Painful Limp

Question 1

Septic Arthritis

Answer 1

1 cause of painful limp in 1-3 yr olds

Usually monoarticular hip, knee, or ankle

Si/Sx: acute-onset pain, arthritis, fever, decreased ROM, Child may lie still and refuse to walk or crawl

Increased WBC, ESR

X-ray: Joint space widening

Dx: Joint aspiration; WBC >/= 10,000 w/ neutrophil predominance, low glucose

S. aureus (most common), H. influenza, Neisseria gonorrhoeae

Question 2

Legg-Calve-Perthes Disease

Answer 2

Aseptic Avascular Necrosis

Head of femur

4-9 yrs; boys > girls

Si/Sx+ afebrile, insidious-onset hip pain, inner thigh, or knee,
Increased pain w/ mvt, decreased w/ rest, antalgic gait

Labs: nml WBC and ESR

X-ray: femoral head sclerosis, increased width of femoral neck

Tx: Decrease weight bearing on affected side over long time

Question 3

Slipped Capital Femoral Epiphysis

Answer 3

Obese male adolescents (8-17 yrs)

Si/Sx=dull, aching pain in hip or knee, increased pain w/ activity

x-ray: lateral mvt of femur shaft in relation to femoral head–> “ice-cream scoop falling off cone”

Dx=clinical
Tx=surgical pinning