Limp in children

Rationale

Limp is a laboured and/or jerky gait, usually caused by weakness, pain, or deformity. Although usually caused by benign conditions, at times it may be limb or life threatening.

Causal Conditions

(list not exhaustive)

1. Congenital (e.g., lower limb, spine)
2. Acquired (e.g., lower limb, spine)
   1. Infection
   2. Inflammation
   3. Tumours
      1. Benign
      2. Malignant
   4. Idiopathic (e.g., slipped capital femoral epiphysis, osteonecrosis)
3. Other
   1. Growing pains
   2. Pain amplification syndromes

Key Objectives

Given a child with a limp, the candidate will identify the most likely cause. In particular, the candidate will rule out the most serious possible diagnoses, which are usually unilateral in children.

Enabling Objectives

Given a child with a limp, the candidate will

1. acquire and interpret critical clinical findings, including those that
   1. determine whether the pain originates in bone, joint, or soft tissue,
   2. localize the site of pain (e.g., unilateral or bilateral) and the site of pathology (e.g., referred pain),
   3. identify signs and symptoms suggestive of serious disease,
   4. calculate leg length discrepancies,
   5. describe stance and gait, and
   6. evaluate range of motion and muscle strength;
2. list and interpret critical investigations, including
   1. appropriate diagnostic imaging modalities (e.g., radiography, magnetic resonance imaging), and
   2. laboratory investigations as indicated (e.g. C-reactive protein level, complete blood count);
3. construct an effective initial management plan, including
   1. providing appropriate analgesia and anti-inflammatory therapy,
   2. determining if the patient requires specialized care, including referral to other health care professionals,
   3. determining if further assessment is needed in case of persistent pain or limp, and
   4. recommending an allowed level of physical activity.