DipMSK Revision Guide · Chapter 18 of 18

Paediatric MSK Conditions

The limping child, SUFE, Perthes, apophysitis, pars injury and JIA.

Syllabus: Paediatric MSK Conditions

Written by Dr David Palethorpe, MBBS, BSc (Hons), MRCGP · NHS GP PartnerReviewed 14 September 202618 min readChapter 18 of 18

Before you start

Try this first

List the same-day triggers in a limping child.

Under 3, ill or febrile, will not weight-bear, restricted hip movement, or immunosuppressed.

2 more warm-up questions in the full chapter.

What this chapter covers

  • 18.1The limping child — age, red flags and the same-day listAge gives the diagnosis before you touch the child: under 3, infection and non-accidental injury; 4 to 8, Perthes; over…Preview below
  • 18.2Septic arthritis and osteomyelitis versus transient synovitisMembers
  • 18.3Hip disorders of growth — SUFE, Perthes and hip dysplasiaMembers
  • 18.4Apophysitis in the growing skeleton — Osgood-Schlatter and Sever’sMembers
  • 18.5Back pain in the child and the young athleteMembers
  • 18.6Juvenile idiopathic arthritis — and the leukaemia that imitates itMembers
  • —Referral, by timeframeRed flags below

The limping child — age, red flags and the same-day list

Core Lens — the takeaway

Age gives the diagnosis before you touch the child: under 3, infection and non-accidental injury; 4 to 8, Perthes; over 10, slipped upper femoral epiphysis. And growing pains never cause a limp.

Recognise

  • Limp is a symptom, not a diagnosis, and the differential changes with age.
  • 1–3 years: septic arthritis, osteomyelitis, transient synovitis, trauma, non-accidental injury; insidiously, hip dysplasia and muscular dystrophy.
  • 3–10 years: transient synovitis commonest, then Perthes, septic arthritis, leukaemia, JIA. 11–16 years: slipped upper femoral epiphysis until proven otherwise, plus bone tumours.

The rest of this chapter is in the DipMSK guide

5 more topics, every section opened up, the recall questions and the guidance summaries — written and reviewed by practising UK doctors.

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Referral, by timeframe

Same day · Emergency
  • Unwell, febrile and refusing to weight-bear, or any NICE NG143 red feature
  • A hot swollen joint with fever at any age, or an infant with pseudoparalysis
  • Acute SUFE unable to weight-bear — transported non-weight-bearing
  • Any adolescent with hip, thigh or knee pain plus obligatory external rotation
  • Any neurological deficit, bladder or bowel disturbance, or suspected cord compression
  • A febrile child with spinal pain, refusal to sit or walk, acquired torticollis, or back pain under 5
  • Suspected non-accidental injury — same-day discussion with paediatrics and safeguarding
  • A red, painful eye in a child with enthesitis-related or psoriatic JIA
  • Under 3, painfully restricted hip movement, or immunosuppression
  • Unexplained petechiae or hepatosplenomegaly in a child — immediate specialist assessment for leukaemia (NG12 1.10.1)

Also in the full chapter: Cancer pathway · Urgent · Routine.

← Chapter 17Chest Wall & Thoracic Pain

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