DDx

STOP LIMPING

S – Septic arthritis – labs, US hip, arthrocentesis

T – Toddler’s fx/Trauma – spiral fx of distal 1/3 tibia in 1-3 yo/Other occult trauma

O – Osteomyelitis – Hematogenous, plain films, ESR, CRP to start – MRI is the best test

P – Perthes dz/SCFE – 3-12 yo, pain w/ internal rotation at the hip/adolescents overweight

L – Limb-length difference – measure from ASIS to medial mal

I – Inflammatory – Transient synovitis – 3-6 yo, afebrile, well, better after NSAID

M – Malignancy – Leukemia, Ewing/osteogenic sarcoma

P- Pyomyositis – Ill appearing, sometimes after minor trauma, need surgeon

I – Iliopsoas abscess – Usually from bacteremia

N – Neurologic – CVA, Guillain Barre, muscular dystrophy, periph neuropathy

G – GI/GU – Appendicitis, hernia, testicular/ovarian torsion