Non-traumatic Limping in the Child: A Pediatric Rheumatologist Perspective on Etiology, Clinical Evaluation, Laboratory Diagnosis, and Diagnostic Algorithms using Musculoskeletal Ultrasound (MSUS)

Abstract

Limping refers to an asymmetrical gait that deviates from the typical gait pattern ex- pected for a child of a certain age. In most children, limping is caused by a mild, self-limiting event, such as a contusion, strain, or sprain. However, a child's limping is always a pathological finding that poses a particular diagnostic challenge and necessitates a thorough assessment. The pediatrician must weigh a wide range of acute and chronic potential causes of a non-traumatic limp, including infection, neoplasia, and chronic inflammatory disorders. A thorough history and clinical examina- tion will help us arrive at the correct diagnosis. Understanding the typical gait is essential to recog- nizing and correctly interpreting the disordered one. The examination of child limping involves us- ing a variety of diagnostic methods. Efficient and cost-effective diagnosis and treatment of the un- derlying condition requires a systematic approach. This review provides the pediatric rheumatolo- gist perspective and approach for evaluating non-traumatic limp in children, with a focus on the use of point-of-care (PoC) musculoskeletal ultrasound (MSUS) as a crucial tool in daily practice.