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Making a Diagnosis

When diagnosing the cause of a limp, there are a wide variety of causes including red flag conditions. 

Clinical assessment is essential as is knowledge of likely causes at different ages.

Details of conditions and investigations are covered in the key conditions and cases.

Remember that non-hip and non-musculoskeletal causes of limp can also occur. Be aware of pitfalls !

Clinical assessment in children is different to that of adults. 

Key points:

  • The child may not give any verbal history and this is often obtained from the parent / carer.
  • The history may not tell you where the problems are (so there is need to examine all joints as part of your general assessment - and at least to perform a pGALS assessment).
  • Children may not verbalise pain and non-verbal clues are important (e.g facial expression, withdrawal of a limb).
  • Normal musculoskeletal development is important to know as there are normal variants and ranges of joint movement, leg alignment, gait and motor milestones change with age.
  • You need to know what is normal to be able to identify what is abnormal.

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