Common Pediatric MSK Concerns


Is the limp painful or painless?

If pain is present, it needs to be characterized:

  1. Is it constant, intermittent or transient?
  2. At what time of day or following which activities is it most painful?
  3. Has the quality and/or intensity of the pain changed over time?
Pain that is constant, non-mechanical and/or wakes the patient from sleep is worrisome. Review the Bone Pain module for a discussion of bone infections and neoplasms. Some limps are painless: this is the characteristic presentation of Legg-Calve-Perthes (or just "Perthes") disease, an idiopathic avascular necrosis of the femoral head which is commonly seen in elementary age children (ages 4-8).

Right hip Legg-Calve-Perthes disease in 8 year old boy
Image source: L. Davidson