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J Am Acad Orthop Surg, Vol 9, No 2, March/April 2001, 89-98.
© 2001 the American Academy of Orthopaedic Surgeons
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The Limping Child: Evaluation and Diagnosis

John M. Flynn, MD and Roger F. Widmann, MD

Dr. Flynn is Assistant Professor of Orthopaedic Surgery, Unviersity of Pennsylvania School of Medicine, Philadelphia; and Attending Surgeon, Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia. Dr. Widmann is Assistant Professor of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, NY; and Assistant Attending Surgeon, Hospital for Special Surgery, New York.

Reprint requests: Dr. Flynn, Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104-4399.

A limp is a common reason for a child to present to the orthopaedist. Because of the long list of potential diagnoses, some of which demand urgent treatment, an organized approach to evaluation is required. With an understanding of normal and abnormal gait, a directed history and physical examination, and the development of a differential diagnosis based on the type of limp, the patient’s age, and the anatomic site that is most likely affected, the orthopaedist can take a selective approach to diagnostic testing. Laboratory tests are indicated when infection, inflammatory arthritis, or a malignant condition is in the differential diagnosis. The C-reactive protein assay is the most sensitive early test for musculoskeletal infections; an abnormal value rapidly returns to normal with effective treatment. Imaging should begin with plain radiography. Ultrasonography is particularly valuable in assessing the irritable hip and guiding aspiration, if necessary.






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Copyright © 2001 by the American Academy of Orthopaedic Surgeons.