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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