4-Year-Old Female with Acute Right Lower Extremity Pain and Refusal to Bear Weight

Case at a Glance

A 4-year-old girl presented with acute onset right leg pain and refusal to bear weight, initially dismissed as growing pains by her primary care office.

Patient's Story

The patient's mother reported that her daughter suddenly began refusing to walk or use her right leg, starting yesterday morning. The child points to her mid-thigh/upper leg area when asked about pain location. She maintains her leg in a flexed position at all times and bends over when attempting to walk or limp. The child's primary care office initially attributed the symptoms to growing pains, but the mother sought a second opinion due to the severity of functional impairment.

Initial Assessment

Physical examination revealed significant functional limitation with the patient refusing to bear weight on the right lower extremity. When positioned at the edge of a chair with the leg bent at 90 degrees, attempted passive range of motion caused visible leg trembling and acute distress. The patient became very upset and pointed specifically to the anterior hip area during examination. Gait pattern showed marked limping with protective positioning of the affected limb.

The Diagnostic Journey

Plain radiographs of the right hip and femur were obtained to rule out fracture, dislocation, or other bony pathology. The imaging studies were reviewed for signs of trauma, infection, or developmental abnormalities. Given the acute onset and significant functional impairment in a previously healthy child, differential diagnosis included septic arthritis, transient synovitis, occult fracture, or soft tissue injury.

Final Diagnosis

Radiographic findings appeared normal with no obvious bony abnormalities identified on initial imaging review.

Treatment Plan

Patient scheduled for follow-up with primary care physician for comprehensive evaluation and potential referral to pediatric orthopedics if symptoms persist. Conservative management with observation and symptomatic care initiated pending further evaluation.

Outcome and Follow-up

Patient referred back to primary care for continued monitoring and potential additional imaging or specialist consultation if clinical symptoms do not improve within 24-48 hours.