Pediatric emergency medicine trisk 0904 0904

Inguinal hernia
Neurologic
Muscular dystrophy
Peripheral neuropathy
Complex regional pain syndrome
Neoplasia
Benign bone tumors
Malignant bone tumors
Leukemia
Intra-abdominal tumors
Sacral tumors
Spinal cord tumors
Metabolic
Rickets
Hyperparathyroidism
Hematologic
Sickle cell disease
Hemophilia
Rheumatic conditions that may result in limp are numerous. Many are
accompanied by systemic symptoms and characteristic skin rashes. Examples
include Henoch–Schönlein purpura, erythema multiforme, acute rheumatic fever,
juvenile idiopathic arthritis (JIA), dermatomyositis, and systemic lupus
erythematosus. Occasionally, limping from arthralgia will precede the
development of the arthritis and systemic involvement. An approach to the child
with joint pain is found in Chapter 60 Pain: Joints , and a detailed discussion of
arthritis is found in Chapter 101 Rheumatologic Emergencies .
In the absence of obvious trauma, fever, or systemic symptoms, the next step in
the approach to the differential diagnosis of a limp is to determine the focality of
the findings and the degree of pain. Localized pain suggests repetitive
microtrauma, bone tumor, or an acquired skeletal deformity. Repetitive
microtrauma may be responsible for osteochondrosis, a term referring to chronic

inflammation of the physis and surrounding structures. This condition is more
common in boys, and can involve the pelvis, knee, or foot. Osteochondrosis of
the ischiopubic synchondrosis (Van neck disease), presents as vague groin or
buttock pain in school-aged children. Sinding-Larsen–Johansson disease involves
the inferior pole of the patella, and Osgood–Schlatter disease involves the