| Legg-Calvé-Perthes | Legg-Calvé-Perthes disease results from interruption of the blood supply to the still-growing femoral head. It occurs in children 2–12 years of age and presents with hip pain and an atraumatic limp. Common physical findings include leg-length discrepancies, and limited abduction and internal rotation. Radiographs reveal sclerosis of the proximal femur with joint space widening. MRI confirms osteonecrosis. |
| Stress fracture | A diagnosis of stress fracture should be considered in patients with a history of overuse and weight-bearing exercise. These patients have pain that is worse with activity, and pain on active leg raising. MRI can detect fractures not seen on plain films.
Stress fractures in the foot cause localized tenderness and swelling in superficial bones, and the pain can be reproduced by having the patient jump on the affected leg. |
| Iliopsoas bursitis | Iliopsoas bursitis presents with snapping or popping of the hip on extension from a flexed position |
| Labral tears (hip) | Labral tears present with sharp anterior hip pain at times, with radiation to the thigh or buttock. Usually, patients will have mechanical symptoms such as clicking with activity. |
| FABER and FADI | The FABER (flexion, abduction, external rotation) and FADIR (flexion, adduction, internal rotation) impingement tests are sensitive for labral tears. |
| Statin-induced myopathy | Elevated CK. Some patients have proximal muscle weakness. |
| Polymyalgia rheumatica | Is usually associated with elevated ESR. |
| Duchenne Muscular Dystrophy | Get a Creatine Kinase, for example, to detect DMD in a 15-month old male who is walking but is unable to stand up from a supine position without support. |
| Running injuries | Running injuries are primarily caused by overuse due to training errors. Runners should be instructed to increase their mileage gradually. |
| Positional Skull Deformity, also called Benign Positional Molding or Occipital Plagiocephaly | “The parallelogram shape of this infant’s head is typical of positional skull deformity, also known as benign positional molding or occipital plagiocephaly. This condition has been estimated to be present in at least 1 in 300 infants, with some studies showing milder variants in up to 48% of healthy infants. The incidence of positional skull deformity is increased in children who sleep in the supine position, but switching to prone sleeping is not recommended because this would increase the risk of sudden infant death syndrome. The deformity can be prevented by routine switching of the dependent side of the infant’s head. Supervised “tummy time” for 30–60 minutes each day can also decrease the amount of flattening and can increase the child’s motor development. Children who have positional skull deformity should also be screened for torticollis. This condition can prevent correct positioning and is remedied with physical therapy techniques. Positional skull deformity should be differentiated from cranial synostosis, which is the result of abnormal fusion of one or more of the sutures between the skull bones. Ipsilateral frontal bossing and ear advancement are not seen, resulting in a trapezoid-shaped head. Most infants with positional skull deformity improve within 2–3 months with the institution of positional changes and tummy time. If the condition does not significantly improve after this amount of time, referral to a pediatric neurosurgeon with expertise in craniofacial malformations would be appropriate.” |
| Patellofemoral Syndrome | |
