Causes Of Limp Research Articles

Lesión bilateral de ligamento cruzado craneal y neuropatía periférica en un canino Golden Retriever con hipotiroidismo: Reporte de caso

The case of a 6 -year -old female Golden Retriever is presented. She was limping in the left posterior limb. A 4/4 grade lameness, pain by palpating the knee, and a negative drawer test, but positive tibial compression was identified. No proprioceptive deficit or signs compatible with lesions joints in X-rays images were found. There was no response to treatment with Meloxicam and Tramadol and because a suspicion of partial rupture of the cranial cruciate ligament, the transposition of tibial tuberosity (TTT) procedure was chosen. The patient returned with lameness in the right hind limb right nine months later and after ruling out other causes of limp, the TTT was successfully performed in the affected limb. However, 18 months later he developed signs of peripheral neuropathy. Metabolic, infectious and hormonal profile analyses revealed increased serum alkaline phosphatase, decreased thyroxine (free T4) and thyroid-stimulating hormone (TSH) values within normal ranges according to the reference laboratory. Based on the patient's history and laboratory findings, the diagnosis was hypothyroidism, and the decision was made to supplement the patient with sodium levothyroxine. Remission of the nervous symptoms was observed 45 days after treatment.

Chronic limping in childhood, what else other than juvenile idiopathic arthritis: a case series

BackgroundLimping is a common clinical symptom in childhood; different clinical conditions may lead to limping and the diagnosis of the underlying cause may often be a challenge for the pediatrician.Case presentationWe describe the clinical manifestations, radiological pictures and disease course of other causes of limping in childhood, through a case series of seven cases and a brief discussion of each disease.Conclusionsalthough trauma is the most common cause of acute limping, when there is no history of traumatic events and the limping has a chronic course, Juvenile Idiopathic Arthritis is usually the most likely clinical diagnosis. However, other some rare conditions should be taken into account if JIA is not confirmed or if it presents with atypical clinical picture.

Spontaneous fractures and hypocuprosis in pen-backgrounded Holstein calves

Bone fractures are a frequent cause of limp in cattle, being pre-existing bone lesions among the predisposing factors. However, there is scant information about the natural occurrence of bone disease. This report aimed to describe an outbreak of spontaneous fractures associated with hypocuprosis in pen-backgrounded calves. Hind limp and irreversible recumbency were noticed in 9-month-old calves of a dairy farm from Córdoba province (Argentina). The issue was only evident in males fed a diet composed (DM) of 57% wet corn, 24% dry corn distiller grains, and 19% corn silage. No mineral mix was supplied. Accumulated morbidity and fatality rates were 5.8 and 100%, respectively. Two autopsies were performed, observing multiple femoral and rib fractures. Severe hypocupremia, very low copper levels in the liver and plasma, deficient dietary copper levels, normocalcemia, marginal hypophosphatemia, and high sulfate concentrations in the water supply were determined. Except for the decreased bone quantity and the multiple fractures, no bone lesion was observed, confirming osteoporosis as the pathological diagnosis, and hypocuprosis as the etiology.

Correction of deformity associated with healed slipped capital femoral epiphysis by Imhäuser osteotomy

Slipped Capital Femoral Epiphysis is the leading cause of limp in the adolescent population. This study aimed to discuss that intertrochanteric Imhauser osteotomy led to an improved functional outcome, and discussing indications, contraindications and surgical technique of Imhauser osteotomy.In moderate and severe slips, residual growth and remodeling after in situ stabilization are unable to compensate for the remaining femoral neck deformity. In these slips, a modified Dunn procedure might be more effective in order to reduce the risk of early onset hip osteoarthritis but carries high risk for avascular necrosis.Subtrochentric Imhauser osteotomy provides excellent option for correction of the residual deformities in chronic or healed SCFE.The Imhauser osteotomy is Subtrochentric valgus, flexion and internal rotation so correct the deformities in the chronic cases of SCFE. In consideration of our 23-year follow-up and in regard to other studies, we still consider the Imhauser ¨user osteotomy to be indicated for SCFE with angles of displacement >40°.

