II. Causes: Common

  1. Acute Limp
    1. Transient Synovitis (most common, >80 to 85% of acute non-Traumatic limp)
    2. Contusion
    3. Foot foreign body
    4. Fracture
    5. Osteomyelitis
    6. Septic Arthritis
    7. Reactive Arthritis
    8. Lyme Arthritis
    9. Poor shoe wear
  2. Chronic Limp
    1. Rheumatic disease (e.g. Dermatomyositis, Rheumatic Fever, Inflammatory Bowel Disease, SLE, Juvenile RA)
    2. Apophysitis (e.g. Osgood-Schlatter Disease, Sever's Disease) and other overuse syndromes
    3. Slipped Capital Femoral Epiphysis (esp. boys at 14 to 16 years old)
    4. Legg-Calve-Perthes Disease (esp. boys at ages 4 to 9 years old)
  3. References
    1. Fischer (1999) J Bone Joint Surg Br 81(6): 1029-34 [PubMed]

III. Causes: LIMPSS Mnemonic

  1. Legg-Calve-Perthes Disease (Femoral Head Avascular Necrosis)
    1. Especially in males, 4-9 years old with Hip Pain and reduced range of motion (84% unilateral)
  2. Infection or Inflammation
    1. Examples: Cellulitis, Osteomyelitis, Septic Hip, Transient Synovitis
  3. Malignancy
    1. Examples: Ewing's Sarcoma and Osteosarcoma represent 90% of Bone Cancers in children; Also ALL
  4. Pain from Trauma
    1. Consider Toddler's Fracture, Non-accidental Trauma
  5. Slipped Capital Femoral Epiphysis (SCFE)
    1. Especially Overweight, black or hispanic boys (14-16 yo) more than girls (11-13 yo) with Hip Pain (90% unilateral)
  6. Somewhere Else (referred pain)
    1. Examples: Appendicitis or psoas abscess, Discitis
    2. Girls: UTI, Ectopic Pregnancy, Ovarian Torsion, Pelvic Inflammatory Disease
  7. References
    1. Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6

IV. Causes: Age 1-5 years

  1. See Common causes for all ages as above
  2. Acute
    1. Hip and Leg
      1. Toxic or Transient Synovitis (most common)
      2. Toddler's Fracture
      3. Tibial Stress Fracture
      4. Septic Hip
      5. Henoch-Schonlein Purpura (esp. Polyarthritis at ankles and knees)
    2. Foot
      1. Hand Foot and Mouth Disease
    3. Systemic
      1. Non-Accidental Trauma in Children (Child Abuse)
      2. Salter Fracture Type 1
      3. Immunizations (local reaction may cause limp due to affected injected leg)
  3. Chronic
    1. Hip
      1. Congenital Hip Dysplasia (most common, esp girls)
    2. Foot
      1. Clubfoot
      2. Kohler Bone Disease
      3. Vertical talus
      4. Congenital Achilles Contracture
    3. Spine
      1. Diskitis
    4. Systemic
      1. Cerebral Palsy
      2. Leg-Length Discrepancy
      3. Juvenile Rheumatoid Arthritis (or Systemic Juvenile Idiopathic Arthritis)

VII. Causes: Hematology and Oncology

  1. Sickle Cell Anemia (causes osteonecrosis)
  2. Henoch-Schonlein Purpura
  3. Benign Neoplasm
    1. Osteoblastoma
    2. Osteoid Osteoma
    3. Bone cyst
  4. Malignant Neoplasm
    1. Ewing Sarcoma
    2. Leukemia
    3. Osteosarcoma
    4. Spinal cord tumor
    5. Metastatic cancer to bone

VIII. Causes: Congenital and Developmental Disorders

  1. Congenital deformity
    1. Clubfoot
    2. Short femur or other Limb Length Discrepancy
    3. Congenital Hip Dysplasia
    4. Discoid lateral meniscus
  2. Developmental bone disorder (see age specific causes as above)
    1. Slipped Capital Femoral Epiphysis (SCFE)
    2. Legg-Calve-Perthes Disease
    3. Blount's Disease (Tibia Vara)
    4. Tarsal Coalition
  3. Neuromuscular disorders
    1. Cerebral Palsy
      1. Developmental Delay
      2. Spasticity or hypertonia
      3. Asymmetric motor activity or Deep Tendon Reflexes
    2. Muscular Dystrophy
    3. Spinal Dysraphism (e.g. Myelomeningocele)
  4. MIscellaneous
    1. Hypermobility Syndrome (e.g. Ehlers-Danlos Syndrome)

IX. Causes: Infection

  1. Osteomyelitis
  2. Transient Synovitis (follows Group A Streptococcus or Viral Infection)
  3. Septic Arthritis
  4. Gonococcal Arthritis
  5. Lyme Disease
  6. Meningitis (especially Meningococcus)
  7. Soft Tissue Abscess or Cellulitis
  8. Pyomyositis
  9. Discitis or Vertebral Osteomyelitis (esp. Lumbar Spine in young children)
    1. Subtle presentation (focal tenderness and preference for supine position may be only findings)
  10. Spinal Epidural Abscess
  11. Acute Appendicitis or other intra-abdominal infection
  12. Infectious Myositis
    1. Viral Myositis
      1. Influenza (esp. affecting calf Muscles, with "Charlie-Chaplain shuffle" with Out-toeing)
    2. Bacterial Myositis (pyomyositis), with focal infection (esp. upper thigh or deep Pelvis)
      1. May be associated with underlying Osteomyelitis

XI. Causes: Miscellaneous

  1. Referred intra-Abdominal Pain
    1. Appendicitis or other psoas abscess
    2. Neuroblastoma
  2. Neurologic causes
    1. Peripheral Neuropathy
    2. Spinal cord lesion or compression
  3. Non-Organic
    1. Growing Pains
    2. School Phobias
    3. Conversion Disorder

Images: Related links to external sites (from Bing)

Related Studies