# Limp

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> Markdown URL: https://mediated.wiki/source/Limp.md
> Source: https://en.wikipedia.org/wiki/Limp
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{{short description|Type of asymmetric abnormality of the gait}}
{{other uses}}
{{redirect|Lameness|lameness in horses|Lameness (equine)}}
{{Use dmy dates|date=April 2022}}
{{Infobox medical condition (new)
| name            = Limp
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| image           = Hinken 2010 PD smallscreen PD 2012.ogg
| caption         = Limping
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| field           = [Neurology](/source/Neurology), [pediatrics](/source/pediatrics), [orthopedics](/source/orthopedics)
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A '''limp''' is a type of [asymmetric abnormality](/source/gait_abnormality) of the [gait](/source/gait_(human)). Limping may be caused by pain, weakness, neuromuscular imbalance, or a skeletal deformity.  The most common underlying cause of a painful limp is [physical trauma](/source/physical_trauma); however, in the absence of trauma, other serious causes, such as [septic arthritis](/source/septic_arthritis) or [slipped capital femoral epiphysis](/source/slipped_capital_femoral_epiphysis), may be present.  The diagnostic approach involves ruling out potentially serious causes via the use of [X-ray](/source/X-ray)s, [blood test](/source/blood_test)s, and sometimes [joint aspiration](/source/joint_aspiration). Initial treatment involves [pain management](/source/pain_management).  A limp is the presenting problem in about 4% of children who visit hospital emergency departments.<ref name=Singer85>{{cite journal |author=Singer JI |title=The cause of gait disturbance in 425 pediatric patients |journal=Pediatr Emerg Care |volume=1 |issue=1 |pages=7–10 |date=March 1985 |pmid=3843430 |doi= 10.1097/00006565-198503000-00003|s2cid=1198461 }}</ref>

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==Definition==
A limp is a type of asymmetric abnormality of the [gait](/source/gait_(human)).  When due to pain it is referred to as an [antalgic gait](/source/antalgic_gait), in which the foot is in contact with the ground for a shorter duration than usual; in severe cases there may be a refusal to walk.<ref name=Review10/> Hip deformities with associated muscular weakness, on the other hand, may be present with a [Trendelenburg gait](/source/Trendelenburg_gait), with the body shifted over the affected hip.<ref name=Review10/>

==Differential diagnosis==
The causes of limping are many and can be either serious or non-serious.  It usually results from pain, weakness, neuromuscular imbalance, or a skeletal deformity.<ref name=Review10>{{cite journal |vauthors=Laine JC, Kaiser SP, Diab M |title=High-risk pediatric orthopedic pitfalls |journal=Emerg. Med. Clin. North Am. |volume=28 |issue=1 |pages=85–102, viii |date=February 2010 |pmid=19945600 |doi=10.1016/j.emc.2009.09.008 }}</ref> In 30% of cases, the underlying cause remains unknown after appropriate investigations.<ref name=Review10/> The most common underlying cause of limping in children is minor [physical trauma](/source/physical_trauma).  In those with no history of trauma, 40% are due to [transient synovitis](/source/transient_synovitis) and 2% are from [Legg–Calvé–Perthes syndrome](/source/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_syndrome).<ref name=Fish09>{{cite journal |vauthors=Fischer SU, Beattie TF |title=The limping child: epidemiology, assessment and outcome |journal=J Bone Joint Surg Br |volume=81 |issue=6 |pages=1029–34 |date=November 1999 |pmid=10615981 |doi= 10.1302/0301-620X.81B6.9607|s2cid=2141675 }}</ref> Other important causes are infectious arthritis, osteomyelitis, and slipped capital femoral epiphysis in children.<ref>{{Cite web |title=Septic Arthritis & Osteomyelitis |url=https://www.pmmonline.org/doctor/limping-child/key-conditions/red-flag-conditions/septic-arthritis-osteomyelitis/ |access-date=2024-10-21 |website=www.pmmonline.org |language=en}}</ref><ref>{{Cite web |title=Slipped Capital Femoral Epiphysis (SCFE) |url=https://www.msdmanuals.com/professional/pediatrics/bone-disorders-in-children/slipped-capital-femoral-epiphysis-scfe |access-date=2024-10-21 |website=MSD Manual Professional Edition |language=en}}</ref>

===Infection===

====Septic arthritis====
[Septic arthritis](/source/Septic_arthritis) can be difficult to separate from less serious conditions such as [transient synovitis](/source/transient_synovitis).  Factors that can help indicate septic arthritis rather than synovitis include a WBC count greater than 12×10<sup>9</sup>/l, fever greater than {{convert|38.5|°C|°F}}, [ESR](/source/Erythrocyte_sedimentation_rate) greater than 40&nbsp;mm/h, [CRP](/source/C-reactive_protein) greater than 2.0&nbsp;mg/dL, and refusal to walk.<ref>{{cite journal |vauthors=Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR |title=Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children |journal=J Bone Joint Surg Am |volume=86-A |issue=8 |pages=1629–35 |date=August 2004 |doi=10.2106/00004623-200408000-00005 |pmid=15292409 }}</ref> People with septic arthritis usually look clinically toxic or sick.<ref name=Review09/> Even in the absence of any of these factors, however, septic arthritis may be present.<ref name="Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP 2006 1251–7">{{cite journal |vauthors=Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP |title=Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study |journal=J Bone Joint Surg Am |volume=88 |issue=6 |pages=1251–7 |date=June 2006 |pmid=16757758 |doi=10.2106/JBJS.E.00216 }}</ref> Joint aspiration is required to confirm the diagnosis.<ref name="Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP 2006 1251–7"/>