Polyostotic Fibrous Dysplasia in a Child with Bone Fractures and Neuropsychiatric Symptoms, Case Report

Fibrous dysplasia of the bone in children is a rare, genetic, heterogeneous disorder, associated with extra - skeletal manifestations in the McCune Albright Syndrome . It results from a post - zygotic activating mutation in the (GNAS) gene coding for (Gs alfa) protein. This leads to replacement of the lamellar bone with under - mineralized fibrous tissue, presenting clinically with limping, pain, and pathological fractures . Objective: To demonstrate the clinical course, challenges and treatment of a child with polyostotic fibrous dysplasia presenting with limping, extra skeletal manifestations, neuropsychiatric symptoms and bone fractures. Method : The clinical information and lab results were obtained directly from the mother and the computerized medical records at the treating hospitals. Genetic analysis was done at Washington University School of Medicine, USA. Informed publication consent was obtained from the parents. R esults : The child presented at the age of 3years with limping and was found to have polyostotic fibrous dysplasia and café au lait spot. Later on, he developed neurological symptoms. He had bone fractures in the proximal femur, requiring surgical intervent ion. Bone pain and frequency of fractures improved after Zoledronate injections. Blood genetic analysis of the GNAS - gene was negative. Conclusion : Polyostotic fibrous dysplasia is a rare cause of limping and recurrent pathological fractures in children. Me dical treatment with Biphosphanate injections can positively affect the clinical course of the disease. A negative blood genetic analysis of the GNAS gene does not exclude the McCune Albright Syndrome, and indicates analysis from the affected tissue. Neuro psychiatric symptoms may manifest with fibrous dysplasia without any endocrine involvement.

Primary Pyomyositis as Unusual Cause of Limp: Three Cases in Immunocompetent Children and Literature Review

AbstractPyomyositis (PM) is an uncommon primary skeletal muscle infection caused mainly by Staphylococcus aureus that is characterized by single or multiple intramuscular abscess formation. In our ward, between 2013 and 2015, three children (two females and one male) aged from 2 to 12 years were diagnosed and treated for PM. Patients' medical records and imaging studies were examined retrospectively. All patients, otherwise healthy, complained of limp, fever, and severe lower limb pain. Skin scratch lesions were detected in two cases; one of them showed an edematous appearance of the affected area. Multifocal bilateral abscesses of gemini and gastrocnemius were detected in the youngest patient; right obturator and iliac muscles were affected in the second patient; and right gluteus and pyriform muscles were involved in the third patient. All patients showed elevated acute phase reactants and had normal serum creatinine kinase levels. Blood cultures and polymerase chain reaction (PCR) investigations were negative in all cases. Magnetic resonance imaging (MRI) findings included muscle enlargement, deep fascia, high signal in subcutaneous tissues, and postgadolinium abscess formation. No patient required surgical or percutaneous drainage. All three were treated conservatively with intravenous oxacillin, associated with ceftriaxone in the first patient and ceftazidime in the other two, followed by oral antibiotic therapy for a period ranging from 5 to 6 weeks. Pyomyositis must be considered as an unusual cause of limp in children of all ages. When promptly diagnosed and adequately treated, it has a favorable outcome without relapses or sequelae as occurred in all our patients.

An unusual cause of limp

A 38-year-old male re-presented to the ED five days after being discharged with a diagnosis of soft tissue injury to the left knee. Re-attendance was prompted by increased inability to weightbear and loss of joint function. The patient limped into the department and was asked to lie supine for examination. Even a cursory visual examination revealed marked infra-patellar swelling with a loss of contour and definition to this aspect of the joint. Pain was not a significant part of the presentation being scored at 2/10 at worst. The patient was an otherwise active adult who had become frustrated by his inability to indulge in any sort of sporting activity since discharge. After visiting the gym that morning he had been advised by one of the staff to re-attend as there was a possibility that he may have a more significant injury than previously diagnosed.

