Limp in a child — likely diagnosis
For each clinical scenario below, select the SINGLE most likely underlying diagnosis from the option list above. Each option may be used once, more than once, or not at all.
- A. Transient synovitis
- B. Septic arthritis
- C. Perthes disease
- D. Slipped upper femoral epiphysis (SUFE)
- E. Juvenile idiopathic arthritis
- F. Non-accidental injury
- G. Osteosarcoma
- H. Developmental dysplasia of the hip (DDH)
1. A 4-year-old boy develops an acute limp and mild hip pain a week after a viral upper respiratory tract infection. He is afebrile, well, and has a normal CRP.
2. A 6-year-old boy has an insidious, painless limp over several weeks, with reduced internal rotation and abduction of the hip. X-ray shows a flattened, fragmented femoral epiphysis.
3. An obese 13-year-old boy presents with hip pain and a limp, with the leg held in external rotation and restricted internal rotation of the hip.
4. A 3-year-old girl presents with fever, severe hip pain, and complete refusal to weight-bear, with a markedly raised CRP and white cell count.
5. An 18-month-old girl who has recently started walking has a waddling gait with asymmetric leg length and a positive Galeazzi sign.
6. A 7-year-old boy has a persistent limp, morning stiffness, and swelling of the knee lasting more than 6 weeks, with no history of trauma or infection.
7. A 5-year-old boy presents with a limp and bruising in unusual sites, with an explanation from carers that is inconsistent with his developmental stage and the pattern of injury.
8. A 12-year-old boy has a several-week history of worsening leg pain and limp, with night pain not relieved by simple analgesia, and a lytic bone lesion on X-ray.
9. A 3-year-old girl has had a limp for 3 days following a mild coryzal illness; she is afebrile, active, and eating normally, with only mild discomfort on extreme hip rotation.
10. A 6-year-old girl presents acutely unwell with fever, a hot swollen knee, and complete inability to weight-bear; joint aspiration confirms the diagnosis.
11. An 8-year-old boy has a painless limp for several months with restricted hip movement; X-ray shows sclerosis and early collapse of the femoral head, and he is otherwise systemically well.
12. A 14-year-old obese boy has a 2-month history of vague knee pain and limp, with the hip examination revealing the diagnostic clue rather than the knee itself.
13. A toddler who recently started walking has an asymmetric limp; examination reveals a shortened leg on one side and asymmetric thigh skin folds.
14. A 10-year-old girl has recurrent limping with joint swelling and stiffness worse in the morning, improving with activity, affecting several joints over several months.
15. An infant has multiple injuries at different stages of healing, including a limp from a suspected limb fracture, with carers giving an inconsistent explanation.
16. A 15-year-old boy has progressive thigh pain and limp, with swelling and tenderness over the distal femur, and a periosteal reaction ('sunburst' pattern) on X-ray.