Clinical Correlate on joint scheme Flashcards
What makes a person high risk for infection?
What are some signs of infection in the joint?
What joints are usually infected?
Steroid therapy -Immunodeficiency -Diabetes -IV drug abuse -Other: UTI, pneumonia, Bite, thorn, invasive procedure
Resistive to passive ROM, joint pain and swelling, fever
Hips, knees, ankles, wrists
52 y/o patient presents with a swollen painful knee having a history of SLE as well as steroid therapy. She complains of a 4 day onset and has a low grade fever. Upon PE you feel a boggy crepitus joint cavity around the knee. What’s the first thing you should do, or order?
A) X-ray the joint
B) CBC and White count differential
C) Gram stain
D) Synovial fluid analysis
Many or all of these would be done, so how do you choose first? According to Dr. Winfield a joint aspiration will do a few things for you. 1) , give you fluid to gram stain (fast) and culture, determine the type of antibiotic you need, cell count, and crystal ID 2) reduce swelling 3) pain relief for the patient.
The next best would be probably be a gram stain, CBC with white count diff, and maybe also a BUN test (uric acid crystals).
You may not need to x-ray the joint at all, but it may determine if the bone is infected
What’s another name for uric acid and how does it get into the joints? What events commonly trigger this? What’s the presentation?
monosodium urate which supersaturates the serum and precipitates into the tissues.
Triggers: start or stop medication (even if uric acid levels are lowered it could trigger a gout attack), diuretics
Presentation-
Red, swollen, painful joint with possible fevers and chills.
Often starts at night.
Initial episodes 50% time start with the first metatarsophalangeal joint (big toe)
Usually lasts 5-7 days → resolves spontaneously.
The time line of onset and resolution, as well as joint location help separate this from an infection.
What are some ways to separate Articular vs Non-articular issues when searching for a diagnosis? How do you make this determination and which tissues are involved in both of these definitions?
Articular
⇓ Active/Passive motion range
Pain provoked/aggravated by movement
Tissues: synovium, synovial fluid, articular cartilage, intra-articular ligaments, joint capsule, and joint bones.
Non-articular
Joint motion is preserved (especially Passive; Active may be limited by pain)
Tenderness by palpation
Tissues
Regional bursa, Tendons, Ligaments, muscles, fascia, nerves, skin.
What are some clinical identifiers of RA?
Inflammatory****** Waxing and waning disease activity - >1 hour of morning stiffness******* - Improvement with use - Systemic symptoms (fever or malaise)***
What are some clinical identifiers of osteoarthritis?
Most common form of arthritis “wear and tear”
Pain after use that improves with rest No systemic symptoms Often single joint*** distal interphalangeal joint swelling*** Non-inflammatory***
Risk Factors Age Obesity Occupation repetitive bending, physical labor Female Trauma
Locations-spine hip knee hands
What are the clinical criteria of OA of the knee?
Knee pain with at least 3 of following:
1. Age > 50 years old 2. Stiffness < 30 minutes 3. Crepitus 4. Bony tenderness 5. Bony enlargement 6. No palpable warmth
What are some non pharmacological interventions for osteoarthritis? What about other managment?
Weight loss – especially for hip and knee OA
- Work simplification
- Use of a cane or a walker
- Physical therapy (quadriceps muscle strengthening)
- OMT
NSAIDs, opioid analgesics
corticosteroid injections
surgical intervention
WHATS THE TAKE HOME MESSAGE FOR THIS LECTURE?
Know the material and then integrate it into solid clinical presentations. Work your way through the scheme using the clues you have.
A 50 y/o patient complaining of joint pain a few nights prior comes into your office for a PE. Her vitals indicate a low grade fever and she has swelling on the first metatarsalphalangeal joint which is painful when she moves it. She takes a few medications including ibuprofen and a diuretic, but other than the joint pain feels and appears healthy. Her favorite hobby is gardening and you notice scaring from previous cuts along the knuckles. Her patient history states that her last visit was due to an infection in her hand about 1 years prior. What is the likely cause of her condition?
