Limp
Encyclopedia
A limp is a type of asymmetric abnormality of the gait
. Limping may be caused by pain, weakness, neuromuscular imbalance, or a skeletal deformity. The most common underlying cause of a painful limp is physical trauma
however in the absence of trauma other serious causes such as septic arthritis
, or slipped capital femoral epiphysis
may be present. The diagnostic approach involves ruling out potentially serious causes via the use of X-rays, blood work, and potentially joint aspiration. Initial treatment involves pain management. A limp is the presenting problem in about 4% of children who visit the emergency department.
. When due to pain it is referred to as an antalgic gait
which has a shortened duration in which the foot is in contact with the ground, in severe cases there may be a refusal to walk. Hip deformities with associated muscular weakness on the other hand may presents with a Trendelenburg gait
with the body shifted over the affect hip.
. In those with no history of trauma 40% are due to transient synovitis and 2 % are from Perthes' disease.
Septic arthritis
can be difficult to separate from more serious conditions such as transient synovitis. Factors that can help indicate septic arthritis rather than synovitis includes a WBC count greater than 12×109/l, fever greater than 38.5 C, ESR
greater than 40mm/hr, CRP
greater than 2.0 mg/dL, and refusal to walk. People with septic arthritis usually look clinically toxic or sick. However even in the absence of any of these factors septic arthritis maybe present. Joint aspiration is required to confirm the diagnosis.
Other
Other infections that classically lead to a limp include Lyme disease
(a bacterial infection spread by a deer tick) and osteomyelitis
(an infection of the bone).
Accidental or deliberate trauma
may result in either a fracture, muscle bruising, or a contusion. It is the leading cause of a limp. Deliberate abuse is important to consider.
Slipped capital femoral epiphysis
Slipped capital femoral epiphysis
(SCFE) is a condition in which the growth plate of the head of the femur slips over the underlying bone. It most commonly presents with hip pain in males during puberty and is associated with obesity
. The majority of people effected have a painful limp and in half of cases both hips are effected. Nearly a quarter of people however present with only knee pain. Treatment involves none weight-bearing and surgery. If not identified early osteonecrosis or death of the head of the femur may occur.
Other
A non painful limp may be due to a number of mechanical conditions including: developmental dysplasia of the hip and leg length differences.
Transient synovitis is a reactive arthritis
of the hip of unknown cause. People are usually able to walk and have either a normal or a low grade fever. They usually look clinically non toxic or otherwise healthy. It may only be diagnosed once all other potential serious causes are excluded. With symptomatic care it usually resolves over one week.
Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (JRA) present gradually with early morning stiffness, fatigue, and weight loss.
Legg-Calve-Perthes disease is a degenerative disease of the head of the femur which results in bone loss and deformity. It usually presents as a chronic condition.
and Ewing’s sarcoma may result in a gradual onset of limping in children. It is often associated with night sweat, easy bruising, weight loss, and pain most prominent at night.
Gait (human)
Human gait is the way locomotion is achieved using human limbs. Different gaits are characterized by differences in limb movement patterns, overall velocity, forces, kinetic and potential energy cycles, and changes in the contact with the surface .- Foot strike :One variable in different gaits is...
. Limping may be caused by pain, weakness, neuromuscular imbalance, or a skeletal deformity. The most common underlying cause of a painful limp is physical trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
however in the absence of trauma other serious causes such as septic arthritis
Septic arthritis
Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic...
, or slipped capital femoral epiphysis
Slipped capital femoral epiphysis
Slipped capital femoral epiphysis is a medical term referring to a fracture through the physis , which results in slippage of the overlying epiphysis....
may be present. The diagnostic approach involves ruling out potentially serious causes via the use of X-rays, blood work, and potentially joint aspiration. Initial treatment involves pain management. A limp is the presenting problem in about 4% of children who visit the emergency department.
Definition
A limp is a type of asymmetric abnormality of the gaitGait (human)
Human gait is the way locomotion is achieved using human limbs. Different gaits are characterized by differences in limb movement patterns, overall velocity, forces, kinetic and potential energy cycles, and changes in the contact with the surface .- Foot strike :One variable in different gaits is...
