Definition. Limp is defined as an uneven, jerky, or laborious gait, usually caused by pain, weakness, or deformity . Limp can be caused by both benign and life-threatening conditions, the management varies from reassurance to major surgery depending upon the cause . EPIDEMIOLOGY.
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Slipped capital femoral epiphysis.
Vasoocclusive crisis of sickle cell disease
Acute rheumatic fever
Juvenile rheumatoid arthritis
Developmental dysplasia of the hip
Hemarthrosis: traumatic, hemophilia
Systemic lupus erythematosis.
Epidural abscess of the spine.
Total no. of admissions: 304
Examination of the skin may reveal the characteristic rash of serum sickness, Henoch-Schönlein purpura , acute rheumatic fever, or Lyme disease.
The spine should be examined for abnormalites (kyphosis or scoliosis) or limited range of motion. Limitations or asymmetry on forward bending may indicate spinal cord tumors or discitis.
Abnormalities in deep tendon reflexes may indicate peripheral neuropathy , or involvement of the central nervous system with spasticity.
Examination of the musculoskeletal system should include evaluation of muscle strength, muscular atrophy, joint tenderness, bony tenderness, bony deformity, joint effusion, range of motion (active and passive).
The Galeazzi test is useful in diagnosing developmental hip dysplasia or leg length discrepancy.
This test is performed by putting the child in a supine position and then flexing the hips and knees by bringing the ankles to the buttocks .
The test is positive when the knees are of different heights. Abnormal shortening of the leg can be caused by DDH, ischemia, Perthes disease.
Both anteroposterior and lateral views should be obtained. The frog-leg view of the pelvis provides the lateral view of the femoral heads.
Bone scintigraphy is a sensitive means of detecting alterations in the metabolic rate of bone and thus a sensitive means of localizing pathology.
50% need a Total Hip by age 50
Always get a frog lateral view
Always check the other side