Acute-onset Limp In A 16-year-old

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Acute-onset Limp In A 16-year-old - Page #1

Author: Mary Wurzelmann, MD Co Author #1: Matthew Baird, MD Senior Editor: Justin Mark Young, MD Editor: Cleo Stafford, II, MD, MS Patient Presentation: A 16-year-old male with a past medical history of attention deficit hyperactivity disorder (ADHD) and growth hormone deficiency with short stature presented to sports medicine clinic from his pediatrician's office for right leg pain that began the day prior while getting boxes from underneath his bed. History: The pain started in his low back and radiated down to the right thigh and lower leg, was associated with tingling in his right foot, and affected his stability in walking. He endorsed pain with movement and reported feeling like he had pulled a muscle in his leg. He denied groin pain, similar symptoms previously, fever, drug use, and bowel or bladder dysfunction. Motrin helped alleviate the pain and heat exacerbated the pain. Physical Exam: Vitals were notable for temperature of 103.8 F and heart rate of 136. Physical exam was notable for moist, warm skin without erythema over the low back and tenderness to palpation from the right lumbar area to gluteal region. There was no bony tenderness of the hip. Flexion, adduction and internal rotation (FADIR), flexion, abduction and external rotation (FABER), and straight leg raise tests elicited low back and gluteal pain, extending to the thigh. Deep tendon reflexes were normal, strength was symmetric in bilateral lower extremities, no clonus was present, and Babinski was negative. He was noted to internally rotate the right leg while ambulating. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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