TREATMENTS &
RESEARCH

Search the
latest
treatment
information
here.

Dr. Huntley's
Diagnosis
Checklist

Have a symptom?
See what questions
a doctor would ask.
 

Asymmetric Limbs

Contents
  1. Read book excerpt
  2. Restless Legs Syndrome: Introduction
  3. Restless Legs Syndrome Misdiagnosis
  4. Restless Legs Syndrome Causes
  5. Restless Legs Syndrome Complications
  6. Restless Legs Syndrome Treatments
  7. Clinical trials
  8. Diagnosis of Restless Legs Syndrome
  9. Restless Legs Syndrome Overview
  10. More book excerpts for Restless Legs Syndrome

Asymmetric Limbs: Excerpt from In A Page: Pediatric Signs and Symptoms

With asymmetry of body parts, it can be difficult to differentiate whether one side is hypertrophic or the other side is atrophic. One of the most common asymmetries seen in children is leg-length discrepancy. Growth disturbances around the knee have a substantial effect on leg length, because distal femur (37%) and proximal tibia (28%) contribute the most to the growth of entire lower extremity.

Differential Diagnosis

  • Physiologic: Left leg is often longer than right, and right arm is longer than left, though it is usually not noticeable
  • Disturbances of bone
    –Increased blood flow such as occurs in arthritis (infectious, inflammatory), neoplasms, or AVM
    –Premature closure of epiphysis occurs with infection, fracture, radiation therapy, JRA
    –Fracture may also result in malposition or malunion
    –Diaphyseal operations (bone grafts, osteotomy)
    –Developmental dysplasia of the hip
    –Coxa vara, tibia vara (Blount disease)
    –Hypoplastic bones (short femur)
    –Legg-Calvé-Perthes disease
    –SCFE
    –Syndromes such as Albright; Ollier disease; neurofibromatosis
    –Rickets
    • Hemihypertrophy
      –Idiopathic: May be associated with other anomalies involving GU tract, hemangiomas, mental retardation, and pigmented skin lesions
      –Associated with tumors: Wilms, adrenocortical, hepatoblastoma
      –Associated with dysmorphogenic syndromes: Beckwith-Wiedemann, Russell-Silver, Proteus
      –Associated with soft tissue abnormalities: Lymphedema, Klippel-Trenaunay-Weber syndrome
      • Neuromuscular disorders
        –Cerebral palsy
        –Poliomyelitis
        –Myelomeningocele
        –Peripheral neuropathy
        –Focal cerebral lesions (Sturge-Weber syndrome)
        –Stroke (due to coagulopathies, sickle cell disease)
    • Hemophilia (bleeding into a joint)
    • Reflex sympathetic dystrophy (RSD)
    • Congenital syphilis
    • Absence or hypoplasia of thumb and radius (Holt-Oram syndrome, TAR syndrome)

    Workup and Diagnosis

    • History
      –Past medical and surgical history
      –Constitutional symptoms (fever, fatigue, weight loss)
      –Family history of similar disorder
    • Physical exam
      –Joint exam should include erythema, warmth, swelling, hyperflexibility, decreased range of motion, tenderness including pain localized to bone
      –Leg-length discrepancy can be measured from symphysis pubis to lateral malleoli while patient is supine or by putting blocks of various thickness under the short leg until pelvis is leveled
      –Dysmorpic features, skin lesions
      –Neurologic exam for muscle weakness, decreased tone, reflexes, mental status
    • Labs
      –Infectious and inflammatory markers such as CBC, ESR, CRP, viral or bacterial titers and/or cultures; tumor markers; chromosomal analysis and genetic markers
      –Radiologic evaluation as indicated by history and physical exam to find abnormalities in any part of musculoskeletal system (lytic lesions, soft tissue and joint swelling)
      –Bone age
      –Leg lengths measured by teleoroentgenogram, orthoradiograph, scanogram, or CT

      • Treatment

      • Since underlying cause of an asymmetric limb is very broad, treatment varies depending on the etiology
      • In certain cases, especially in those in which specific treatment would make a difference (DDH, SCFE, infection, inflammation malignancy), diagnosis must be made as soon as possible to prevent permanent damage
      • Consider surgical (shortening or lengthening procedures, prostheses) and nonsurgical (orthotics, pressure stockings)
      • Angular deformity should be looked at carefully and corrected before or at the same time of length equalization to avoid joint dislocation

Book Source Details

  • Book Title: In A Page: Pediatric Signs and Symptoms
  • Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
  • Year of Publication: 2007
  • Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Restless Legs Syndrome

More Medical Textbooks Online about Restless Legs Syndrome

Review other book chapters online related to Restless Legs Syndrome:

Medical Books Excerpts
  • BACK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • BREAST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • CHEST PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • EYE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • FACE PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • FLANK PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • HEEL PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • HIP PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • JAW PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • JOINT PAIN
  • "Algorithmic Diagnosis of Symptoms and Signs" (2003)
  • [ read ]
  • Back Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Chest Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Hip Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Knee Pain
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Toeing Out
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • Toeing In
  • "In A Page: Pediatric Signs and Symptoms" (2007)
  • [ read ]
  • MYOCLONUS
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • Myoclonus
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Back pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Eye pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Rectal pain
  • "Handbook of Signs & Symptoms (Third Edition)" (2006)
  • [ read ]
  • Seizures
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Back Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Chest Pain
  • "A Pocket Manual of Differential Diagnosis" (1999)
  • [ read ]
  • Myoclonus
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Arm pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Back pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Chest pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Facial pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Flank pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Jaw pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Neck pain
  • "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
  • [ read ]
  • Seizures
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chest Pain, Atypical
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Low Back Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Abdominal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Calf Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Chronic Pelvic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Hip Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Knee Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Neck Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Pleuritic Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Shoulder Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Scrotal Pain
  • "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
  • [ read ]
  • Seizures
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Eye Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Hip Pain
  • "Field Guide to Bedside Diagnosis" (2007)
  • [ read ]
  • Myoclonus
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Abdominal pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Back pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Chest pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Eye pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Flank pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Jaw pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Neck pain
  • "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
  • [ read ]
  • Myoclonus
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Arm pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Back pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Breast pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Chest pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Eye pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Facial pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Flank pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Jaw pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Neck pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Rectal pain
  • "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
  • [ read ]
  • Seizures
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Abdominal Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Back Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Chest Pain
  • "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
  • [ read ]
  • Myoclonus
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Arm pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Back pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Chest pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Flank pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Jaw pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • Neck pain
  • "Nursing: Interpreting Signs and Symptoms" (2007)
  • [ read ]
  • ARM PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • EYE PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
  • HIP PAIN
  • "Differential Diagnosis in Primary Care" (2007)
  • [ read ]
 

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.



More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9

 » Next page: MYOCLONUS (Differential Diagnosis in Primary Care)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

Tools & Services:

Medical Articles:

Forums & Message Boards
 
HONcode We subscribe to the HONcode principles

By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.

Home | Symptoms | Diseases | Diagnosis | Videos | Tools | Forum | About Us | Terms of Use | Privacy Policy | Site Map | Advertise

Copyright © 2009 Health Grades Inc. All rights reserved.