Limp (peds): Difference between revisions
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==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== | ||
| Line 12: | Line 12: | ||
===Other causes of limping=== | ===Other causes of limping=== | ||
*Developmental dysplasia | *Developmental dysplasia | ||
*Fracture | *[[Fracture]] | ||
**[[Toddler's fracture]] | **[[Toddler's fracture]] | ||
**[[Tillaux fracture]], adolescent | **[[Tillaux fracture]], adolescent | ||
*Neoplasm: | *Neoplasm: | ||
**Leukemia | **[[leukemia (peds)|Leukemia]] | ||
**Ewings | **Ewings | ||
**Osteogenic sarcoma | **Osteogenic sarcoma | ||
**Metastatic neuroblastoma | **Metastatic [[neuroblastoma (peds)|neuroblastoma]] | ||
*Osteomyelitis | *[[Osteomyelitis]] | ||
*Myositis | *[[Myositis]] | ||
*Other: | *Other: | ||
**Appendicitis | **[[Appendicitis]] | ||
**Meningitis | **[[Meningitis]] | ||
** | **[[Epidural abscess (spine)]] | ||
==Evaluation== | ==Evaluation== | ||
Revision as of 22:54, 5 October 2019
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:
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, total CK
- 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% |