 |
This article may require copy editing for grammar, style, cohesion, tone, or spelling. You can assist by editing it. (February 2012) |
| ICD-9 | 719.7 |
|---|---|
| DiseasesDB | 22069 |
| eMedicine | article/802506 |
A limp is a type of asymmetric abnormality of the gait. Limping may be caused by pain, weakness, neuromuscular imbalance, or a skeletal deformity. The most common underlying cause of a painful limp is physical trauma; however, in the absence of trauma, other serious causes such as septic arthritis, or slipped capital femoral epiphysis may be present. The diagnostic approach involves ruling out potentially serious causes via the use of X-rays, blood work, and potentially joint aspiration. Initial treatment involves pain management. A limp is the presenting problem in about 4% of children who visit the emergency department.
Contents |
Definition [link]
A limp is a type of asymmetric abnormality of the gait. When due to pain it is referred to as an antalgic gait, which has a shortened duration in which the foot is in contact with the ground; in severe cases there may be a refusal to walk.[1] Hip deformities with associated muscular weakness, on the other hand, may present with a Trendelenburg gait, with the body shifted over the affected hip.[1]
Differential diagnosis [link]
The causes of limping are many and can be either serious or non-serious. It usually results from pain, weakness, neuromuscular imbalance, or a skeletal deformity.[1] However, in 30% of cases the underlying cause remains unknown after appropriate investigations.[1] The most common underlying cause of limping in children is minor trauma. In those with no history of trauma, 40% are due to transient synovitis and 2% are from Perthes' disease.[2]
Infection [link]
- Septic arthritis
Septic arthritis can be difficult to separate from more serious conditions such as transient synovitis. Factors that can help indicate septic arthritis rather than synovitis includes a WBC count greater than 12×109/l, fever greater than 38.5 C, ESR greater than 40mm/hr, CRP greater than 2.0 mg/dL, and refusal to walk.[3] People with septic arthritis usually look clinically toxic or sick.[4] However even in the absence of any of these factors septic arthritis maybe present.[5] Joint aspiration is required to confirm the diagnosis.[5]
- Other
Other infections that classically lead to a limp include Lyme disease (a bacterial infection spread by a deer tick) and osteomyelitis (an infection of the bone).[6]
Mechanical [link]
- Trauma
Accidental or deliberate trauma may result in either a fracture, muscle bruising, or a contusion.[6] It is the leading cause of a limp.[1] Deliberate abuse is important to consider.
- Slipped capital femoral epiphysis
Slipped capital femoral epiphysis (SCFE) is a condition in which the growth plate of the head of the femur slips over the underlying bone. It most commonly presents with hip pain in males during puberty and is associated with obesity.[1] The majority of people affected have a painful limp and in half of cases both hips are effected.[1] Nearly a quarter of people however present with only knee pain.[6] Treatment involves none weight-bearing and surgery.[1] If not identified early osteonecrosis or death of the head of the femur may occur.[6]
- Other
A non-painful limp may be due to a number of mechanical conditions including: developmental dysplasia of the hip and leg length differences.[6]
Inflammatory [link]
- Transient synovitis
Transient synovitis is a reactive arthritis of the hip of unknown cause.[1] People are usually able to walk and have either a normal or a low grade fever.[1] They usually look clinically non toxic or otherwise healthy.[4] It may only be diagnosed once all other potential serious causes are excluded. With symptomatic care it usually resolves over one week.[1]
- Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (JRA) present gradually with early morning stiffness, fatigue, and weight loss.[4]
Vascular [link]
- Legg-Calve-Perthes disease
Legg-Calve-Perthes disease is a degenerative disease of the head of the femur which results in bone loss and deformity. It usually presents as a chronic condition.[6]
Neoplastic [link]
Cancers including acute lymphocytic leukemia, osteosarcoma and Ewing’s sarcoma may result in a gradual onset of limping in children. It is often associated with night sweat, easy bruising, weight loss, and pain most prominent at night.[4][6]
Diagnostic approach [link]
The diagnosis of the cause of a limp is often made based on history, physical exam findings, laboratory tests, and radiological examination. If a limp is associated with pain it should be urgently investigated, while non-painful limps can be approached and investigated more gradually.[4] Young children have difficult determining the location of leg pain thus in this population ‘‘knee pain equals hip pain’’.[6] A SCFE can usually be excluded on an xray of the hips.[1] A ultrasound or xray guided aspiration of the hip joint maybe required to rule out an infectious process within the hip.[1]
Epidemiology [link]
A limp at one hospital emergency department was the presenting complaint in 4 % of children.[7] It occurs twice as commonly in boys as in girls.[2]
References [link]
- ^ a b c d e f g h i j k l m Laine JC, Kaiser SP, Diab M (February 2010). "High-risk pediatric orthopedic pitfalls". Emerg. Med. Clin. North Am. 28 (1): 85–102, viii. DOI:10.1016/j.emc.2009.09.008. PMID 19945600.
- ^ a b Fischer SU, Beattie TF (November 1999). "The limping child: epidemiology, assessment and outcome". J Bone Joint Surg Br 81 (6): 1029–34. DOI:10.1302/0301-620X.81B6.9607. PMID 10615981.
- ^ Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR (August 2004). "Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children". J Bone Joint Surg Am 86-A (8): 1629–35. PMID 15292409.
- ^ a b c d e Sawyer JR, Kapoor M (February 2009). "The limping child: a systematic approach to diagnosis". Am Fam Physician 79 (3): 215–24. PMID 19202969.
- ^ a b Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP (June 2006). "Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study". J Bone Joint Surg Am 88 (6): 1251–7. DOI:10.2106/JBJS.E.00216. PMID 16757758.
