Makindo Medical Notes

Children may limp because of pain, weakness, deformity, or even behavioural causes. The spectrum ranges from benign conditions such as transient synovitis to life-threatening sepsis or malignancy. Serious causes must always be excluded first.

🚨 Most Urgent Causes

• Septic Arthritis: Sudden severe joint pain, fever, refusal to bear weight. Requires immediate IV antibiotics and usually surgical drainage.
• Osteomyelitis: Bone pain, fever, swelling, tenderness. Needs urgent IV antibiotics ± surgical debridement.
• Slipped Capital Femoral Epiphysis (SCFE): Adolescent with groin/knee pain and limp. Non-weight bearing immediately + urgent surgery to avoid avascular necrosis.
• Fracture: Trauma history, pain, swelling, possible deformity. Prompt immobilisation, reduction, or surgery.

🧾 Other Important Causes

• Transient Synovitis (Irritable Hip): Common post-viral, self-limiting with NSAIDs and rest.
• Legg-Calvé-Perthes Disease: Avascular necrosis of femoral head in boys (4–10 yrs). Causes insidious limp, treated with physiotherapy or surgery.
• Juvenile Idiopathic Arthritis (JIA): Chronic limp, morning stiffness, systemic symptoms in some subtypes. Requires DMARDs ± steroids.
• Developmental Dysplasia of the Hip (DDH): Can present late with limp, leg length discrepancy. Managed with Pavlik harness in infants, surgery later.

🩺 Clinical Assessment

• History: Onset (sudden vs gradual), duration, associated events (viral illness, trauma, new shoes), systemic symptoms.
• General Health: Is the child unwell? Fever = red flag 🚨.

👩‍⚕️ Examination

• Full systemic exam: temperature, HR, BP.
• Examine all joints and soft tissues, not just the hip.
• Brief neurological assessment (weakness, tone, reflexes).
• Measure leg length; assess pain at rest and on weight-bearing.

🔬 Investigations

• Bloods: FBC, CRP, ESR, blood cultures if febrile.
• Plain pelvic radiographs: AP and frog-lateral views.
• Ultrasound: hip effusion in suspected septic arthritis/transient synovitis.
• MRI: for osteomyelitis, Perthes, or subtle SCFE.

📊 Age-Based Causes

• 1–3 years: Developmental dysplasia of the hip (DDH), septic arthritis.
• 3–10 years: Transient synovitis, Perthes’ disease.
• 11–15 years: Slipped Capital Femoral Epiphysis (SCFE).

📌 Clinical Pearls

✅ Any child who is unwell, febrile, or unable to bear weight must be assumed septic arthritis until proven otherwise. ✅ Always examine the knee when hip pathology is suspected (referred pain is common). ✅ Limp + systemic illness = urgent red flag (think infection or malignancy).