Limp in children

Rationale

Limp is a laboured, jerky or strenuous way of walking, usually caused by weakness, pain, or deformity. Although usually caused by benign conditions, at times it may be life or limb threatening.

Causal Conditions

(list not exhaustive)

1. Congenital (lower limb, spine)
2. Acquired (lower limb, spine)
   1. Infection
   2. Inflammation
   3. Tumours
      1. Benign
      2. Malignant
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 ruling out the most serious possible diagnoses. Note, in particular, that the most serious diseases causing a limp or leg pain in children are usually unilateral.

Enabling Objectives

Given a child with a limp, the candidate will

1. acquire and interpret critical clinical findings, including
   1. determining whether the pain originates in bone, joint, or soft tissue.
   2. localizing the site of pain (e.g., unilateral or bilateral) and the site of pathology (e.g., referred pain).
   3. recognizing signs and symptoms suggestive of serious disease;
   4. calculating leg length discrepancies;
   5. describing stance and gait;
2. list and interpret critical investigations, including
   1. appropriate diagnostic imaging modalities (e.g., X-ray, nuclear scan);
3. constructing an effective initial management plan, including
   1. determining if the patient requires specialized care, including referral to other health care professionals;
   2. in the case of a child persistent pain or limp, determining if further assessment is needed.