A) Viral infection
B) Gout
C) Osteoarthritis
D) Rhumatoid arthritis
B) correct-indicated by the evening onset and first appearance on the first metatarsalphalangeal joint (big toe) and the diuretic which can lead to crystal formation.
A) Was meant to throw a curve ball because gout has similar symptoms to an infection: fever, swelling, pain, and her last appointment and occupation are there to raise suspicion.
C and D) arthritis types can blend together and these were there as red herrings.
36 y/o female presents with fairly recent trauma to the left knee joint (5 months prior) while playing ultimate Frisbee with some only friends at a high school reunion. Apparently, someone thought it would be funny to “clip her.” No ligament tears were reported by her previous physician, but the joint is painful when used and is stiff in the morning for about 20-30 mins. What’s the likely etiology of her condition?
A) Rhumatoid arthritis
B) Osteoarthritis
C) Gout
D) Muscle strain
B) correct- clues: gender, joint pain when used, and stiffness under 30 mins.
A) Risk factors for both RA and osteoarthritis are trauma, and gender. RA pain improves with use and usually lasts longer than 1 hr in the morning.
C) Nope
D) A partial tear could be aggravated in not immobilized but there is less evidence for this. Complete tear would present differently.
You have a young 23 y/o male patient present with low back pain. He says it’s been ongoing for about 6wks and you notice he’s hunched forward which is consistent with his story of low back pain. Standing flexion exam is neg, but seated flexion exam is positive on the left side. Serologic studies are neg. What do you conclude on this information alone?
He has ankylosing spondylitis- aside from stating that the condition has a genetic predisposition. HLA-B27 (class I) all the classic signs are present.
What make Psoriatic arthritis unique and how do you detect it clinically?
Psoriasis predates the arthritis for years. This is probably the most important finding for clinical diagnosis as the joint distribution varies.
Seronegative, chronic inflammatory condition
HLA1-B27
Psoriasis-salmon colored rash, nail pitting
You have a young man 26 y/o present with abdominal cramps and pain, with recurrent diarrhea and weight loss. He’s been having problems also with aching joints but suspects the flu. Though he has no fever, chills, or any other signs of infection, and hasn’t done any recent traveling out side the US. An unusual finding is some inflammation around the eyes. He reports this isn’t the first time he’s had these symptoms. What’s your best guess at this point?
Inflammatory bowl disease with recurrent inflammmation of the intestines; arthritis often fluctuates with bowl involvement.
Genetic component -white or jewish
Age 10-60 y/o
Presents-cramps, pain, diarrhea, weight loss, hematochezia
also inflammatory eye disease and skin lesions.
How do you diagnose Inflammatory Osteoarthritis?
A) Serologic inflammatory markers are elevated: ESR, CRP
B) Swelling of the soft tissue in the PIP and DIP joints
C) Serology for ACCP is negative
D) ROM exercises are impeded
B) is correct
This is how you diagnose this disorder
A) These markers will be normal
C) This rules out RA
D) nonsense
What are the 3 major signs of an acute post infectious arthritis/reactive arthritis?
Genetic predisposition
Recent infection
Trouble with see, pee, and climb a tree
aka- conjuctivitis, urethritis, and arthritis.
What information would arthrocentesis of methaline blue reveal about whether a joint was open or closed?
If the dye traveled through the joint to the laceration it would reveal itself as an open joint.
Any deep wound in the proximity of a joint should be suspected of being what?
An open joint injury
What would you debride a bacterial infection, or traumatic injury?
To prevent bacterial colonization from foreign material (soil etc), and to clean up death neutrophils and other tissue. This can also result in poor antibiotic penetration into the affected tissue. Make a less hospitable environment for facaltative anaerobes.
Define cellulitis based on Dr. Brysacz lecture
A milder form of soft tissue infection without association of microvascular thrombosis and necrosis. No signs of systemic toxicity and can be treated adequately with antibiotic therapy.
