Makindo Medical Notes

A limp in an adult can be due to pain, structural abnormalities, neurological problems, or systemic disease. The key is to separate **acute emergencies 🚨** from **chronic or mechanical causes 🕒**.

🔴 Emergency & Serious Causes

• 🦴 Fracture: Sudden severe pain, swelling, deformity, and inability to bear weight. Usually post-trauma. 👉 Diagnosis: X-ray ± CT. 👉 Management: Splinting, analgesia, surgery if displaced or unstable.
• 🦠 Septic Arthritis: Acute hot swollen joint with fever. Very painful to move, weight-bearing impossible. 👉 Diagnosis: Joint aspiration (pus), ↑WCC/CRP. 👉 Management: Urgent IV antibiotics + surgical washout.
• 🩺 Avascular Necrosis (AVN): Groin or hip pain, limp that worsens with activity. Risk factors: steroids, alcohol, trauma. 👉 Diagnosis: MRI early. 👉 Management: Activity modification, decompression surgery, hip replacement in late stages.

🟡 Common Musculoskeletal Causes

• ⚙️ Osteoarthritis: Chronic pain, stiffness, reduced range of motion. Crepitus in hips/knees. 👉 X-ray: joint space narrowing, osteophytes. 👉 Managed with weight loss, physiotherapy, NSAIDs; joint replacement if severe.
• 🔥 Hip Bursitis: Lateral hip pain, worse when lying on side or walking. 👉 Clinical diagnosis ± ultrasound. 👉 Managed with NSAIDs, steroid injections, physiotherapy.
• ⚡ Labral Tear: Hip/groin pain with clicking or locking. 👉 MRI arthrogram for diagnosis. 👉 Arthroscopic repair or physiotherapy.

🧠 Neurological & Spinal Causes

• ⚡ Lumbar Radiculopathy (Sciatica): Shooting pain down the leg, numbness or weakness. 👉 Diagnosed with clinical exam + MRI spine. 👉 Managed with NSAIDs, physiotherapy, epidural steroids, surgery if severe.
• 🌀 Spinal Stenosis: Leg pain/numbness when walking, relieved by sitting ("shopping trolley sign"). 👉 MRI spine for confirmation. 👉 Treated with physiotherapy, injections, or decompression surgery.
• 🧠 Peripheral Neuropathy: Numbness, tingling, foot drop, unsteady gait. Common in diabetes, alcohol misuse, B12 deficiency. 👉 Nerve conduction studies, blood tests. 👉 Managed by treating underlying cause, physiotherapy, orthotics.

🟢 Metabolic & Inflammatory Causes

• 💎 Gout: Sudden, severe joint pain with redness and swelling, often in the foot or ankle. 👉 Diagnosis by aspiration (urate crystals). 👉 Acute treatment with NSAIDs or colchicine; prevention with allopurinol.
• 🧬 Chronic Inflammatory Disease: Rheumatoid arthritis or spondyloarthropathies can cause limp from joint destruction, stiffness, or pain. 👉 Managed with DMARDs, biologics, physiotherapy.

📌 Clinical Pearls

• 🚨 Always rule out **fracture, infection, or AVN** first — delays cause disability.
• 🧪 Examine gait, joint range of motion, pulses, and neurology carefully.
• 🔍 Take history: trauma, fever, alcohol/steroid use, systemic illness.
• 💊 Early physiotherapy and pain control help prevent chronic limp patterns.

A limp in adults is often multifactorial: pain + muscle weakness + compensation. Think in categories: acute emergency, chronic joint disease, neurological, metabolic. Your job is to spot the red flags 🚨.