Limp Dr Donaldson Flashcards
Sx of bone cancer
Bone pain - worst at night
Hx of limping child
Trauma
B symptoms
FHx of arthritis or IBD (other AI conditions)
Consider non accidental injury
What makes diagnosis of arthritis more common?
Multi joints affected
Which children are most at risk of non accidental injury?
Non ambulatory children
Drugs and alcohol
Previous social care involvement
Mental health issues in family
Criminal records on family
Define limp
Any deviation from normal gait expected for child
Red flags of limp
Non weight bearing
Inability to walk acutely
Severe localised pain and fever over 38.5
Pain waking at night
Bony prominence or tenderness
B symptoms
Limp for longer than one week
Non accidental injury risk
Most common cause of limp
Transient Synovitis 40%
What is perthes
Avascular necrosis of head of femur
Who is most at risk of SUFE?
Obese boy 8-10 years old
Amber features of limp
Symptoms greater than 72 hours
Age under 2 or over 9 (less risk of transient synovitis)
No red flags
Multiple previous episodes
Green features of limp
Symptoms under 72 hours
Mobile but limping
Responds to analgesia
No red or amber features
What is pGALS?
Paediatric gait arms legs spine
Useful MSK assessment tool
How to examine a limping child?
Fever
Abdo check for hepatosplemomegaly
MSK spine arms legs
Check skin for rashes or lymph nodes
Neuro exam - tone power sensation reflexes
Check leg length
Check joint itself
DDx limp aged 0-4
Developmental dysplasia of hips
Toddlers fracture
Physeal fracture
Puncture wound
Sprain
Contusion
Osteomyelitis
Septic arthritis
Synovitis
Discitis
Neoplasm
Developmental dysplasia of hip Sx & risk factors for developing it
Delayed walking
Breech presentation, FHx, twin pregnancy
What is toddlers fracture
Small fracture due to twisting while learning to walk
DDx of limp in 4-10
Fracture
Perthes
Transient Synovitis
Juvenile idiopathic arthritis
Osteomyelitis / septic arthritis
DDx of limp on 10+
SUFE
Fracture
Perthes
Osgood Schlatter Disease
What is Osgood Schlatter Disease
Necrosis at tendon insertion on bone
More in active children
Septic arthritis Ix
Bloods - FBC, CRP, ESR, LFT, UEs, film, G&S, cultures
Urgent USS - to check for fluid in joint
NBM, IV access and fluids
Orthopaedic aspiration of joint
Score for septic arthritis
Kocher score
- one point for fever over 38.5, inability to weight bear, ESR over 40 or CRP over 20 and high WCC
- greater the score, more likely for septic arthritis
Define perthes
Avascular necrosis of capital femoral epiphysis
Which sex is more com,on for perthes
Boys 4:1
Describe perthes presentation
inc age peak / XR findings too
Gradual onset limp
15% bilateral
3 to 9 year old boys
XR joint shows flattening of femoral head with joint space widening
Describe SUFE presentation
Obese boy 8 year olds
20% bilateral
Subtle symptoms, gradual onset
Endocrine disorder
Ix for SUFE
XR hip in frog leg position
When are no Ix needed for limp?
No red flags
Ambulating well
Clear diagnosis
Ix for limp
XR affected area - pelvis too
USS for ?effusion
Bloods - FBC, film, ESR, CRP, UE, LFT
2nd line Ix for limp
Rheumatological vasculitic bloods
LDH, ferritin, urinary catecholamines
Renal
