma
How to distinguish Benign vs malignant bone tumors
BENIGN features Well defined or sclerotic border Small, multiple lesions Lack of cortical destruction Confined to bone
MALIGNANT features Poor definition Large Cortex spiculated or extensive periosteal reaction Extension into soft tissue
Name 5 osteochondroses and their location
Sever’s - Calcaneus
Sinding-Larsen-Johansson - Patella
Osgood-Schlatter - Proximal tibial tuberosity
Kohler’s - tarsal navicular
Freiberg’s - second metatarsal head (sometimes 3rd/4th)
