Differential Diagnosis for a 4-year-old Boy Waking Up Limping Without Injury
- Single most likely diagnosis:
- Transient Synovitis: This condition is a common cause of acute hip pain and limping in children, often without a clear history of trauma. It is characterized by inflammation of the synovial tissues within the hip joint, leading to pain and limited mobility.
- Other Likely diagnoses:
- Legg-Calve-Perthes Disease: A condition where the blood supply to the head of the femur is disrupted, leading to necrosis of the bone. It typically presents in children between the ages of 4 and 8 with hip pain and limping.
- Septic Arthritis: An infection within a joint, which can cause severe pain, swelling, and limping. While less common, it's a significant concern due to the potential for rapid joint destruction.
- Osteomyelitis: An infection of the bone, which can cause pain, fever, and limping. The onset can be acute, and it requires prompt treatment to prevent long-term damage.
- Do Not Miss diagnoses:
- Slipped Capital Femoral Epiphysis (SCFE): A condition where the growth plate in the hip joint becomes displaced, leading to pain and limping. It is a medical emergency due to the risk of avascular necrosis if not promptly treated.
- Malignancy (e.g., Osteosarcoma, Ewing's Sarcoma): Although rare, bone cancers can present with pain and limping. Early diagnosis is crucial for effective treatment and prognosis.
- Juvenile Idiopathic Arthritis (JIA): An autoimmune condition that can cause joint pain, swelling, and limping. While not immediately life-threatening, it requires early diagnosis for appropriate management to prevent long-term joint damage.
- Rare diagnoses:
- Kohler Disease: A rare condition characterized by avascular necrosis of the navicular bone in the foot, leading to pain and limping.
- Freiberg's Disease: A rare condition causing avascular necrosis of the metatarsal heads, leading to pain in the foot and limping.
- Hemophilia or other bleeding disorders: Can cause hemarthrosis (bleeding into joints), leading to pain, swelling, and limping, especially after minor trauma or spontaneously.