Patient has sudden onset monoarticular pain with elevated ESR and Uric acid. Should you aspirate the joint?
yes even if you suspect gout, because they could have an underlying infection
How do you treat an osteochondroma? What about Osgood schlatter disease?
Osteochondroma is a benign bony growth with a cartilage cap usually originating from long bone. Can be removed surgically, most do not become malignant.
Osgood schaltter is a self limiting ossicle of the proximal tibial growth plate. Manifests in kids with limping.
Do no inject with steroids as this can soften the bone around the growth plate and affect growth.
What is Virchow’s node? What does it suggest is present? What should you do as a family physician with this information?
Lump on the supraclavicular fossa, suggestive of breast cancer.
Do a mammogram, or chest x-ray. Look for breast or lung cancer.
Right side usually breast
Left-could be anything:breast, lung, GI
What is a panendoscopy and what type of malignancies should never have an incisional or excisional lymph node biopsy without doing this first?
A panendoscopy is a complete physical examination of the head and neck by pharyngoscopy, laryngoscopy, and upper GI endoscopy
Malignancies of the head and neck, with or without adenopathy
Why? you can spread it, or loose the chance to find the primary source
FNA is ok (fine needle aspirate)
How would an ultrasound be useful when exploring the nature of a mass in the supraclavicular fossa?
useful in determining whether the mass is solid or cystic
What are some complications of biopsy techniques?
Bleeding, infection, hematoma, brusing, damage to other structures (nerves, arteries, lympatics), scarring.
What are the red flags for infection of the cervical spine historically and during physical examination?
How would you distinguish a superficial from a deep infection?
Historically-
Fever and chills
Night sweats or pain, unexplained weight loss
Recent infection
Unremitting pain despite rest and NSAIDs
(high risk activities for infection IV drugs etc)
Physical findings- FEVER
Superficial-
Fever/chills and sweats
Neck pain, stiffness, swelling (w/o peritonsillar abscess)
Deep- Tachycardia
Elevation of the floor of the mouth
Bulging of the pharyngeal wall
TAKE IMMEDIATE ACTION IF:
PAIN out of proportion
Advanced airway signs (voice change, dyspnea short breath. Signify impending airway obstruction)
What do you call an infection of the: vertebrae, intervertebral disk, Epideral space, or Fascial planes?
Osteomyelitis, Discitis, Epidural abscess, Fasciitis
If you suspect a deep neck infection is meningitis, how would you perform a physical exam and what findings would you expect?
Fever >100.4, altered mental status, nuchal rigidity
Lay them supine and ask them to flex the neck, the legs should flex in response, or have them attempt to extend the leg while the hip is flexed.
What are the Historical and Physical finding red flags for neurologic maladies of the cervical spine?
Historic-major trauma or minor trauma in the elderly
Physical- Bowl or bladder incontinence Saddle anesthesia Decreased or absent anal sphinter tone Perianal or perineal sensory loss Severe or progressive neurologic defect Major motor weakness
What is the mechanism of injury in an Occipito-Atlantal Dislocation (OAD)? What is the reason for the high mortality associate with this condition, and which nerves are involved?
Hyperflexion or extension or lateral flexion
Ligamentous instability-these ligaments hold your head to your spine
CN VI X XI paresis; apnea
What’s a radiculopathy and what are the common causes of it? What would you observe upon taking a history and physical exam?
Nerve root compression at the neck with pain, tingling and numbness sometimes accompanied by loss of function
Common causes: neural foraminal narrowing from cervical arthritis in older adults
cervical disk lesion (disk degeneration or disk herniation)
C5-6 or C6-7 (most common)
History
neck stiffness
pain radiating to the shoulder/ upper extremity
aggravated by coughing sneezing or straining
paresthesias of the fingers
weakness in the extremity
Physical
Reduced lordosis
Reduced ROM
Arm pain on extension
Cervical fracture (broken neck) history and physical findings are what?
