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LIMP
Weakness
CPMDSpinal Cord Lesion
GBSPeripheral neuroDisuse/immobility
PainTrauma
Hemarthroses
Salter-harris #Greenstick #Soft tissue
Infection
Inflammation
Septic arthritisOsteomyelitisDiscitis
AbscessCellulitis
JIAReactiveHSPRheumatic feverTransient synovitis
Leg length discrepancySCFEOsgood-SchlatterPatellofemoral
Structural/mechanical
Neoplasm
GI/GU
vascular
Legg-Calve-Perthes
Sickle- Cell
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Acute vs chronic Course Pain/painless
OPQRST
Bilateral/unilateral
Waking at night
Aggravating/Relieving Activity, medications,
Triggers Trauma
head, back, hip, knee,ankle, etc.
Infection
Activity/footware Meds
Other Symptoms: Fever, wt loss, anorexia
Bladder/bowel
Neuro: parasthesias,weakness, paralysis
GU discharge
Derm
Consider the possibility of abuse
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PMed Hx: Recent infection
GI, GU, viral.
Cancer
Previous injury/surgery
Obesity Soft tissue/bone disorders
Neuro
Endo Hypothyroid, hypogonadism (increase SCFE risk)
Pregnancy/Dev: History of hip dysplasias, club feet,
CP, MD
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Nutrition gross deficiencies.
Meds/All/Vax
Family Hx: MSK Ehler-Danlos, Marfans, MD
Inflammatory
IBD/AS/psoriatic arthritis (HLA B27), JIA
Neuro Heme
bleeding disorders, hemoglobinopathies,
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General: sick/well, obese Vitals: fever, tachy, shocky HEENT: uveitis, CVS: carditis
Resp GI & GU: r/o referred pain. MSK/Neuro: back, hip, knee, ankle
SEADS, bulk, tone, tenderness
power, ROM, sensation, reflexes, pulses Weight bear, gait
Derm: rashes Special: Gowers sign, leg length (ASIS to MM),
Galeazzi, FABER
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Basic bloodwork:
CBC, CRP, ESR.
When you suspect rheum, septic joint or onco. When to aspirate a joint:
Fever >38.5
ESR >40/CRP >20
WBC elevation >12 Cant weight bear
Send aspirate for cell count, gram stain/culture,protein, glucose.
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Imaging:
XR reasonable in majority of trauma
Keep in mind Salter-Harris I not readilyapparent on XR
Bilateral hip films if ?SCFE
MRI or bone scan for suspected osteomyelitis
MRI/CT for suspected spinal pathology
U/S to assess effusion (still need aspirate ifsuspected infn)
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Other:
Septic joint, reactive arthritis: consider urine
for C&G. stool culture, Rheum: ANA, antiDSdna, HLAB27,
Rheumatic Fever: throat culture, ASOT
Blood/Bone culture: osteo
Bleeding: PTT, INR
Sickle: peripheral smear
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Emergent (admission required) Septic arthritis:
>5: Cloxacillin x 3-4 weeks.
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Urgent: Splint suspected Salter-Harris I
Casting of fractures
Abx for cellulitis
Outpatient: (NSAIDs, +/- referral)
Rheum
Legg-Calve-Perthes
Transient Synovitis/Myositis
Overuse
Minor Trauma
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Sawyer, J.R., Kapoor, M., The Limping Child: A Systematic Approachto Diagnosis,Am Fam Physician. 2009 Feb 1;79(3):215-224. http://www.aafp.org/afp/2009/0201/p215.html
Clark, M.C., Approach to the child with a limp.
http://www.uptodate.com/contents/approach-to-the-child-with-a-limp?source=related_link