Limp in children: Differentiating benign from dire causes
Key decision points in the stepwise approach presented here can make your investigation more efficient and productive.
How the opening case resolved
The boy avoided weight-bearing on the affected leg, but had no focal bone tenderness. Moving the hip, but not the knee, reproduced pain. Radiographs were negative for fracture or changes typical of Legg-Calve-Perthes disease. He was afebrile in the office, but the mother described a fever at home. The child appeared ill, but stable. We decided to obtain a blood sample.
Results for CRP, ESR, and white blood cell count were normal. With this information, we reassured the mother that the diagnosis was likely transient synovitis. We advised a weight-appropriate dose of ibuprofen and scheduled a follow-up appointment for 2 days later.
CORRESPONDENCE John Whiteside, MD, St. Mary’s Family Medicine Residency, 1160 Patterson Road, Grand Junction, CO 81506; john.whiteside@stmarygj.org