====Other====
Other infections that classically lead to a limp include [Lyme disease](/source/Lyme_disease) (a bacterial infection spread by [deer ticks](/source/Ixodes)) and [osteomyelitis](/source/osteomyelitis) (an infection of the bone).<ref name=Frick06/>

===Mechanical===

====Trauma====
Accidental or deliberate [physical trauma](/source/physical_trauma) may result in either a fracture, muscle bruising, or a contusion.<ref name=Frick06/> It is the leading cause of a limp.<ref name=Review10/> Deliberate abuse is important to consider.

====Slipped capital femoral epiphysis====
[Slipped capital femoral epiphysis](/source/Slipped_capital_femoral_epiphysis) (SCFE) is a condition in which the [growth plate](/source/growth_plate) of the head of the femur slips over the underlying bone.  It most commonly presents with hip pain in males during puberty and is associated with [obesity](/source/obesity).<ref name=Review10/> The majority of people affected have a painful limp and in half of cases both hips are affected.<ref name=Review10/> Nearly a quarter of people present with only knee pain.<ref name=Frick06>{{cite journal |author=Frick SL |title=Evaluation of the child who has hip pain |journal=Orthop. Clin. North Am. |volume=37 |issue=2 |pages=133–40, v |date=April 2006 |pmid=16638444 |doi=10.1016/j.ocl.2005.12.003 }}</ref> Treatment involves non-weight-bearing movement and surgery.<ref name=Review10/> If not identified early, [osteonecrosis](/source/osteonecrosis) or death of the head of the femur may occur.<ref name=Frick06/>

====Other====
A non-painful limp may be due to a number of mechanical conditions including [hip dysplasia](/source/hip_dysplasia_(human)) and leg length differences.<ref name=Frick06/>

===Inflammatory===

====Transient synovitis====
[Transient synovitis](/source/Transient_synovitis) is a [reactive arthritis](/source/reactive_arthritis) of the hip of unknown cause.<ref name=Review10/> People are usually able to walk and may have a low grade fever.<ref name=Review10/> They usually look clinically nontoxic or otherwise healthy.<ref name=Review09/> It may only be diagnosed once all other potential serious causes are excluded.  With symptomatic care it usually resolves over one week.<ref name=Review10/>

====Juvenile rheumatoid arthritis====
[Juvenile rheumatoid arthritis](/source/Juvenile_rheumatoid_arthritis) presents gradually with early morning stiffness, fatigue, and weight loss.<ref name=Review09/>

===Vascular===

====Legg–Calvé–Perthes syndrome====
[Legg–Calvé–Perthes syndrome](/source/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_syndrome) is a degenerative disease of the head of the femur which results in bone loss and deformity.  It usually presents as a chronic condition.<ref name=Frick06/>

===Neoplastic===
Cancers including [acute lymphocytic leukemia](/source/acute_lymphocytic_leukemia), [osteosarcoma](/source/osteosarcoma), and [Ewing’s sarcoma](/source/Ewing%E2%80%99s_sarcoma) may result in a gradual onset of limping in children.  It is often associated with night sweating, easy bruising, weight loss, and pain most prominent at night.<ref name=Review09/><ref name=Frick06/>

==Diagnostic approach==
The diagnosis of the cause of a limp is often made based on history, physical exam findings, laboratory tests, and radiological examination.  If a limp is associated with pain it should be urgently investigated, while non-painful limps can be approached and investigated more gradually.<ref name=Review09>{{cite journal |vauthors=Sawyer JR, Kapoor M |title=The limping child: a systematic approach to diagnosis |journal=Am Fam Physician |volume=79 |issue=3 |pages=215–24 |date=February 2009 |pmid=19202969 }}</ref> Young children have difficulty determining the location of leg pain, thus in this population, ''knee pain equals hip pain''.<ref name=Frick06/> SCFE can usually be excluded by an x-ray of the hips.<ref name=Review10/> An ultrasound or x-ray guided aspiration of the hip joint maybe required to rule out an infectious process within the hip.<ref name=Review10/>

==Epidemiology==
A limp at one hospital emergency department was the presenting complaint in 4% of children.<ref name=Singer85/> It occurs twice as commonly in boys as in girls.<ref name=Fish09/>

==References==
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== External links ==
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|  ICD9           = {{ICD9|719.7}}
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|  eMedicineSubj  = article
|  eMedicineTopic = 802506
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{{Arthropathies and related conditions}}
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Category:Gait abnormalities
Category:Articles containing video clips

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Adapted from the Wikipedia article [Limp](https://en.wikipedia.org/wiki/Limp) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Limp?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.