Limp (peds): Difference between revisions
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== | ==Background== | ||
{{Hip anatomy background images}} | |||
*It can be difficult to differentiate hip from knee pain in children | |||
**Knee pain can be referred pain from the hip | |||
==Clinical Features== | |||
*Pediatric patient with a reported limp with ambulation | |||
*May additionally have leg, [[hip pain (peds)|hip]], and/or knee tenderness to palpation | |||
==Differential Diagnosis== | |||
{{Pediatric hip DDX}} | |||
==Evaluation== | |||
===Workup=== | |||
*X-ray hip (AP & bilateral frog-leg view), femur, knee | |||
*Consider CBC, ESR, CRP, total CK | |||
*Blood culture if febrile.<ref>https://www.emrap.org/episode/ema2023november/abstract16</ref> | |||
*Consider: | |||
**[[Ultrasound]] to evaluate for effusion | |||
**CT to evaluate for abscess | |||
{{Kocher criteria}} | |||
==Management== | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
[[ | *[[Pediatric hip pain]] | ||
*[[Septic arthritis of the hip (peds)]] | |||
==External Links== | |||
*[http://pemplaybook.org/podcast/please-just-stop-limping/ Pediatric Emergency Playbook Podcast: Please Just STOP LIMPING] | |||
[[Category: | ==References== | ||
[[Category: | <references/> | ||
[[Category:Pediatrics]] | |||
[[Category:Orthopedics]] | |||
Latest revision as of 22:44, 5 November 2025
Background
- It can be difficult to differentiate hip from knee pain in children
- Knee pain can be referred pain from the hip
Clinical Features
- Pediatric patient with a reported limp with ambulation
- May additionally have leg, hip, and/or knee tenderness to palpation
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
Workup
- X-ray hip (AP & bilateral frog-leg view), femur, knee
- Consider CBC, ESR, CRP, total CK
- Blood culture if febrile.[1]
- Consider:
- Ultrasound to evaluate for effusion
- CT to evaluate for abscess
Kocher Criteria for septic arthritis of the hip
- ESR > 40 mm/hr
- WBC > 12,000/microliter
- Refusal or inability to weight bear on affected joint
- Fever 38.5° C or greater
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |