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Causes and Management of Limping in Children

This document provides guidance on evaluating and managing a limping child. It lists numerous potential causes of limping organized by category such as infection, inflammation, neoplasm, and vascular or structural issues. It describes factors to consider in the history such as acute vs chronic presentation, aggravating/relieving factors, and associated symptoms. Examination findings involving various body systems are outlined. It provides guidance on basic tests, when to aspirate a joint, appropriate imaging, and additional tests depending in the suspected condition. Management recommendations are provided for emergent, urgent and outpatient situations depending on the condition. References for additional information are also included.

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infinityonward
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423 views12 pages

Causes and Management of Limping in Children

This document provides guidance on evaluating and managing a limping child. It lists numerous potential causes of limping organized by category such as infection, inflammation, neoplasm, and vascular or structural issues. It describes factors to consider in the history such as acute vs chronic presentation, aggravating/relieving factors, and associated symptoms. Examination findings involving various body systems are outlined. It provides guidance on basic tests, when to aspirate a joint, appropriate imaging, and additional tests depending in the suspected condition. Management recommendations are provided for emergent, urgent and outpatient situations depending on the condition. References for additional information are also included.

Uploaded by

infinityonward
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
  • Title
  • Differential
  • History
  • Physical Exam
  • Investigations
  • Treatment
  • References

GI/GU LIMP Weakness CP MD Spinal Cord Lesion GBS Peripheral neuro Disuse/immobility Trauma Hemarthroses Salter-harris # Greenstick # Soft

tissue Pain Infection Septic arthritis Osteomyelitis Discitis Abscess Cellulitis Inflammation JIA Reactive HSP Rheumatic fever Transient synovitis

Neoplasm

Structural/mechanical Leg length discrepancy SCFE Osgood-Schlatter Patellofemoral

vascular

Legg-Calve-Perthes Sickle- Cell

Acute vs chronic Course Pain/painless

Triggers

Trauma

Aggravating/Relieving
Activity, medications,

OPQRST Bilateral/unilateral Waking at night

Other Symptoms:

Infection Activity/footware Meds

head, back, hip, knee, ankle, etc.

Fever, wt loss, anorexia Bladder/bowel Neuro: parasthesias,

Consider the possibility of abuse

weakness, paralysis GU discharge Derm

PMed Hx:

Pregnancy/Dev:

Recent infection GI, GU, viral. Cancer Previous injury/surgery Obesity Soft tissue/bone disorders Neuro Endo Hypothyroid, hypogonadism (increase SCFE risk) History of hip dysplasias, club feet, CP, MD

Nutrition
gross deficiencies.

Meds/All/Vax Family Hx:

MSK Ehler-Danlos, Marfans, MD Inflammatory IBD/AS/psoriatic arthritis (HLA B27), JIA Neuro Heme bleeding disorders, hemoglobinopathies,

General: sick/well, obese Vitals: fever, tachy, shocky HEENT: uveitis, CVS: carditis Resp GI & GU: r/o referred pain. MSK/Neuro: back, hip, knee, ankle

Derm: rashes Special: Gowers sign, leg length (ASIS to MM), Galeazzi, FABER

SEADS, bulk, tone, tenderness power, ROM, sensation, reflexes, pulses Weight bear, gait

Basic bloodwork:
CBC, CRP, ESR. When you suspect rheum, septic joint or onco.

When to aspirate a joint:


Fever >38.5 ESR >40/CRP >20 WBC elevation >12 Cant weight bear

Send aspirate for cell count, gram stain/culture,

protein, glucose.

Imaging:
XR reasonable in majority of trauma Keep in mind Salter-Harris I not readily

apparent on XR Bilateral hip films if ?SCFE MRI or bone scan for suspected osteomyelitis MRI/CT for suspected spinal pathology U/S to assess effusion (still need aspirate if suspected infn)

Other:
Septic joint, reactive arthritis: consider urine

for C&G. stool culture, Rheum: ANA, antiDSdna, HLAB27, Rheumatic Fever: throat culture, ASOT Blood/Bone culture: osteo Bleeding: PTT, INR Sickle: peripheral smear

Emergent (admission required)


Septic arthritis: >5: Cloxacillin x 3-4 weeks. <5: Cefuroxime x 3-4 weeks. Sexually active: Cefotaxime x 7 days. Osteomyelitis: Cloxacillin x 4-6 weeks. Vanco if MRSA suspected. SCFE: ortho referral for pinning. Neoplastic: onco referral, staging. Acute neurologicaI, sickle cell, abscesses, etc.

Urgent:
Splint suspected Salter-Harris I Casting of fractures Abx for cellulitis

Outpatient: (NSAIDs, +/- referral)


Rheum Legg-Calve-Perthes Transient Synovitis/Myositis Overuse Minor Trauma

Sawyer, J.R., Kapoor, M., The Limping Child: A Systematic Approach to Diagnosis, Am Fam Physician. 2009 Feb 1;79(3):215-224.

http://www.aafp.org/afp/2009/0201/p215.html http://www.uptodate.com/contents/approach-to-the-child-with-alimp?source=related_link

Clark, M.C., Approach to the child with a limp.

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