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MSK > The acute limping child > Flashcards

The acute limping child Flashcards

1
Q

What are common causes of limp?

A 
Septic arthritis
Osteomyelitis
Perthes
SUFE
Toddlers fracture
Soft tissue injury
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2
Q

What are less common causes of limp?

A

Non-accidental injury
Tumour
Endocrinopathies

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3
Q

What pathologies can affect children age 0-3?

A 
Septic arthritis
Osteomyelitis
Developmental dysplasia of the hip
Toddlers fracture
Soft tissue injury
Non accidental injury
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4
Q

What are possible causes of limp in children age 3-10?

A 
Trauma
Osteomyelitis
Septic arthritis
Transient synovitis
Perthes disease
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5
Q

What are possible causes of limp in children aged 11-15?

A

Trauma
Septic arthritis
Osteomyelitis
SUFE

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6
Q

What is SUFE?

A

Slipped upper femoral epiphysis

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7
Q

What is the general aetiology of SUFE?

A

Increased load, weak physis, or both

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8
Q

What can cause secondary SUFE?

A

Hypothyroidism
Hypogonadism
Renal osteodystrophy
Growth hormone therapy

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9
Q

What history should be taken in suspected SUFE?

A 
Limp
Pain - groin, knee, thigh
General malaise/loss of appetite
Temperature
Recent URTI/ear infections
Trauma
Pseudoparalysis
Listen to parent
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10
Q

What would be findings in physical exam of SUFE?

A 
Body habitus
Externally rotated extremity
Obligatory external rotation in flexion
Range of movement limited by pain
Healing arthroscopy portals on ipsilateral knee
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11
Q

What infection/inflammation can cause limp?

A

Septic arthritis
Osteomyelitis
Transient synovitis
Muscle abscess

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12
Q

What would you expect to find in the history of someone with an infection?

A 
Limp - age dependent
Pain
General malaise
Temperature
Recent URTI
Trauma
Pseudoparalysis
Listen to the parent
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13
Q

What would you expect to find in examination of someone with infection?

A

Do they look sick
Limp
Refusal to bear weight
Localising area

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14
Q

What are initial investigations for infection?

A

Temp
X-ray
USS
Bloods - WCC, CRP, cultures

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15
Q

How would septic arthritis specifically present?

A 
Limping
Pseudoparalysis
Swollen red joint
Refusal to move joint
Pain 
Temperature
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16
Q

What is the most common causative organism for septic arthritis?

A

Staph aureus

17
Q

What are indications for surgery in osteomyelitis?

A 
Aspiration for culture
Drainage for subperiosteal abscess
Drainage of joint sepsis
Debridement of dead tissue
Biopsy in equivocal cases
18
Q

What are features of transient synovitis?

A 
Limping - touch weight bearing
Slightly unwell
History of viral infection
Apyrexial
Allowing joint to be examined
Low CRP, normal WCC
May have joint effusion
Not that unwell
19
Q

What features raise concern of neoplasm?

A 
Night pain
Often incidental trauma
Stops doing sport/going out
Sweats and fatigue
Abnormal blood results - low Hb, atypical blood film, atypical platelets
Get a paediatrician/oncologist opinion
20
Q

What should be asked in the history of a limping child?

A 
Duration and progression of limp
Recent trauma and mechanism
Associated pain and SOCRATES
Accompanying weakness
Time of day when worse
Can child walk or bear weight
Has limp interfered with normal activities
Systemic symptoms?
Medical history - birth history, immunisation, nutritional history, developmental history
Drug history, allergies
Family history
21
Q

What is antalgic gait?

A

Shortened stance phase

22
Q

What types of gait may present in limp?

A

Antalgic
Abductor lurch
Equinus
Circumduction

23
Q

What is equinus gait?

A

Toe to heel gait

24
Q

What is circumduction gait?

A

Circumduction during swing phase

25
Q

What should be done on examination of a limping child?

A

Check sole of foot for foreign bodies
Check for deformities, eryhtema, swelling, effusion
Limitation of active ROM, assymetry
Assess shoes for unusual wear on soles, point of initial foot strike, and assess fit
Scoliosis, midline dimples, hairy patches - spinal pathology
Assess gait with child barefoot
Assess thigh or calf muscle circumference and symmetry
Leg length assessment
Feel and move spine, hip, knee, ankle, foot
Neuro assessment

MSK (30 decks)

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