SIGNS & SYMPTOMS, INVESTIGATIONS & DIAGNOSIS

SIGNS & SYMPTOMS

Red flags:

• Night pain
• Red, swollen & tender joints with stiffness

B symptoms: fever, fatigue, weight loss, night sweats

Unexplained rashes/bruising

Limp with stiffness

• Weight-bearing difficulty
• Papular rash
• Severe trauma with anxiety/agitation

Condition-specific:

-DDH: limited limb abduction, asymmetrical thigh creases (if left untreated, can lead to hip pain & OA in older children)

• Toddler fracture: point tenderness, redness, bruising
• Transient Synovitis: Like reactive arthritis, secondary to viral infections and is self-limiting.

Associated with hip pain, no restriction on movement

• Perthes: limited hip rotation, referred pain to groin/thigh/knee
• SUFE: Acute hip/thigh/knee pain, antalgic gait, shortened affected limb, toes pointing outwards & limited adduction/internal rotation. Prompt diagnosis and treatment is needed to avoid avascular necrosis
• Osgood-Schlatter: anterior knee pain, tibial tuberosity tenderness (provoked by knee extension on resistance), self-limiting overuse injury
• Osteochondritis dissecans: 10- 19 yrs old, associated with locking & instability of the knee joint
• Sever’s: heel pain from repetitive microtrauma
• Chondromalacia patella: Anterior knee pain when walking up/downstairs

INVESTIGATIONS & DIAGNOSIS

DDH: Ortolani and Barlow manoeuvres

X-ray: indicated for bony tenderness/trauma

Further imaging based on clinical suspicion