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HWN Suggests

Limping Child? Think LIMPSS

So when you’re faced with a patient who isn’t able to verbalize that their juvenile idiopathic arthritis is flaring up, what are the can’t-miss diagnoses for a limping child in the ED? The list can be long and cumbersome, but there’s an easy mnemonic for that: LIMPSS.

“L” Is for “My Legg Is Rotting!”

Legg-Calvé-Perthes disease (LCPD) is a progressive idiopathic avascular necrosis of the femoral head. It’s typically seen in children aged 3 to 12 years, boys more than girls (4:1), and whites more than blacks (10:1). Although the classic presentation of LCPD is unilateral pain with difficulty internally rotating and abducting the hip, up to 1 in 6 children…

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 Approach to the Pediatric Limp

Minor trauma is the most common etiology for a limp, with the median age being 4 years, boys outnumbering girls 2:1, and localization typically to the hip. In those that deny history of trauma, the most common diagnosis is transient synovitis, with 77% having a benign cause without requiring surgical intervention or hospital admission.

 PEM Playbook – Please Stop Limping

So many things can be going on — how do we tackle this chief complaint? You’re dreading a big work-up. You almost want to tell the kid: please STOP LIMPING…

 The Approach to a Limping Child

Additional considerations other than the typical “who, what, where, when, why” questions are as follows... Age of the child. Depending on the child’s age, different diagnoses can be considered. Toddler fractures more commonly occur in 9-36 month old children, Legg-Calve-Perthes is seen more frequently in the 5-8 yr old child and slipped capital femoral epiphysis (SCFE) are more prevalent during mid-adolescence...

Articles of Interest

The Limping Child: A Systematic Approach to Diagnosis

Deviations from a normal age-appropriate gait pattern can be caused by a wide variety of conditions. In most children, limping is caused by a mild, self-limiting event, such as a contusion, strain, or sprain. In some cases, however, a limp can be a sign of a serious or even life-threatening condition

The limping or non-weight bearing child

Most children presenting with a limp do not require investigations.

Resources

NHS

Irritable hip (also known as transient synovitis) is a common childhood condition that causes hip pain and limping. Children with irritable hip may also be reluctant to place weight on the affected hip joint, making it difficult for them to stand or walk.