Paediatric, Limp
Pathway Home
Population Covered By The Guidance
This pathway provides guidance on imaging a child with a newly developed limp.
Date reviewed: July 2014
Date of next review: July 2023
Published: July 2014
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
 |
High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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|---|---|---|
| 1a |  |
Perthes Disease Image 1a and 1b (Plain Radiography): Frontal views in a neutral position and abduction with external rotation. The left hip shows marked fragmentation and resorption of bone and broadening of the femoral head and neck in keeping with advanced Perthes Disease. |
| 1b |  |
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| 2a |  |
Slipped Capital Femoral Epiphysis (SCFE) Image 2a and 2b (Plain Radiography): SCFE is demonstrated in the left hip. |
| 2b |  |
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Teaching Points
Teaching Points
- Depending on the age of the child and his/her ability to localize pain, as well as a thorough clinical history and examination, the choice of investigation is dictated by the most likely cause
- Initially, plain films and ultrasonography are recommended
- If further investigations are required, consideration should be given to a radionuclide scan, CT or MRI
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Flynn JM, Widmann RF. The limping child: evaluation and diagnosis. J Am Acad Orthop Surg. 2001;9:89-98. (Review article)
- Englaro EE, Gelfand MJ, Paltiel HJ. Bone scintigraphy in preschool children with lower extremity pain of unknown origin. J Nucl Med. 1992;33:351-4. (Level IV evidence)
- Blatt SD, Rosenthal BM, Barnhart DC. Diagnostic utility of lower extremity radiographs of young children with gait disturbance. Pediatrics. 1991;87:138-40. (Level IV evidence)
- McConnochie KM, Roghmann KJ, Pasternack J, Monroe DJ, Monaco LP. Prediction rules for selective radiographic assessment of extremity injuries in children and adolescents. Pediatrics. 1990;86:45-57. (Level III evidence)
- Aronson J, Garvin K, Seibert J, Glasier C, Tursky EA. Efficiency of the bone scan for occult limping toddlers. J Pediatr Orthop. 1992;12:38-44. (Level III evidence)
- Myers MT, Thompson GH. Imaging the child with a limp. Pediatr Clin North Am. 1997;44:637-58. (Review article)
- Scott RJ, Christogersen MR, Robertson WW Jr, et al. Acute osteomyelitis in children: a review of 116 cases. J Pediatr Orthop. 1990;10:649-52. (Level III evidence)
- McCoy JR, Morrissy RT, Seibert J. Clinical experience with the technetium-99 scan in children. Clin Orthop. 1981;154:175-80. (Level III evidence)
- Royal SG. Investigation of the irritable hip. J Pediatr Orthop. 1992;12:396-7. (Level III evidence)
- Alexander JE, Seibert JJ, Glasier CM, et al. High-resolution hip ultrasound in the limping child. J Clin Ultrasound. 1989;17:19-24. (Level IV evidence)
- Zawin JK, Hoffer FA, Rand FF, Teele RL. Joint effusion in children with an irritable hip: US diagnosis and aspiration. Radiology. 1993;187:459-63. (Level II evidence). View the reference
- Terjesen T, Osthus P. Ultrasound in the diagnosis and follow-up of transient synovitis of the hip. J Pediatr Orthop. 1991;11:608-13. (Level III evidence)
- Fernandez M, Carrol CL, Baker CJ. Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics. 2000;105:1299-304. (Level III evidence)
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans Magnetic Resonance Imaging (MRI) |
Magnetic Resonance Imaging (MRI) Radiation Risk of Medical Imaging for Adults and Children |
File Formats
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