Limp (peds): Difference between revisions
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==Background== | ==Background== | ||
{{Hip anatomy background images}} | |||
*It can be difficult to differentiate hip from knee pain in children | *It can be difficult to differentiate hip from knee pain in children | ||
**Knee pain can be referred pain from the hip | |||
==Clinical Features== | ==Clinical Features== | ||
*Pediatric patient with a reported limp with ambulation | *Pediatric patient with a reported limp with ambulation | ||
*May additionally have leg, hip, and/or knee tenderness to palpation | *May additionally have leg, [[hip pain (peds)|hip]], and/or knee tenderness to palpation | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pediatric hip DDX}} | {{Pediatric hip DDX}} | ||
==Evaluation== | ==Evaluation== | ||
*X-ray hip ( | ===Workup=== | ||
*Consider CBC, ESR, total CK | *X-ray hip (AP & bilateral frog-leg view), femur, knee | ||
*Consider | *Consider CBC, ESR, CRP, total CK | ||
*Blood culture if febrile.<ref>https://www.emrap.org/episode/ema2023november/abstract16</ref> | |||
*Consider: | |||
**[[Ultrasound]] to evaluate for effusion | |||
**CT to evaluate for abscess | |||
{{Kocher criteria}} | {{Kocher criteria}} | ||
Latest revision as of 22:44, 5 November 2025
Background
- It can be difficult to differentiate hip from knee pain in children
- Knee pain can be referred pain from the hip
Clinical Features
- Pediatric patient with a reported limp with ambulation
- May additionally have leg, hip, and/or knee tenderness to palpation
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
Workup
- X-ray hip (AP & bilateral frog-leg view), femur, knee
- Consider CBC, ESR, CRP, total CK
- Blood culture if febrile.[1]
- Consider:
- Ultrasound to evaluate for effusion
- CT to evaluate for abscess
Kocher Criteria for septic arthritis of the hip
- ESR > 40 mm/hr
- WBC > 12,000/microliter
- Refusal or inability to weight bear on affected joint
- Fever 38.5° C or greater
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |