Limp / Extremity pain

Bone tumor
Growing pains
Juvenile idiopathic arthritis
Legg Calve Perthes disease
Osgood Schlatter disease
Osteomyelitis
Post-infectious arthritis
Reactive arthritis
Rheumatic fever
Septic arthritis
Slipped capital femoral epiphysis
Transient synovitis
Trauma / injury

  • Identify the basic anatomy and physiology of the musculoskeletal system
  • Describe the growth and development of bones, joints, and surrounding soft tissues
  • Describe the components of normal gait
  • Explain the infectious and non-infectious causes of musculoskeletal pain and inflammation
  • Define innate and humoral immunity and describe the pathophysiology of autoimmune diseases
  • Summarize the process of repair and healing of musculoskeletal injury
  • Describe the basic principles of pharmacology used in the management of inflammation and pain

Overview & Foundational Knowledge

Tse SML & Laxer RM. Approach to Acute Limb Pain in Childhood. Pediatrics in Review 2006; 27: 170-180.

http://pedsinreview.aappublications.org/content/27/5/170

Case based discussion of non-inflammatory and inflammatory causes of acute limb pain. Essential read.

Huurman WW & Ginsburg GM. Musculoskeletal Injury in Children. Pediatrics in Review 1997; 18: 429.

http://pedsinreview.aappublications.org/content/18/12/429

Review of orthopedic injuries in children.

Junnila JL & Cartwright VW.  Chronic Musculoskeletal Pain in Children: Part I. Initial Evaluation. American Family Physician 2006; 74: 115-22.

http://www.aafp.org/afp/2006/0701/p115.html

Overview on the evaluation of musculoskeletal pain in children.

Junnila JL & Cartwright VW.  Chronic Musculoskeletal Pain in Children: Part II. Rheumatic Causes.  American Family Physician 2006; 74: 293-300.

http://www.aafp.org/afp/2006/0715/p293.html

Overview describing when to refer chronic musculoskeletal pain and inflammatory joint conditions.

John J & Chandran L. Arthritis in Children and Adolescents. Pediatrics in Review 2011; 32: 470.

http://pedsinreview.aappublications.org/content/32/11/470

http://pedsinreview.aappublications.org/content/suppl/2012/01/05/32.11.470.DC1.html

Review of inflammatory causes of arthritis in children.

Clinical Resources

Evaluation of the child with joint pain or swelling

http://www.uptodate.com /contents/evaluation-of-the-child-with-joint-pain-or-swelling?detectedLanguage=en&source=search_result&search=joint+pain&selectedTitle=2~150&provider=noProvider

The images and tables from the article are most useful. Table format of the pGALS physical exam with pictures. Useful table of the differential diagnosis of the child with limp.

Virtual Patients or Cases

Gill P, MacPherson P, LeBlanc C, Ellsworth J PedCases- A Learning Module for Evaluation of a Pediatric Limp for Medical Students. MedEdPORTAL 2010. Available from:

https://www.mededportal.org/publication/7910

Audio podcast on the evaluation of the child with a limp. Includes nine cases on the pediatric patient with a limp. Available online through MedEdPORTAL. 

University of Alberta Pedscases

Access through www.pedscases.com

Case based quiz on joint pain in a child.

University of Alberta Pedscases

Access through www.pedscases.com

Case based quiz on differential diagnosis of the child with a limp across different age groups.

Clinical Presentations