The limping child: evaluation and diagnosis

A limp is a common reason for a child to present to the orthopaedist. Because of the long list of potential diagnoses, some of which demand urgent treatment, an organized approach to evaluation is required. With an understanding of normal and abnormal gait, a directed history and physical examinatio...

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Bibliographic Details
Published inJournal of the American Academy of Orthopaedic Surgeons Vol. 9; no. 2; p. 89
Main Authors Flynn, J M, Widmann, R F
Format Journal Article
LanguageEnglish
Published United States 01.03.2001
Subjects
Arthritis - diagnosis
Bone Diseases - diagnosis
Bone Diseases, Infectious - diagnosis
C-Reactive Protein - analysis
Diagnosis, Differential
Gait
Hip Joint
Humans
Joint Diseases - diagnosis
Knee Joint
Magnetic Resonance Imaging
Physical Examination
Tomography, X-Ray Computed
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Summary:A limp is a common reason for a child to present to the orthopaedist. Because of the long list of potential diagnoses, some of which demand urgent treatment, an organized approach to evaluation is required. With an understanding of normal and abnormal gait, a directed history and physical examination, and the development of a differential diagnosis based on the type of limp, the patient's age, and the anatomic site that is most likely affected, the orthopaedist can take a selective approach to diagnostic testing. Laboratory tests are indicated when infection, inflammatory arthritis, or a malignant condition is in the differential diagnosis. The C-reactive protein assay is the most sensitive early test for musculoskeletal infections; an abnormal value rapidly returns to normal with effective treatment. Imaging should begin with plain radiography. Ultrasonography is particularly valuable in assessing the irritable hip and guiding aspiration, if necessary.
ISSN:1067-151X
1940-5480
DOI:10.5435/00124635-200103000-00003