1 / 26

THE LIMPING CHILD

THE LIMPING CHILD. PRESENTED BY DANIEL L. MORRISON, D.O. CLINICAL PROFESSOR, MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE. Introduction.

heavynne-mays
Download Presentation

THE LIMPING CHILD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. THE LIMPING CHILD PRESENTED BY DANIEL L. MORRISON, D.O. CLINICAL PROFESSOR, MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE

  2. Introduction • Limping is a common problem in children and adolescents. The different diagnoses of limping is extensive and includes numerous abnormalities of the lower extremity and spine.

  3. Common conditions that can cause a child to limp: • Conditions divided into two categories: • Antalgic • Trendelenburg

  4. Antalgic definition • Painful limp • The child spends the greater portion of the gait cycle on the asymptomatic leg than the symptomatic.

  5. Antalgic • Infectious • Septic arthritis • Osteomyelitis • Acute • Subacute • Diskitis • Rheumatologic • Juvenile arthritis

  6. Antalgiccont. • Trauma • Sprains,strains, contusions • Fractures • Toddler’s fx • Stress fx • Be aware of child abuse

  7. Antalgiccont. • Neoplasia • Benign • Osteoid osteoma • Malignant • Osteogenic sarcoma • Ewing sarcoma • Leukemia • Spinal cord tumors

  8. Antalgiccont. • Congenital • Tarsal coalition • Acquired • Legg-Calve-Perthes disease • Slipped capital femoral epiphysis

  9. Trendelenburg • Dr. Friedrich Trendelenberg born in Berlin in 1844. • Classic article reproduced the gait of patients with congenital dislocations of the hip.

  10. Trendelenburg’s Sign • Positive sign shows the pelvis hanging down on the swinging side • Negative sign show the pelvis angled up on the swinging side

  11. Trendelenburg Limp • Developmental dysplasia of the hip • Leg length discrepancy • Neuromuscular Disease • Cerebral palsy • Muscular dystrophy

  12. Clinical History • Begin with thorough history, family history, and physical examination • Onset (acute-insidious) • Age (chronological-developmental) • Symptom complex

  13. Differential Diagnosis based upon age • Toddler (1-3 years of age) • Childhood (4-10 years) • Adolescence (11+ years)

  14. Differential for Toddlers • Infection • Septic arthritis-hip,knee • Osteomyelitis • Diskitis

  15. Differential for Toddlers cont. • Occult trauma • Sprains, strains, contusions • Toddler’s fx • Stress fx

  16. Differential for Childhood • Infection • Septic arthritis of hip or knee • Osteomyelitis • Diskitis

  17. Differential for Childhoodcont. • Transient synovitis of the hip • Legg-Calve-Perthes disease • Juvenile arthritis • Trauma • Neoplasia • Leg length discrepancy

  18. Differential for Adolescence • Slipped capital femoral epiphysis • Juvenile arthritis • Trauma • Leg length discrepancy

  19. Differential for Adolescence cont. • Neoplasia • HNP • Congenital Spine • Spina Bifida Occulta • Spondylolisthesis • L5 radiculopathy

  20. Physical Examination • Observing the child’s walk after removing all clothing except diaper or underwear and having the child walk a sufficient distance to observe the gait pattern.

  21. Gait Analysis • Stance Phase • Heel strike, foot flat, midstance, heel off, toe off • Swing Phase • Acceleration, mid swing, deceleration

  22. Distinguishing characteristics: • redness, swelling, tenderness • abrasion suggesting trauma • café au lait spots • rash

  23. Characteristics cont. • joint effusions • soft tissue masses • alteration of strength, sensation, or DTRs

  24. Laboratory Assessment • Blood cultures • WBC count with differential • Erythrocyte sedimentation rate • C-reactive protein level • Antinuclear antibody

  25. Imaging Modalities • Plain Radiographs • Bone Scan • Ultrasound • Computed Topography • MRI

  26. Conclusion

More Related