Limping Child pemsource.org yes no Hx of trauma or overuse? Careful Hx & Overuse Acute trauma Consider trauma history as red herring PE, vital signs

Hair yes tourniquet Apophysitis Radiographs CBC, ESR/CRP, Blood cultures, Systemic symptoms? Foreign body Osgood-Schlatter in foot Sinding Larsen Johansson X-ray area of pain, IV heplock _ still limping Abscess Sever’s disease + no Acute abdomen Iselin disease Give Fracture Sprain Bone pain, Transient Synovitis Joint effusion IT band syndrome Toddler’s Strain Hip pain, small to no ibuprofen: Knee, thigh, or (by PE or US), Patellofemoral pain synd fracture Contusion focal effusion if resolves, hip pain Osteochondritis dissecans Ligamentous tenderness Normal CBC, ESR/CRP erythema & injury Improves somewhat Shin splints warmth d/c with Achilles tendonitis Growing pains with ibuprofen close f/u yes no Plantar fasciitis (intermittent Tx with ibuprofen and +/- fever limp) give 24 hr f/u for AP/frog-leg Other lower Stress fracture recheck + RTER precautions _ lateral extremity pelvis x-ray imaging as Septic Arthritis Kocher criteria: Score/risk indicated Non wt-bearing 4 – 99% Back pain Leukemia Bone tumor Osteomyelitis Psoas abscess ESR > 40 3 – 93% + Spinal Night pain, pallor, Palpable mass Leukocytosis w/ Psoas sign Fever > 38.5 2 – 40% + fever, HSM, Pain at night left shift Incr WBC, ESR WBC > 12,000 1 – 3% SCFE (10—16 years) lymphadenopathy Abnormal X-ray Very elevated ESR Dx: CT or MRI Tenderness Legg-Calve-Perthes Discoid meniscus Incr or Decr WBC Dx: MRI Dx: MRI Discitis Arthrocentesis as indicated (4-10 years) Kohlers disease Thrombocytopenia Tx :as for septic Sacroiliitis Spine Clindamycin or Vancomycin Freiberg disease Anemia arthritis Pain at SI joint _ osteomyelitis Add Cefazolin 1-48 mo old Buschke disease Dx: MRI Blasts FABER* test + Add Cefotaxime < 1 mo old Dx: bone marrow bx *FABER: flexion, abduction, external rotation of hip Dx: MRI causes pain at SI joint