Neuroblastoma

Neuroblastoma is the most common solid extracranial tumor of childhood. Even though >25% of presentations are orthopaedic in nature, ranging from a limp to lower limb paralysis, neuroblastoma is a rare cause of limping in childhood and can therefore be easily missed by the admitting orthopaedic surgeon. Four cases of metastatic neuroblastoma are reported who all presented with hip pain within the last 3 years at Royal Manchester Children's Hospital. They all posed a diagnostic dilemma and an alternative diagnosis was initially made. A simple screening examination of the abdomen after ultrasonographic hip examination for sepsis would have led to an earlier diagnosis in all 4 cases. We suggest that including the abdomen in children undergoing a hip sonographic examination in those who are slightly atypical in nature or have indications of malignancy may lead to an early diagnosis of this rare cause of hip pain. IV.

Fever and Limp

Fever and limp is a common presentation in the pediatric emergency department. We describe a case of a 21-month-old female patient with prolonged fever and difficulty bearing weight, ultimately diagnosed with a large intracranial abscess. Intracranial abscesses are a rare cause of limp and an uncommon diagnosis in pediatric patients without underlying congenital heart disease. This case highlights the importance of differentiating the features of limp secondary to pain from limp secondary to weakness, which is particularly difficult in the preschool-aged group. It is imperative for practitioners to consider disease of the central nervous system when evaluating acutely nonambulatory children with fevers.

The child with a limp: a symptom and not a diagnosis

The limping child frequently poses a diagnostic challenge and clinical assessment may not be easy. Epidemiological studies are sparse; in one study1 children with an acute limp accounted for <2%...

Transient synovitis of the hip: more evidence for a viral aetiology

Transient synovitis (TS) of the hip is a common cause of limping in children. A link with infection has been suggested but has not been firmly established. We conducted a case-control study to determine whether the TS is associated with infection. We enrolled children diagnosed with TS in our emergency department over a 10-week period. For each case, we identified an age-matched and sex-matched child with a fracture. Parents of cases and controls were questioned with regard to recent infectious illness in their child according to a predefined questionnaire. A paired analysis showed that children with TS (N=29) were more likely to have experienced recent infection with vomiting or diarrhoea (P=0.004) and 'common cold symptoms/runny nose' (P=0.006) than the children with fractures (N=29). Other symptoms suggestive of either viral or bacterial infection were not significantly associated with TS. TS is associated with symptoms of gastroenteritis and the common cold.

Primary subacute Salmonella osteomyelitis of the navicular bone in a child with normal immunity

Primary subacute haematogenous osteomyelitis is one of the causes of limp. It usually involves tubular bones. Flat and small bones are affected less commonly. Diagnosis is difficult and usually takes weeks together for completion. Salmonella spp. can be isolated as a cause of primary subacute haematogenous osteomyelitis, if a usually underlying disorder, such as sickle cell anemia is associated. In this study, we present a child with normal immunity diagnosed as Salmonella primary subacute haematogenous osteomyelitis of the navicular bone, which is a rare condition. Primary subacute haematogenous osteomyelitis must be considered as a cause of limp for timely diagnosis and treatment.

(v) The irritable hip in childhood

Transient Synovitis is the most common cause of limp in childhood. By definition, hip “irritability” should be transient and function should return to normal in 7–10 days. The differential diagnosis is important, particularly the early recognition of septic arthritis or tumour. Clinical experience, team-working and appropriate investigations should ensure effective management of the child when there is concern. In practice, the vast majority of these cases can be recognised and reviewed in the casualty department as outpatients.

Stability and leg length equality in total hip arthroplasty

Limp is one of the most frustrating persistent symptoms after hip arthroplasty for both the patient and surgeon. There are a multitude of causes of limp; however, leg-length inequality is the leading culprit. Leg-length inequality can lead to anger, litigation, morbidity, and ultimately revision surgery. However, geometrically equal leg lengths may not be an attainable goal in all patients. The stability of the total hip arthroplasty is intimately related to leg length, and equality may need to be sacrificed for stability. Therefore, both the patient and the surgeon should have realistic expectations and an awareness of this problem. © 2003 Elsevier Inc. All rights reserved.

