26. Child with a limp in the ED
Doctor: Hello, I’m Dr. Nicholson. What brings you here this morning Madame?
Mother: Hello Doctor. My son Luke has woken up this morning with a limp.
Doctor: OK. So how old is Luke? Does he have any relevant medical history? Has he had any other symptoms recently such as pain, fever, common cold or gastrointestinal symptoms? Has he had any blow or other injury?
Mother: Luke is 6 years old. He has no past medical history. He had cold symptoms a few days ago with COVID-19 discarded by his pediatrician. He hasn’t had any other symptoms. He doesn’t recall any bumps or falls. He complains of hip pain on the left side.
Doctor: Let’s take a look at Luke then.
Weight: 20 kg. Well appearing, well-nourished and hydrated. Axillary temperature: 36.5ºC. No respiratory distress. Locomotor system: antalgic gait. Left lower extremity: hip abducted and externally rotated at rest. No swelling or erythema. No point tenderness of the hip, knee or ankle. Pain with internal hip rotation. No limitation of joint motion at any other level. No distal neurovascular deficit. Right lower extremity and upper extremities: normal. Cardiac and pulmonary auscultation: normal. Abdomen: normal. HEENT: normal.
Doctor: Very well Luke. The physical examination shows left hip involvement. Combined with the history details, the most probable diagnosis is transient synovitis. As the name itself indicates, it is a temporary condition with excellent prognosis and full recovery expected within a week. The causes are not established, but half of the children with transient synovitis have had a recent upper respiratory tract infection.
Mother: Right, so he doesn’t need any other tests then?
Doctor: At this moment he doesn’t need any tests, it is enough with the patient history and the physical examination. However, revaluation would be needed if the limp and pain persisted for more than a week or he presented new symptoms.
Mother: So, is there any treatment?
Doctor: There’s no need for any specific treatment except for pain management with nonsteroidal anti-inflammatory drugs such as ibuprofen. For Luke, it would be 5 ml of ibuprofen (40mg/ml) every 8 hours for 3 to 5 days until the pain disappears. I would recommend physical rest for the first few days and then return to full activity as tolerated.
Mother: Thank you Dr. Nicholson. Let’s hope Luke recovers soon.
– Limp: cojera
– Pain: dolor
– Common cold: catarro común
– Blow/bump: golpe
– Injury: lesión
– Pediatrician (US)/paediatrician (UK): pediatra
– Fall: caída
– Hip: cadera
– Antialgic gait: marcha antiálgica
– Point tenderness: punto doloroso/dolor a punta de dedo
– Knee: rodilla
– Joint motion: movilidad articular
– involvement: afectación
– transient synovitis: sinovitis transitoria
– prognosis: pronóstico
– full recovery: recuperación completa
– expected within a week: esperable en una semana