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What Causes Inability To Bear Weight On Right Leg?
Question: Seeking help with differential dx. 4yo male. Chief complaint: mother concerned with limp. Won't bear weight on his rt leg. Seemed fine yesterday while riding bike. No known injury but did come home awfully dirty. Walking last night, appeared normal. Ate and went to bed. Today, won't bear weight on the right leg. Hx: Asthma since infant. Most recent exacerbation about 2 weeks ago, resolved with azithromycin and steroids. Typically exacerbations with viral upper respiratory infections.
No allergies.
Meds: Completed prednisone 5 day burst with abx 2 weeks prior. Albuterol MDI PRN. Ibuprofen 180mg prn, 3 hours ago.
ROS: Unremarkable and denies all. Neuor: Denies lower extremity numbness, tingling or incontinence.
Vitals: HR: 100, BP 110/70, RR 18 SAt 98% T 99.0f Wt: 18kg Ht 35
General: Obese child. Oriented to PPt.
EXT/MSK: Full range of motion and nontender to right ankle, right tibfib and right foot, but tender with internal rotation and abduction of the rt hip specifically, but also of the right knee. No obvious swelling or redness. At rest in bed, hip is flexed and externally rotated. Able to sit on side of bed, and will reluctantly stand with rt foot on floor with ambulation attempt, not wanting to bear weight.
Neuro: Motor exam 5/5 strength, but painful and limited at rt hip.
Skin: Healing scab from abrasion on rt lower leg (bike pedal from a week ago)
No allergies.
Meds: Completed prednisone 5 day burst with abx 2 weeks prior. Albuterol MDI PRN. Ibuprofen 180mg prn, 3 hours ago.
ROS: Unremarkable and denies all. Neuor: Denies lower extremity numbness, tingling or incontinence.
Vitals: HR: 100, BP 110/70, RR 18 SAt 98% T 99.0f Wt: 18kg Ht 35
General: Obese child. Oriented to PPt.
EXT/MSK: Full range of motion and nontender to right ankle, right tibfib and right foot, but tender with internal rotation and abduction of the rt hip specifically, but also of the right knee. No obvious swelling or redness. At rest in bed, hip is flexed and externally rotated. Able to sit on side of bed, and will reluctantly stand with rt foot on floor with ambulation attempt, not wanting to bear weight.
Neuro: Motor exam 5/5 strength, but painful and limited at rt hip.
Skin: Healing scab from abrasion on rt lower leg (bike pedal from a week ago)
Brief Answer:
Details below
Detailed Answer:
Hello
Thanks for asking to healthcareamgic
I have gone through the detailed history and examination.On the basis of that and with flexed and externally rotated hip my provisional diagnosis is
Iliopsoas muscle spasm
and my differential diagnosis are
1)Hip joint synovitis-Age is prefereble but no history of fever or systemic illness
2)Slipped capital femoral epiphysis
Points against-Age
Point in favour-overweight
3)Fracture neck femur
Point against-No history of trauma,pain is not severe
Point in favor- Deformity of hip
4)Tear to the tendon
5)Avascular necrosis is very - No precipitating factor.history of only short course of steriod
I hope this helps.
Regards
Details below
Detailed Answer:
Hello
Thanks for asking to healthcareamgic
I have gone through the detailed history and examination.On the basis of that and with flexed and externally rotated hip my provisional diagnosis is
Iliopsoas muscle spasm
and my differential diagnosis are
1)Hip joint synovitis-Age is prefereble but no history of fever or systemic illness
2)Slipped capital femoral epiphysis
Points against-Age
Point in favour-overweight
3)Fracture neck femur
Point against-No history of trauma,pain is not severe
Point in favor- Deformity of hip
4)Tear to the tendon
5)Avascular necrosis is very - No precipitating factor.history of only short course of steriod
I hope this helps.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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