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Flashcards in 17- refuse to walk Deck (14):

Differential Diagnosis of Limp or Refusal to Walk

reactive arthritis
septic arthritis
transient synovitis- after viral URI
Juvenile idiopathic arthritis (JIA)
Slipped capital femoral epiphysis
Legg-Calve-Perthes disease


Most common hip disorder in adolescents

Slipped capital femoral epiphysis


Juvenile idiopathic arthritis (JIA)

children must be less than 16 years of age and have arthritis in at least one joint for more than six weeks.


Juvenile idiopathic arthritis (JIA) subtypes

Systemic (includes constitutional symptoms such as fever and rash)
Oligoarthritis (previously called pauciarticular, this type of oligoarthritis typically affects the knee; onset of the arthritis is acute, and it is associated with an asymptomatic iridocyclitis)
Polyarthritis (rheumatoid factor positive and rheumatoid factor negative)
Psoriatic arthritis
Enthesitis-related arthritis
"Other arthritis" (has overlapping features with multiple categories or does not meet full criteria for one category)


Slipped capital femoral epiphysis

posterior displacement of the capital femoral epiphysis from the femoral neck through the cartilage growth plate

limp and impaired internal rotation

commonly in obese adolescents, Endocrine factors also may be important.

Diagnosis: plain film

Therapy usually involves pinning to stabilize the epiphysis but no manipulation.


Legg-Calve-Perthes disease

boys between the ages of 4 and 10.

avascular necrosis of the capital femoral epiphysis.

chronic pain rather than acute.

Various etiologies have been postulated, including infectious, trauma, developmental, and prothrombotic conditions.

Typically self-resolving, but may lead to complications including femoral head deformity and degenerative arthritis.


developmental dysplasia of the hip

group of conditions in infants where the femoral head is not properly aligned with the acetabulum. The spectrum includes hips that are dysplastic, dislocatable, subluxated (partially dislocated), and dislocated.


septic arthritis labs

Fever (> 38.5º C oral) was the best predictor of septic arthritis, followed by:

**Elevated CRP level >20 mg/L
Elevated ESR
Elevated white blood cell count
Refusal to bear weight


ESR vs CRP in terms of timing

ESR: rises comparatively slowly in response to an inflammatory stimulus and may not return to normal for weeks after clinical improvement occurs.

CRP: Elevation is relatively quick, beginning at four to six hours after initial insult, peaking at 36 to 50 hours, and returning to normal within three to seven days after the stimulus is withdrawn


ESR vs CRP- which is more specific and more reproducible?



treatment of septic arthritis

aspiration of the joint

antibiotics and drainage of site


common bacteria in septic arthritis

Staphylococcus aureus
Streptococcus (neonate: group B; infant and older child: Group A and Streptococcus pneumoniae)
Haemophilus influenzae type b (in unimmunized children)
Neisseria gonorrhea (adolescents)
Kingella kingae (in children less than 4 years)


transient synovitis treatment

rest, NSAIDS

resolves 3-10 days


what should you watch for with transient synovitis

Persistent fever over 100.4° F
Increased leg pain
Redness or swelling of the leg
A rash