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Diagnosing and managing hip problems in childhood.
[pyomyositis]
The
hip
and
proximate
tissues
are
implicated
in
a
variety
of
childhood
conditions
,
and
in
the
differential
diagnosis
of
many
more
.
To
a
large
extent
the
possible
diagnoses
are
limited
by
the
child
's
age
,
an
accurate
history
and
thorough
examination
.
Developmental
dysplasia
of
the
hip
(
DDH
)
is
a
spectrum
disorder
of
joint
development
and
/
or
instability
.
It
is
a
major
cause
of
morbidity
in
children
and
adults
.
It
can
be
classified
into
three
types
:
neuromuscular
;
teratological
;
and
idiopathic
(
the
most
common
type
)
.
Examination
of
the
hips
is
carried
out
neonatally
using
Ortolani
and
Barlow
manoeuvres
to
look
for
dislocation
.
These
tests
have
high
sensitivity
but
low
specificity
,
and
this
is
one
reason
why
DDH
is
still
picked
up
late
.
When
a
limping
child
presents
it
is
important
that
the
less
common
diagnoses
,
including
infection
,
neoplasia
and
slipped
femoral
epiphysis
are
kept
in
mind
and
urgent
referral
made
if
necessary
.
In
one
study
,
where
a
diagnosis
was
made
,
the
hip
joint
was
the
culprit
in
the
majority
of
cases
.
Of
these
,
40
%
were
diagnosed
as
irritable
hip
or
transient
synovitis
.
Other
inflammatory
arthritides
/
tendinoses
accounted
for
3
.
2
%
,
Perthes
'
disease
2
%
,
and
infection
3
.
6
%
.
Any
age
group
is
vulnerable
to
infection
such
as
septic
arthritis
,
osteomyelitis
and
pelvic
pyomyositis
.
Early
diagnosis
and
treatment
,
comprising
antibiotics
with
or
without
surgery
,
is
critical
.
In
the
limping
child
,
fever
with
focal
tenderness
or
restricted
range
of
movement
is
indicative
of
infection
unless
investigations
show
otherwise
.
Diseases
Validation
Diseases presenting
"early diagnosis"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
alexander disease
allergic bronchopulmonary aspergillosis
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
classical phenylketonuria
coats disease
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
congenital toxoplasmosis
cowden syndrome
cushing syndrome
cutaneous mastocytosis
cystinuria
dentin dysplasia
dentinogenesis imperfecta
dracunculiasis
erdheim-chester disease
erythropoietic protoporphyria
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kabuki syndrome
kallmann syndrome
kindler syndrome
krabbe disease
locked-in syndrome
monosomy 21
neuralgic amyotrophy
oculocutaneous albinism
oligodontia
omenn syndrome
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
primary effusion lymphoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
triple a syndrome
typhoid
von hippel-lindau disease
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
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