- ^ a b c d e f g h Frick SL (April 2006). "Evaluation of the child who has hip pain". Orthop. Clin. North Am. 37 (2): 133–40, v. DOI:10.1016/j.ocl.2005.12.003. PMID 16638444.
- ^ Singer JI (March 1985). "The cause of gait disturbance in 425 pediatric patients". Pediatr Emerg Care 1 (1): 7–10. DOI:10.1097/00006565-198503000-00003. PMID 3843430.
|
|||||||||||||||||||||||
https://wn.com/Limp
Limp (band)
Limp was an American pop punk band formed in 1994, with strong influences in both rock and ska, hailing from the San Francisco Bay Area. Limp released three studio albums on Honest Don's, a subsidiary label of Fat Wreck Chords, as well as an EP released on Fueled by Ramen, before their 2002 breakup.
History
Limp formed in 1994 with founding members Phil Ensor (vocals, guitar) and Serge Verkhovsky (bass), and would later borrow Dance Hall Crashers member Scott Goodell to be the band's first drummer. They recorded a demo that was given to Marty Gregori of Bracket, which was later passed along to Michael Burkett at Fat Wreck Chords. The demo caught the labels interest and initially, a 7" record was planned for release. After recording "Clear Color" and "Bug Dance", a full-length album was instead offered on the labels recently launched subsidiary, Honest Don's. The outcome would be Limp's debut Pop & Disorderly released in 1997. The album was recorded as a four piece featuring Ensor, Verkhovsky, second guitarist Billy Bouchard and new drummer Johnny Cruz. Overall, the album showcased a strong pop punk influence, with major focus on vocal harmonies, two traits the band would continue to exercise throughout their career. Although Ensor provided lead vocals for almost the entire album, Bouchard would supply them on "Eighteen", as well as "Holiday Road", a cover of the Lindsey Buckingham song from the 1983 film National Lampoon's Vacation.
When the Pawn...
When the Pawn Hits the Conflicts He Thinks Like a King What He Knows Throws the Blows When He Goes to the Fight and He'll Win the Whole Thing 'fore He Enters the Ring There's No Body to Batter When Your Mind Is Your Might so When You Go Solo, You Hold Your Own Hand and Remember That Depth Is the Greatest of Heights and If You Know Where You Stand, Then You Know Where to Land and If You Fall It Won't Matter, Cuz You'll Know That You're Right (commonly shortened to simply When the Pawn...) is the second album by American singer-songwriter Fiona Apple, released by Epic Records in the United States on November 9, 1999. In 2010, Spin magazine named the album the 106th greatest of the last 25 years. A year later, Slant Magazine named it the 79th best album of the 1990s.
Background
The album title is a poem Apple wrote on tour after reading the readers' negative letters about her in the December 1997 issue of Spin magazine.
The album's long title has become a source of trivia, and when it was released held the world record for longest album title at 444 characters (previously held by one of the volumes in The Best... Album in the World...Ever!). Rolling Stone magazine made fun of the title/poem, calling it, "When the Pawn Hits the Conflicts He Thinks Oh the Hell With It". However, in October 2007 Soulwax released their remix album Most of the Remixes, which has 100 characters more in its title. This was later surpassed in 2008 by the Chumbawamba album The Boy Bands Have Won..., whose full title contains 865 characters of text.
Astoria
Astoria may refer to:
Populated places in the United States
(listed in order of population)
Other locations
- Astoria Boulevard (BMT Astoria Line), subway stop along the boulevard
Art, entertainment, and media
Fictional entities
Astoria (recording studio)
Astoria is a grand houseboat, built in 1911 for impresario Fred Karno, and adapted as a recording studio in the 1980s by its new owner, Pink Floyd guitarist David Gilmour. It is moored on the River Thames at Hampton, Greater London. Gilmour purchased the boat in 1986, because he "spent half of [his] life in recording studios with no windows, no light, but on the boat there are many windows, with beautiful scenery on the outside".
Early history
The boat was built in 1911 for impresario Fred Karno who wanted to have the best houseboat on the river to become permanently moored alongside his hotel the Karsino at Tagg's Island. He designed it so that there could be an entire 90-piece orchestra playing on deck.
The boat is framed in mahogany and has mainly Crittall windows with taller, wider windows towards one end. It is topped by very ornate metalwork canopies and balustrades.
Gilmour era
I just happened to find this beautiful boat that was built as a houseboat and was very cheap, so I bought it. And then only afterward did I think I could maybe use it to record. The control room is a 30-foot by 20-foot room. It's a very comfortable working environment--- three bedrooms, kitchen, bathroom, a big lounge. It's 90 feet long.
Astoria (Marianas Trench album)
Astoria is the fourth studio album recorded by Canadian rock band Marianas Trench. It was released on October 23, 2015 through 604 Records (in Canada) and Cherrytree Records and Interscope Records (internationally). The album represents the band's official return to the music scene after promotion of their previous album, Ever After (2011), ended in 2013 and was preceded by the retrospective EP, Something Old / Something New earlier in 2015.
Background
In 2011, Marianas Trench release their third studio album, Ever After, which produced five top-50 singles, including lead single "Haven't Had Enough", which became the group's highest charting single to date (since the creation of the Billboard Canadian Hot 100 in 2007) at number 9. After releasing the last single from that era, "By Now", in 2013, the group returned to the studio to record their next album. During the promotion for Ever After, lead singer and songwriter, Josh Ramsay, also achieved mainstream success as a songwriter and producer on fellow Canadian Carly Rae Jepsen's No. 1 hit "Call Me Maybe" (2012). This helped pave the way for the band signing an American record deal with Cherrytree Records and promoting to a broader audience.