. When due to pain it is referred to as an antalgic gait
Antalgic gait
Antalgic gait is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase. It can be a good indication of pain with weight-bearing.-Conditions associated with an antalgic gait:* Coxalgia...
which has a shortened duration in which the foot is in contact with the ground, in severe cases there may be a refusal to walk. Hip deformities with associated muscular weakness on the other hand may presents with a Trendelenburg gait
Trendelenburg gait
The Trendelenburg gait pattern is an abnormal gait caused by weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus. People with a lesion of superior gluteal nerve have weakness of abducting the thigh at the hip...
with the body shifted over the affect hip.
Differential diagnosis
The causes of limping are many and can be either serious or non serious. It usually results from either pain, weakness, neuromuscular imbalance, or a skeletal deformity. However the underlying cause in 30% of cases remains unknown after appropriate investigations. The most common underlying cause of limping in children is minor traumaPhysical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
. In those with no history of trauma 40% are due to transient synovitis and 2 % are from Perthes' disease.
Infection
Septic arthritisSeptic arthritis
Septic arthritis
Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic...
can be difficult to separate from more serious conditions such as transient synovitis. Factors that can help indicate septic arthritis rather than synovitis includes a WBC count greater than 12×109/l, fever greater than 38.5 C, ESR
ESR
ESR may refer to:Technology:* Electro Slag Remelting* Electronic Staff Record, a human resources and payroll system of the UK National Health Service...
greater than 40mm/hr, CRP
CRP
-Biochemistry and medicine:* C-reactive protein , an acute phase protein produced by the liver* cAMP receptor protein is a regulatory protein in bacteria* Collagen-related peptides...
greater than 2.0 mg/dL, and refusal to walk. People with septic arthritis usually look clinically toxic or sick. However even in the absence of any of these factors septic arthritis maybe present. Joint aspiration is required to confirm the diagnosis.
Other
Other infections that classically lead to a limp include Lyme disease
Lyme disease
Lyme disease, or Lyme borreliosis, is an emerging infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi sensu stricto is the main cause of Lyme disease in the United States, whereas Borrelia afzelii and Borrelia garinii cause most...
(a bacterial infection spread by a deer tick) and osteomyelitis
Osteomyelitis
Osteomyelitis simply means an infection of the bone or bone marrow...
(an infection of the bone).
Mechanical
TraumaAccidental or deliberate trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
may result in either a fracture, muscle bruising, or a contusion. It is the leading cause of a limp. Deliberate abuse is important to consider.
Slipped capital femoral epiphysis
Slipped capital femoral epiphysis
Slipped capital femoral epiphysis
Slipped capital femoral epiphysis is a medical term referring to a fracture through the physis , which results in slippage of the overlying epiphysis....
(SCFE) is a condition in which the growth plate of the head of the femur slips over the underlying bone. It most commonly presents with hip pain in males during puberty and is associated with obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
. The majority of people effected have a painful limp and in half of cases both hips are effected. Nearly a quarter of people however present with only knee pain. Treatment involves none weight-bearing and surgery. If not identified early osteonecrosis or death of the head of the femur may occur.
Other
A non painful limp may be due to a number of mechanical conditions including: developmental dysplasia of the hip and leg length differences.
Inflammatory
Transient synovitisTransient synovitis is a reactive arthritis
Reactive arthritis
Reactive arthritis , is classified as an autoimmune condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger the disease. Reiter's syndrome has symptoms similar to various other conditions collectively...
of the hip of unknown cause. People are usually able to walk and have either a normal or a low grade fever. They usually look clinically non toxic or otherwise healthy. It may only be diagnosed once all other potential serious causes are excluded. With symptomatic care it usually resolves over one week.
Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (JRA) present gradually with early morning stiffness, fatigue, and weight loss.
Vascular
Legg-Calve-Perthes diseaseLegg-Calve-Perthes disease is a degenerative disease of the head of the femur which results in bone loss and deformity. It usually presents as a chronic condition.
Neoplastic
Cancers including acute lymphocytic leukemia, osteosarcomaOsteosarcoma
Osteosarcoma is an aggressive cancerous neoplasm arising from primitive transformed cells of mesenchymal origin that exhibit osteoblastic differentiation and produce malignant osteoid...
and Ewing’s sarcoma may result in a gradual onset of limping in children. It is often associated with night sweat, easy bruising, weight loss, and pain most prominent at night.