Limp / Extremity Pain

Key Conditions

Key conditions are the core conditions that the Paediatric Undergraduate and Clerkship Directors of Canada (PUPDOC) felt are essential for graduating medical students to know. The Key Conditions are neither a differential diagnosis nor a clinical approach. They highlight conditions that may be unique to paediatrics, that are essential, or that are common. Key Conditions can present in a number of ways – each is listed as under the most common Clinical Presentation.

• Bone Tumour
• Growing Pains
• Juvenile Idiopathic Arthritis
• Legg Calve Perthes Disease
• Osgood Schlatter Disease
• Osteomyelitis
• Post-Infectious Arthritis
• Reactive Arthritis
• Rheumatic Fever
• Septic Arthritis
• Slipped Capital Femoral Epiphysis
• Transient Synovitis

Clinical Approach

Clinical approaches represent one of many methods to think through a clinical presentation, and narrow down a differential diagnosis. There are many conditions that can present with similar symptomatology. These presentations are not meant to contain an exhaustive list of differential diagnoses, but rather outline how to think through patient signs and symptoms, and understand some of the most common and important Paediatric conditions. There are many different ways to approach any clinical presentation, and these approaches are not meant to replace clinical judgement.

Pre-Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Clerkship

Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.

Objectives

By the end of the Paediatric Clerkship, a medical student will be able to:

1. Describe the components of normal gait in the paediatric population.
2. Explain the pathophysiology of bone and soft tissue injury and repair in the paediatric population.
3. Recognize the clinical features and propose a management plan for patients with osteomyelitis, septic arthritis, rheumatic fever, and post-infectious and reactive arthritis.
4. Recognize the clinical features of a bone tumor, growing pains, juvenile idiopathic arthritis, Legg Calve Perthes disease, Osgood Schlatter disease, slipped capital femoral epiphysis, and transient synovitis

Half Day Cases

• A 12 year old girl presents to the emergency department with pain in her knee. When you examine her, you note that she has a large joint effusion in that same knee
• A 5 year old boy comes to your clinic with fever and pain in his arm. You notice that the arm is swollen, warm to touch and is erythematous
• A 9 year old boy comes to the emergency department with pain in his hip and difficulty walking
• A 14 year old has come in with fever for 3 days and lethargy. She complains of pain in her knees and wrist, and you notice on examination that she has a joint effusions in those extremities as well.

Resources

The following resources have been reviewed and collated by canuc-paeds. These resources are aimed to provide information at the level of the medical student. These include overviews of topics, clinical resources, and useful guidelines that contain relevant materials.