Osteochondritis dissecans of the head of the talus: an unusual cause of limping in a child

We describe the case of an 11-year-old boy who presented with a 2-month history of a right-sided painful limp. Roentgenograms and computerized tomography (CT) scanning revealed osteochondritis dissecans of the head of the talus. Conservative treatment was successful and roentgenograms 3 years after the onset of the symptoms demonstrated normal density of the talar head. Osteochondritis dissecans of the head of the talus is an extremely rare entity. There are few references in the world literature and no previous description of its CT appearance.

Expanding the concept of the toddler's fracture.

Fracture of the tibia is a well-known, often occult cause of limping and leg pain in young children. This fracture is typically a hairline, oblique fracture of the shaft of the tibia, and in some cases the fracture can be so subtle that bone scintigraphy or follow-up radiography may be required for its detection. In addition, a variety of other fractures that are less well known and just as difficult to detect can occur in the tibia and the foot in young children. These fractures include plastic bowing and buckle-type fractures, especially of the fibula; impaction, compression, or stress (fatigue) fractures of the tibia and fibula; and fractures of the metatarsal and tarsal bones. All of these fractures can be remarkably similar to the non-displaced spiral tibial fracture in their clinical appearance and should be included under the rubric of "toddler's fracture."

Toxic Synovitis of the Hip in Children

Toxic synovitis, an acute inflammatory condition of the hip, is the most common cause of limp and acute pain of the hip in children under 10 years of age. Usually, the synovitis and joint effusion are present unilaterally. The etiology of the condition is unknown, although in a few cases a recent history of an upper respiratory tract infection may be present. The child with toxic synovitis may complain of a limp and pain in the hip, the anteromedial aspect of the thigh, and the knee. The white cell count and erythrocyte sedimentation rate may be slightly elevated, as is the body temperature. Ultrasound is recommended as the primary imaging tool in the diagnosis and treatment of toxic synovitis. Septic arthritis, Perthes disease, and osteomyelitis are a few of the differential diagnoses that the practitioner should consider. Most cases can be managed with bed rest at home and administration of a nonsteroidal anti-inflammatory medication. Follow-up care should occur 2 weeks after diagnosis to ensure there is no recurrence of the joint effusion or progression to avascular necrosis. Radiographs of the hip should be repeated at 1 month and 3 months to complete the patient follow-up.

Osteomyelitis of the talus: an unusual cause of limping in childhood.

Hematogenous osteomyelitis of the talus is a rare and infrequently considered cause of limping in children. We describe five children younger than 2 years of age with osteomyelitis of the talus who had a limp and a paucity of constitutional symptoms. Conventional radiography and scintigraphy were the imaging techniques used. The usual radiologic features include soft-tissue swelling and an osteolytic defect in the talus without sequestrum formation of periosteal reaction. Bone scans were positive in all cases and led to the localization of the lesion in two patients. Definitive diagnosis was made in all cases only after needle aspiration or open biopsy and curettage. Increased awareness of this unusual lesion and its subtle early radiologic manifestations will allow prompt diagnosis and treatment.

The Limping Child

Evaluation of a limping child requires careful consideration and a basic knowledge of potential problems affecting the child. The most important point is not to miss or delay diagnosis of the septic hip. This is truly an orthopedic emergency. Complaints of knee pain should not throw the physician off the track of a diagnosis of hip disease. It is also important to be aware of how the medical history affects the musculoskeletal system. Many causes of limp are best analyzed by repeat examination and stepwise laboratory and radiographic evaluation. One should realize that a painful limp can be caused by something as mundane as a thorn in the heel or as serious as a tumor of the spine: Be suspicious.

The Limping Child

Evaluation of a limping child requires careful consideration and a basic knowledge of potential problems affecting the child. The most important point is not to miss or delay diagnosis of the septic hip. This is truly an orthopedic emergency. Complaints of knee pain should not throw the physician off the track of a diagnosis of hip disease. It is also important to be aware of how the medical history affects the musculoskeletal system. Many causes of limp are best analyzed by repeat examination and stepwise laboratory and radiographic evaluation. One should realize that a painful limp can be caused by something as mundane as a thorn in the heel or as serious as a tumor of the spine: Be suspicious.