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Evaluating the Child With a Limp.

Nailah Adams Morancie1, Margaret R Helton1

  • 1University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

American Family Physician
|May 16, 2023
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Summary
This summary is machine-generated.

Limping in children often stems from hip issues like transient synovitis, but septic arthritis requires urgent attention. Differentiating causes involves clinical signs, lab tests, and imaging for accurate diagnosis and treatment.

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Area of Science:

  • Pediatrics
  • Orthopedics
  • Rheumatology

Background:

  • Limping is a common gait deviation in children, frequently associated with pain.
  • The differential diagnosis for limping is extensive, encompassing congenital, infectious, inflammatory, traumatic, and neoplastic causes.

Purpose of the Study:

  • To outline the differential diagnosis of limping in children.
  • To highlight key differentiating features between common causes of pediatric limping, particularly transient synovitis and septic arthritis.

Main Methods:

  • Review of clinical presentations, patient history, and physical examination findings.
  • Guidance on laboratory testing (CBC, ESR, CRP) and imaging modalities (ultrasound, MRI, radiography).
  • Emphasis on urgent joint aspiration for suspected septic arthritis.

Main Results:

  • Transient synovitis is the most common cause of non-traumatic limping in children (80-85%).
  • Septic arthritis is distinguished by fever, ill appearance, elevated inflammatory markers, and confirmed by joint fluid analysis.
  • Specific historical and physical findings suggest other diagnoses like developmental dysplasia of the hip, neoplasms, slipped capital femoral epiphysis, and Osgood-Schlatter disease.

Conclusions:

  • Accurate diagnosis of pediatric limping relies on a systematic approach integrating clinical evaluation, laboratory data, and appropriate imaging.
  • Prompt identification and management of serious conditions like septic arthritis are crucial to prevent long-term joint damage.