Home | | Paediatrics | Paediatrics: The limping child

Chapter: Paediatrics: Bones and joints

Paediatrics: The limping child

Exclude trauma and infection before considering other disorders.

The limping child

 

Exclude trauma and infection before considering other disorders.

 

Examination

 

Lower limbs, back, and abdomen need to be examined. Observe the fol-lowing:

   Limb position of least pain (e.g. in hip septic arthritis, the hip is held in flexion and external rotation).

 

·  Gait

 

   Movement and mobility:

   ability to weight bear passively and actively;

   ability to move the joints and limbs freely;

   palpate for tenderness, heat, and swelling around the joint; palpate the entire length of the extremity, the abdomen, and spine;

   leg length difference: anterior superior iliac spine (ASIS) to medial malleoli. to determine if discrepancy is in femur, or tibia perform galeazzi test (flex knees and hips and examine from the side);

   range of movement (ROM): in individual joint and compare with other side;

   neurological and vascular status: abdominal examination.

 

Beware of referred pain from joint above or from the abdomen (con-sider appendicitis, inguinal hernia, UTI with hip pain). Always assess the joint above and below. Hip pathology may present as knee pain.

 

Investigations

 

·  Temperature.

 

   Bloods: FBC, ESR (may be normal), CRP, blood cultures, blood film, rheumatoid factor (RF), antinuclear antibody (ANA), anti-streptolysin (ASO) titre, Lyme titre, HLA-B27.

   Urine: dipstick + MSU.

   X-rays: antero-posterior (AP), lateral plain X-ray of entire bone involved including joint above and below (e.g. if hip: AP pelvis and frog leg lateral views).

   US scan: of muscle and bone.

   MRI: very sensitive and specific—good for soft tissues and bone pathology.

Three phase bone scan: when pain not easily localizable; sensitive, but not specific. Radiation exposure.

 

Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Paediatrics: Bones and joints : Paediatrics: The limping child |

Related Topics

Paediatrics: Bones and joints


Privacy Policy, Terms and Conditions, DMCA Policy and Compliant

Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.