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Progressive Limp In A 5-year-old Boy - Page #1
 

Author: Mark Riederer, MD
Co Author #1: Andrea Bracikowski, MD

Patient Presentation:
A 5-year-old boy presents to clinic for a several week history of limp.

History:
A 5-year-old right-hand dominant male presented to Pediatric Orthopaedic Clinic with a 3-week history of a limp. Five weeks prior he began playing ice hockey. His parents noticed he fell frequently on the ice. About 2 weeks later his parents noted his running became "asymmetric", and he resorted to skipping rather than running. He did not complain of pain. There was no history of an injury. He did not wake from sleep with pain. In the mornings he was not stiff nor did he have swollen knees or ankles. He attends pre-kindergarten and the staff had not noted a change in his gait. He continued to be active and playful. Approximately one month prior to the onset of the limp he had a pharyngitis illness without fever and rapid strep testing was negative. There was no history of weight loss, easy bruising, change in appetite or fevers.
His past medical history is significant for a skin hemangioma over his lower back and upper buttocks and allergic rhinitis. He has had no prior surgeries. There is a family history of diabetes and heart disease. He is on cetirizine. He has no medication or food allergies.

Physical Exam:
He is a pleasant, cooperative male in no acute distress. His head is normocephalic. His neck is nontender to palpation. His spine shows normal alignment and is nontender to palpation. No pain is elicited with forward bending or extension of his spine. His pelvis is level. He has full passive range of motion of his hips, knees, ankles, and feet without pain. He has 5/5 strength in his lower extremities. His knees and ankles are nontender to palpation and there are no palpable effusions. He walks with a slight antalgic gait. The right-sided limp is even more prominent on his parent’s video of him running.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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