DEFINITION, PREVALENCE & ETIOLOGY

DEFINITION

• Antalgic gait is the most common presentation: abnormal gait pattern with shortened stance phase and increased swing phase to offload pain
• Can result from pain, weakness or deformity
• Causes can be self-limiting (e.g., Transient Synovitis) or life-threatening (e.g., septic arthritis/malignancy)

PREVALENCE

transient synovitis: more common in males

Perthes disease: more common in males

SUFE: common in adolescent overweight boys aged 3-10

Severs disease: most common in boys 10-12 playing sports

Chondromalacia patella: more common in females

ETIOLOGY

Multiple causes based on age groups:

<3 years:

• DDH o Risk factors:
  • Female gender
  • Breech position
  • First vaginal delivery
  • Family history
• Fractures/soft tissue injuries o secondary to the Toddler’s fracture/malignancy

3-10 years:

• Transient synovitis
• Perthes disease o Idiopathic o Associated with necrosis of the femoral head
• Fractures/soft tissue injuries

10-18 years:

• Fractures/soft tissue injuries
• SUFE
• Osgood-Schlatter syndrome
• Osteochondritis dissecans
• Chondromalacia patella
• Severs disease

Any age:

• Infections: septic arthritis, osteomyelitis, discitis (pain during nappy changes, causing back flexion)
• Malignancy: osteosarcomas (the most common bone cancer in kids > 10 years), leukaemia, lymphomas
• Haematological: sickle cell, haemophilia
• Metabolic: rickets (lack of Vitamin D, bone tenderness, bowing of legs, kyphoscoliosis, proximal muscle weakness)
• Neuromuscular conditions: CP, Spina Bifida, Muscular dystrophy
• Inflammatory joint disease: JIA (joint pain & swelling, morning stiffness, >6 weeks & associated with uveitis) & Lyme arthritis (associated with classical bullseye rash) – Non-MSK: testicular torsion, appendicitis