Limp Flashcards
(14 cards)
What are Ddx for limp?
Acute painful: Infection - septic arthritis, osteomyelitis Transient synovitis Trauma Malignancy Perthe's disease Juvenile Idiopathic arthritis Slipped upper femoral epiphysis
Chornic: Decelopmental dysplasia of the hip Cerebral palsy - neuromuscular Duchenne's muscular dystrophy JIA Perthe's SUFE
What is transient synovitis? Age group?
Acute hip pain associated with viral infection
Sudden onset of pain in hip or limp
No pain at rest
Decreased range of motion
Child is afebrile/mild fever and does not appear ill
2-12 years old
Boys
What are differences in onset, fever, appearance, hip movement, white cell count, ESR, US, X-ray, Manamgnet and course of Transient synovitis and septic arthritis?
Onset: both acute limp
Fever: Mild/absent in TS, Moderate/high in SA
Appearance: Well in TS, Ill in SA
Hip movement: Comfortable at rest in TS, limited internal rotation. SA: Hip held flexed, severe pain at rest
WCC: TS - normal. SA - normal/high
ESR: TS - normal, SA - raised
US: Both - fluid in joint
X-ray: Both - normal
Mx: TS: rest, analgesia
SA: Joint aspiration, prolonged ABX, rest, analgesia
Course: TS - <1 week, SA: Progressive and severe joint damage if not treated
What is management of Transient synovitis?
Bed rest and analgesia
Resolves in < 1 week
What is Perthes disease? Who does it usually affect? Age range
Avascular necrosis of the femoral epiphysis due to interruption of blood supple followed by revascularisation and reossification over 18m-36m
Boys 5-10 years old
Describe presentation of Perthes disease
Insidious onset of limp
Hip pain over few weeks
Stiffness and reduced range of motion
Bilateral in 10-20%
What investigation in Perthes disease?
X-ray of both hips:
- Increased density in femoral head which becomes fragmented and irregular
- Widening of joint sapce
- Decreased femoral head size
Bone scan
MRI scan
What management in Perthes disease?
Most cases resolve with conservative management
Rest
Physiotherapy to optimise hip movement
To keep femoral head in acetabulum: cast, braces
If < 6 years, observe
Older: Surgical management with moderate results
Catterall staging of Perthes disease?
1: Clinical and histological features only
2: Sclerosis with or without cystic changes and preservation of the articular surface
3: Loss of structural integrity of the femoral head
4: Loss of acetabular integrity
What is Slipped Capital Femoral Epiphysis? Who does it occur in?
Displacement of the epiphysis of the femoral head poster-inferiorly
Requires prompt treatment to prevent vascular necrosis
Obese boys age 10 - 15
Bilateral in 20%
How does slipped capital femoral epiphysis present?
Limp
Hip pain which may be referred to the knee
Acute onset following minor trauma or insidious
Restricted abdcution and internal rotation of the hip
What investigations in slipped capital femoral epiphysis?
AP and lateral (frog-leg) views of x-ray
What is management of slipped capital femoral epiphysis?
Bed rest
Non-weight bearing
Surgical with pin internal fixation in situ
Screw in centre of the epiphysis
What should you do with an acute limp in child < 3 years old?
Urgent hospital assessment for septic arthritis and child maltreatment
Transient synovitis is uncommon in this age group
