open access
Limping in children — insidious problem with various clinical manifestations
Affiliations- Oddział Dzieci Starszych z Pododdziałami Neurologii i Reumatologii Szpitala Dziecięcego im. św. Ludwika w Krakowie
open access
Abstract
Limping in children is a quite common problem in pediatric practice and especially in rheumatology. It most often occurs as a sudden gait disorder accompanied by pain. The vast majority is a symptom of traumatic lesions and overload changes of lower limbs but also inflammatory and infectious diseases. However, some of the serious diseases may be more underhand, causing difficulties in carrying out proper diagnosis and early recognition of the disease. The delay in the implementation of effective treatment often has a huge impact on the further course of the disease and therefore also the prognosis and efficiency of the patient. On a clinical example, we show the patient’s path from the first symptoms to diagnosis, indicating
diagnostic traps and tools to solve problems.
Abstract
Limping in children is a quite common problem in pediatric practice and especially in rheumatology. It most often occurs as a sudden gait disorder accompanied by pain. The vast majority is a symptom of traumatic lesions and overload changes of lower limbs but also inflammatory and infectious diseases. However, some of the serious diseases may be more underhand, causing difficulties in carrying out proper diagnosis and early recognition of the disease. The delay in the implementation of effective treatment often has a huge impact on the further course of the disease and therefore also the prognosis and efficiency of the patient. On a clinical example, we show the patient’s path from the first symptoms to diagnosis, indicating
diagnostic traps and tools to solve problems.
Keywords
limping; Ewing sarcoma; Lyme disease; clinical features; diagnostic; treatment
About this articleTitle
Limping in children — insidious problem with various clinical manifestations
Journal
Issue
Article type
Case report
Pages
23-31
Published online
2020-07-01
Page views
623
Article views/downloads
245
DOI
Bibliographic record
Forum Reumatol 2020;6(1):23-31.
Keywords
limping
Ewing sarcoma
Lyme disease
clinical features
diagnostic
treatment
Authors
Małgorzata Kurbiel
Zbigniew Żuber
References (25)- Sawyer JR, Kapoor M. The Limping Child: A Systematic Approach to Diagnosis. Am Fam Physician. 2009; 79(3): 215–224.
- Hill D, Whiteside J. Limp in children: Differentiating benign from dire causes, . J Fam Pract. 2011; 60(4): 193–197.
- Rush J.K., Thompson J.D. Limping Child, Medscape. https://emedicine.medscape.com/article/1258835-overview (Oct 16, 2017 ).
- Kliegman R, Stanton B. Nelson Pediatria. Elsevier U&P, Wrocław 2013.
- Santili C, Júnior W, Goiano E, et al. Limping in Children. Revista Brasileira de Ortopedia (English Edition). 2009; 44(4): 290–298.
- Hill D, Whiteside J. Limp in children: Differentiating benign from dire causes. J Fam Pract. 2011; 60(4): 193–197.
- Naranje S, Kelly DM, Sawyer JRA. systemic approach to the evaluation of a limping child. Am Fam Physician. 2015; 92(10): 908–16.
- Kumar V, Cotrani R, Robbins S. Patologia Robbinsa. Urban&Partner, Wrocław 2005.
- Stachura J, Domagała W. Patologia znaczy słowo o chorobie. Wydawnictwo PAU, Kraków 2003.
- Grier H. The Ewing family of tumors. Ewing’s sarcoma and primitive neuroectodermal tumors. Pediatric Clinics of North America. 1997; 44(4): 991–1004.
- Randall L, Calvert G. at al. Ewing’s Sarcoma Family of Tumors (ESFT).
- Tuziak T., Rodzina mięsaków Ewinga/PNET (prymitywne nowotwory neuroektodermalne), Monografia. http://www.sarcoma.pl/pliki/Monografia/rozdzial27.pdf.
- Ohno T, Rao VN, Reddy ES. EWS/Fli-1 chimeric protein is a transcriptional activator. Cancer Res. 1993; 53(24): 5859–5863.
- Rossow KL, Janknecht R. The Ewing's sarcoma gene product functions as a transcriptional activator. Cancer Res. 2001; 61(6): 2690–2695.
- Krajowy Rejestr Nowotworów w Polsce. Min. Zdr. Warszawa. 2019.
- Parvizi J, Kim G. Ewing Sarcoma. High Yield Orthopaedics. 2010: 169–170.
- https://www webmd com/cancer/ewings-sarcoma#1 (11.03.2019).
- http://sarcomahelp.org/translate/pl-miesak-ewinga.html (11.03.2019).
- Goryń T, Szostakowski B. Pieńkowski A. Advances in bone reconstructions after sarcoma resection. Oncol Clin Pract. 2018; 14.
- Budny A, Litak J. at al. Ewing`s Sarcoma. Journal of Education, Health and Sport. 2017; 7(6): 265–272.
- Bernstein M, Kovar H, Paulussen M, et al. Ewing's Sarcoma Family of Tumors: Current Management. The Oncologist. 2006; 11(5): 503–519.
- Raciborska A, Bilska K, Drabko K, et al. Validation of a multi-modal treatment protocol for Ewing sarcoma-A report from the polish pediatric oncology group. Pediatric Blood & Cancer. 2014; 61(12): 2170–2174.
- Hage Jv. Faculty Opinions recommendation of High-Dose Chemotherapy and Blood Autologous Stem-Cell Rescue Compared With Standard Chemotherapy in Localized High-Risk Ewing Sarcoma: Results of Euro-E.W.I.N.G.99 and Ewing-2008. J Clin Oncol. . 2018; 36(31): 3110–3119.
- Flisiak R, Pancewicz R. at al. Diagnostyka i leczenie Boreliozy z Lyme: zalecenia Polskiego Towarzystwa Epidemiologów i Lekarzy Chorób Zakaźnych. 2013.
- Pancewicz S. Jaki jest obraz kliniczny zapalenia stawów w przebiegu boreliozy? Wywiad. 2018 Apr 18. https://www.mp.pl/reumatologia/wywiady/208040,jaki-jest-obraz-kliniczny-zapalenia-stawow-w-przebiegu-boreliozy.html (11.03.2019).
