the limping child Flashcards
stance phase
weight bearing
heel strike-> plantar flex -> toe-off
swing phase
toe-off -> heel strike
rotation and tilting of pelvis and stability of lumbar spine and abdomen
antalgic gait
usually from pain, less time in stance phase
trendelenburg gait
stance phase body sway away from weak hip abductor and swing phase droop of the weak side
waddling gait
seen in b/l hip involvement or neurological dz
stiff-legged gati
knee extension and circumduction w/pelvic elevation on affected side
toe-walking
habitual or due to mm contractures, spasticity or puncture
steppage
difficulties w/dorsiflexion of foot
assocaited with peroneal neuropathies
stooped
might indicate abdominal pathology
generalized mm weakness
from muscular dystrophy or metabolic cause
0-4 developmental Ddx
hip dysplasia
0-4 trauma Ddx
toddlers fracture physeal fracture puncture wound sprain contusion
0-4 infectious ddx
osteomyelitis
septic arthritis
transient/toxic synovitis
discitis
4-10 trauma ddx
physeal fracture
puncture wound
sprain
contusion
4-10 infectious ddx
transient/toxic synovitis
septic arthritis
osteomyelitis
4-10 other ddx
legg-calve-perthes disease
leukemia
JIA
10-18 trauma ddx
slipped capital femoral epiphysis fractrue sprain contusion
10-18 infectious ddx
osteomyelitis
septic arthritis
lyme disease
gonoccal arthritis
10-18 other ddx
stress fractures
developmental hip dysplasia
0-4 abnormal formation of hip joint unknown cause 5-9x more common in female can often see other ortho problems
risk factors for hip dysplasia
female
breech
nulliparous
oligohydraminos
barlow
press down to dislocate hip
ortolani
press up to relocate hip
toddlers fracture
spiral fracture of tibia <5yrs old
often difficult to see on x-ray
sx: pain, refusal to walk, minor swelling/warmth, pain with palpation
Tx: cast
physeal gracute
girls 0-16, boys 0-18 weakest are of growing bone 15% of all childhood fractures B>G salter harris fracture
stress fracture
small crack in bone often from overuse/high impact sports weight bearing bones 2nd/3rd meta most common 10-18
Sx and Tx of stress fracture
pain that increases with weight bearing, tender to touch
Tx- rest
osteomyelitis
inflammation of bone marrow and adjacent bone
all ages
children via hematogenous spread
usually in metaphysis of long bones
Sx and Tx of osteomyelitis
local inflammation fever bone tenderness decreased ROM Tx IV abx for 4-6wks
most common inciting agent in osteomyelitis
S. aureus
septic arthritis
infection w/the joint space
all ages
bacterial, viral, fungal, parasite
intense synovitis is result of inflammatory response
Sx and Tx of septic arthritis
monoarticualr erythema, swelling, pain, decreased ROM
knee most common
Tx IV/PO abx
transient/toxic synovitis
aka irritable hip syndrome acute hip pain, decreased ROM hip in flexion/abduction and ext rotation age 0-10 yrs Dx of exclusion unknown cause self limited, NSAIDS
legg-calve-perthes disease (LPC)
aka idiopathic osteonecrosis of femoral head
4-10
B>G
typically thin, active boys
Sx and Tx of LPC
slight limp, pain in knee, thigh, or groin
limited ROM
leg length discrepancy
meds/reduce activity, immobilization not good anymore
slipped capital femoral epiphysis (SCFE)
noninflammatory condition, femoral head displaced from femoral neck
can begin as u/l but most become b/l
typically overweight boys
assocaited with endocrine disorders (primary hypothryoid and HGH deficiency)
Sx and Tx of SCFE
insidious, complaint of pain in hip and limp
Tx surgical stabilization- pin
JIA
chronic pain for min of 6wks
<16
joint effusion, pain, limited ROM, warmth, worse in am
unknown cause
growing pains
intermittent nonarticular pains in childhood
dx of exclusion
Sx: typically pain at night and limited to calf, thigh, or shin
pain is short live resolved with heat, massage, or mild pain killers
pain free during day
unknown cause
