Symptoms, Causes and Treatment

A limp is a very common reason for consultations with children. Although there are numerous possible causes, in practice most cases are due to non-serious causes and the limp is temporary, with progressive improvement in the following hours or days. Mild trauma is the most common cause of a limp. In Some cases there is a history of trauma that is known and remembered by the patient or his family, in which case diagnosis is simpler. However, in other cases, especially in young children, the trauma may have gone unnoticed by family members or caregivers. In this scenario, an absence of serious lesions on examination and a rapid progression to improvement usually guide the diagnosis. However, there are other causes, some of them serious,that can cause a limp in children. Therefore, in all cases of lamps which are not triggered by some trauma, or if there is trauma but there is no improvement in the following hours or days, it is important to consult your paediatrician.

At the assessment by the paediatrician, it is very important to be able to detail:

• Possible triggers: trauma, a change of footwear, start or intensification of physical activity or recent infections (e.g. upper respiratory infections,gastroenteritis, urinary tract infections).

• Whether the child manifests pain or not (there are diseases that cause a limp without pain) and where it is located.

• Characteristics of the limp: start, time of evolution,improvement or worsening of pain with rest.

• If there are other accompanying manifestations, such as fever, a skin rash or unexplained weight loss.

• Recent history of infections, especially upper respiratory infections, gastroenteritis, or urinary tract infections.

• If there have been similar previous episodes or if there is a history in the family of rheumatological diseases that could point to hereditary causes.

The exploration of the locomotor apparatus of lower limbs and the spinal column is directed to the identification of manifestations of inflammation or involvement of their bones or joints.

Often, to complete the assessment of the child with a limp, it may be necessary to perform imaging tests (X-ray, ultrasound, tomography, magnetic resonance,scintigraphy) of the affected area or blood, urine or synovial fluid (from the contents of a joint).

Transient hip synovitis

Among the causes of a limp which are not due to trauma,special mention should be made of transient hip synovitis,which is probably the most common cause during childhood. This is a transient and benign inflammation of the hip joint producing transient pain and a limp. Itis more common in children between three and ten years.Its cause is unknown, but the fact that in many cases the child has recently suffered from an upper respiratory tract infection (fever and common cold) or gastrointestinal(fever, diarrhoea or vomiting) leads to suspicion that there is an infectious trigger.
Transient hip synovitis produces a limp with pain, which the child refers to in the hip or thigh, both when walking and when exploring the mobility of the hip with the child lying on the bed. It is treated with rest and anti-inflammatories, usually ibuprofen. The rapid progression to the disappearance of the limp and pain,normally within a period of one to two weeks, together with the absence of signs of other diseases, confirm the diagnosis of transient hip synovitis.