Sunteți pe pagina 1din 5

Acute Limping Child

Definition Any asymmetric deviation from the normal gait pattern as expected. It maybe be caused by pain, weakness, neuromuscular imbalance or a skeletal deformity Normal Gait Can be divided into swing phase and stance phase. Swing phase forms 4 ! of the gait cycle and stance phase foms " ! of the gait cycle. #he most common form of limp is antalgic gait. Abnormal gait Antalgic $ait Steppage $ait #rendelburg $ait Circumduction $ait #ip%toe gait Charlie Chaplin like $ait Antalgic &'ainful( $ait #he patient attempts to avoid putting weight on one leg due to pain. Causes #rauma to hip, knee, ankle, leg, or foot )iabetic foot or peripheral neuropathy Arthritis or gout *oint or limb deformity Stress fracture +one infection #umor +listers 'ainful calluses Ingrown toenail ,oreign body Characteri-ed by foot drop due to loss of dorsiflexion. #he foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, re.uiring someone to lift the leg higher than normal when walking Causes $uillain%+arre syndrome /erniated lumbar disk 0ultiple sclerosis 'eroneal muscle atrophy 'eroneal nerve trauma Associated with a weakness of the gluteus medius. It is characteri-ed by the dropping of the pelvis on the unaffected side of the body at the moment of heelstrike on the affected side. In this deviation the pelvic drop during the walking cycle lasts until heel strike on the unaffected

Steppage $ait

#rendelburg $ait &gluteus medius lurch(

Circumductio n $ait

#ip%toe gait

Charlie Chaplin like $ait

side and is accompanied by an apparent lateral protrusion of the affected hip. #he person with a #rendelenburg gait also shortens the step on the unaffected side and displays a lateral deviation of the entire trunk and the affected side during the stance phase of the affected lower limb. #he patient stands with unilateral weakness on the affected side, arm flexed, adducted and internally rotated. 1eg on same side is in extension with plantar flexion of the foot and toes. 2hen walking, the patient will hold his or her arm to one side and drags his or her affected leg in a semicircle &circumduction( due to weakness of distal muscles &foot drop( and extensor hypertonia in lower limb. #his is most commonly seen in stroke. 2ith mild hemiparesis, loss of normal arm swing and slight circumduction may be the only abnormalities. #oe walking is sometimes the result of cerebral palsy, muscular dystrophy or another generali-ed disease of nerve and muscle. Children with autism also may walk on their toes or the balls of their feet, but many do not. A gait seen in bilateral external torsion of tibia, caused by faulty sitting or sleeping, as in prolonged maintenance of 3spread%eagle4 or frogleg position

Causes of Limping Child Congenital &))/, Club foot ( )evelopmental &legg%Calve4s 'erthes dis., SC,5( Infection &septic arthritis( Inflammation &transient synovitis, *uvenile rheumatoid arthritis( 6eoplasia &leukemia, osteosarcma, 5wing4s sarcoma( #rauma &fractures, muscle bruising, contusion( 6euromuscular &cerebral palsy( Classification of Limping Child According to Age 7%8 years old 9 Septic hip Soft tissue in:ury ;ccult fracture ))/ &most common( 11) < ask = .uestions % #rue or false 11) % If false what is the cause> &pelvic tilt, e.uinos in foot, hip dislocation( % If true what is the cause > &femoral?tibial( % If femoral, is it supratrochanteric or infratrochanteric( % If supratrochanteric, is the hip dicocated>

8 to 7 years 9

1egg < Calve4s 'erthes disease % )egenerative disease of the head of femur which results in bone loss and deformity. It is an idiopathic avascular necrosis of the femoral head #ransient Synovitis Septic Arthritis 7 to 74 years Slipped Capital ,emoral 5piphysis &SC,5( % A condition where the growth plate of the head of the femur slips over the underlying bone( Diagnostic Approach 0ade based on9 /istory & any history of abuse, in younger patient ask the care taker, onset, course, duration( 'hysical exam findings &gait,cavus deformities, deep tendon reflexes, @;0 of knee and hip, ,aber test, $alea--i test( Investigations Investigations Physical Test #rendelenburg test Ased to identify conditions that cause weakness in the hip abductors. #he child stands on the affected limb and lifts the unaffected limb from the floor. In a positive test, the pelvis fails to stay level and drops down toward the unaffected side. #he $alea--i sign Can signal conditions that cause a leg%length discrepancy. #he child should lie in the supine position with the hips and knees flexed. #he test is positive if the knee on the affected side is lower than that on the normal side

#he 'atrick test &the ,A+5@ test( can indicate pathology of the sacroiliac :oint. 2ith the child in the supine position, the examiner flexes, abducts, and externally rotates the hip :oint. In a positive test, pain occurs in the sacroiliac :oint.

#he pelvic compression test

Indicate the presence of sacroiliac :oint pathology. 2ith the child in the supine position, the examiner compresses the iliac wings toward each other. 'ain with this maneuver indicates sacroiliac :oint pathology. #he psoas sign Can signal a psoas abscess or appendicitis. 2ith the child lying on his or her side, the hip is passively extended. 'ain with hip extension indicates a positive test. BSpecial attention should be paid to performing a thorough spinal, pelvic, neurologic, abdominal, and genitourinary examination. Conditions affecting these systems are associated with limping Laboratory test C+C 5S@,C@' & elevated in infectious process( *oint aspiration 'lain x%ray &pelvic film, lower limb x%ray( Imaging Cray Altrasound C# scan 0@I +one scintigraphy )iagnosis

Treatment #reatment of the underlying cause 'hysical therapy < to strengthen muscle and to correct gait )evices < 2alking aids