CLINICAL DILEMMAS The limping child

CLINICAL DILEMMAS The limping child

Children may limp because of pain, weakness, deformity or to gain attention; the causes vary from sepsis to a spinal tumour and from a leg length discrepancy to a simple blister. Serious causes must be excluded and the ‘surgical sieve’ helps identify the most likely diagnoses ( Table 44.18 ). /uni25CF /uni25CF /uni25CF /uni25CF Sir Benjamin Collins Brodie , 1783–1862, surgeon, St George’s Hospital, London, UK, described ‘Brodie’s abscess’ in 1828. and, in addition, a brief neurological examination, measure - ment of leg length and an assessment of pain at rest or on weight-bearing. Many conditions, such as sepsis and juvenile arthritis, can present at any age but certain hip conditions are more likely in able 44.19 ). particular age groups ( T oposterior Plain radiographs should include both anter and ‘frog’ lateral views of the pelvis. Always bear in mind the a tumour; further imaging such as MRI may be possibility of required. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

TABLE 44.18 A guide to the clinical assessment of the limping child. Symptom onset: sudden or gradual? Symptom duration Concurrent events: recent viral infection, trauma, new sport? General health: is the child well? TABLE 44.19 Age at presentation of certain hip conditions. Age (years) Diagnosis 1–3 Sepsis Late presenting developmental dysplasia of the hip 3–10 Transient synovitis Perthes’ disease 11–15 Slipped upper femoral epiphysis

CLINICAL DILEMMAS The limping child

Children may limp because of pain, weakness, deformity or to gain attention; the causes vary from sepsis to a spinal tumour and from a leg length discrepancy to a simple blister. Serious causes must be excluded and the ‘surgical sieve’ helps identify the most likely diagnoses ( Table 44.18 ). /uni25CF /uni25CF /uni25CF /uni25CF Sir Benjamin Collins Brodie , 1783–1862, surgeon, St George’s Hospital, London, UK, described ‘Brodie’s abscess’ in 1828. and, in addition, a brief neurological examination, measure - ment of leg length and an assessment of pain at rest or on weight-bearing. Many conditions, such as sepsis and juvenile arthritis, can present at any age but certain hip conditions are more likely in able 44.19 ). particular age groups ( T oposterior Plain radiographs should include both anter and ‘frog’ lateral views of the pelvis. Always bear in mind the a tumour; further imaging such as MRI may be possibility of required. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

TABLE 44.18 A guide to the clinical assessment of the limping child. Symptom onset: sudden or gradual? Symptom duration Concurrent events: recent viral infection, trauma, new sport? General health: is the child well? TABLE 44.19 Age at presentation of certain hip conditions. Age (years) Diagnosis 1–3 Sepsis Late presenting developmental dysplasia of the hip 3–10 Transient synovitis Perthes’ disease 11–15 Slipped upper femoral epiphysis

CLINICAL DILEMMAS The limping child

Children may limp because of pain, weakness, deformity or to gain attention; the causes vary from sepsis to a spinal tumour and from a leg length discrepancy to a simple blister. Serious causes must be excluded and the ‘surgical sieve’ helps identify the most likely diagnoses ( Table 44.18 ). /uni25CF /uni25CF /uni25CF /uni25CF Sir Benjamin Collins Brodie , 1783–1862, surgeon, St George’s Hospital, London, UK, described ‘Brodie’s abscess’ in 1828. and, in addition, a brief neurological examination, measure - ment of leg length and an assessment of pain at rest or on weight-bearing. Many conditions, such as sepsis and juvenile arthritis, can present at any age but certain hip conditions are more likely in able 44.19 ). particular age groups ( T oposterior Plain radiographs should include both anter and ‘frog’ lateral views of the pelvis. Always bear in mind the a tumour; further imaging such as MRI may be possibility of required. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

TABLE 44.18 A guide to the clinical assessment of the limping child. Symptom onset: sudden or gradual? Symptom duration Concurrent events: recent viral infection, trauma, new sport? General health: is the child well? TABLE 44.19 Age at presentation of certain hip conditions. Age (years) Diagnosis 1–3 Sepsis Late presenting developmental dysplasia of the hip 3–10 Transient synovitis Perthes’ disease 11–15 Slipped upper femoral epiphysis