Musculoskeletal examination and the limping child — branching viva

Branching viva on the paediatric musculoskeletal examination and the limping child: performing the pGALS screen, applying the Kocher and Caird prediction rules to an irritable hip, recognising the age-stratified differential, and catching the slipped capital femoral epiphysis that hides behind knee pain.

branching clinical structured oral1 min readVerification in progress

Prompt

Emergency department: a five-year-old boy with a one-day limp after a viral illness, febrile at 39 degrees, holding the right hip flexed and abducted, refusing to bear weight. The examiner asks: describe your pGALS and pREMS approach, apply the Kocher rule, give your probability of sepsis — then branches to the Caird CRP addition, the immediate management, the age-stratified differential, and finally to an overweight thirteen-year-old with knee pain that reframes the diagnosis as a slipped capital femoral epiphysis.

Opening question

A five-year-old boy is febrile at 39 degrees, holds his right hip flexed and abducted, refuses to bear weight, and has had a viral illness in the past week. Describe your pGALS and pREMS approach, apply the Kocher prediction rule, and give your probability of septic arthritis. [1] [4]

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References4Show ledger

[1]Foster HE, Kay LJ, Friswell M, Coady D, Myers A. Musculoskeletal screening examination (pGALS) for school-age children based on the adult GALS screen. Arthritis and Rheumatism, 2006.PMID 17013854
[2]Foster HE, Jandial S. pGALS - paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system. Pediatric Rheumatology Online Journal, 2013.PMID 24219838
[4]Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. Journal of Bone and Joint Surgery. American Volume, 1999.PMID 10608376
[6]Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. Journal of Bone and Joint Surgery. American Volume, 2006.PMID 16757758