History- Significant trauma Severe pain, spasm, tenderness Radiating arm pain Global sensory – motor deficits (spinal cord injury)
Physical-
Swelling/bruising
Tenderness & spasm on palpation
Whiplash-acute cervical strain/sprain
Physical normal neruologic exam
Validity of MRI in the upper cervical spine ligaments to detect acute whiplash injury has not been demonstrated
According to the American college of radiology criteria in the evaluation of chronic neck pain what should be done initially on patient with this condition?
5 view radiographic exam
w or w/o history of remote trauma, w/ hx of malignancy, or neck surgery.
What is cervical spondylosis? How does it present and what does it look like on x-ray examination?
Its really any degenerative changes that take place in the spine.
Present-limited ROM in the morning, pain on extension
X-ray: Facet joint arthrosis/sclerosis, loss of lordosis, osteophytes, Disc height reduction.
Cervical spondylotic Myelopathy
Most common spinal cord disorder from spondylosis
Hallmark symptom is weakness or stiffness in the legs!
3 important pathologic factors
1) static mechanical
Result in the reduction of spinal canal diameter & spinal cord compression-myelopathy
myelopathy-paresthesias, weakness or clumsiness
2) dynamic mechanical
During extension the ligamentum flavum may buckle into the spinal cord reducing space for the cord
During flexion spinal cord is stretched over osteophytic ridges
3) Spinal cord ischemia
What are the signs of cervical radiculopathy vs myelopathy?
Radiculopathy-
Muscle wasting is unilateral
Muscle stretch reflexes weak
Abdominal reflexes Normal
Myelopathy
Muscle wasting is bilateral
Muscle stretch reflexes Hyper
Abdominal reflexes Absent
Thoracic region strain- H&P findings?
History
Paravertebral discomfort relieved by rest, worsened by activity
Lifting heavy object, fall, or car accident
Physical Tenderness in middle back Restricted and painful ROM Normal reflexes and strength Holds unusual posture
Osteoporosis and steroids make the thoracic spine more susceptible to what?
Compression fractures, scoliosis, and postural changes
What are the signs of a functional thoracic kyphosis?
Pec lat levator scap-hypertonic and weakened trap
Serratus A and Rhomboid too, results in stress posture for you.
Internal rotation ADducted and flexed, a signs that soon there will be a test.
Thoracic aortic aneurysm H&P
History
Most are asymptomatic
Chest pain, shortness of breath, cough, possible, with slow deterioration
Congestive heart failure
Congestion of head & neck (from IVC compression)
Physical- bedside Echo or other imaging (slower)
Most back pain (97%) has what type of cause? How should it be treated?
mechanical- lifiting, sudden jolt, herniated disks etc) however there are many other types to consider.
The majority (80-90%) will get better within 6 wks Usually exercise, proper lifting and bending techniques will help mitigate future events
Why do you need to be judicious about ordering CT and MRI scans?
They could reveal dysfunctions unrelated to the patients symptoms that are normal for their age, they’re expensive and may not give you any new information.
All back pain complains require what type of care?
Thorough evaluation and competent patient education
Lumbar disk herniation can sometimes cause weakness in addition to pain and numbness as the result of what? How should this initially be handled? How might the presentation of a herniated disk be different from lumbar disk disease?
Quick eval and MRI
Lumbar disk herniation-compression of nerve root causes pain, often with numbness, radiates through buttocks and down one leg below the knee. Red flags: Pain worse with cough, or sitting.
Lumbar disk disease-A shooting or tingling pain
A patient comes into your clinic with pain in the lumbar area that they describe as shooting pain, but does not occur in intermittently in waves that peak in intensity and then quiet briefly. What condition can you safely rule out?
A) Radiculopathy
B) myelopathy
C) lumbar disk disease
D) kidney stones
D) kidney stones b/c they present with sharp waves of pain that peak and then subside.
You were treating an elderly female patient for osteroarthritis and in addition to finding osteophyte impingement of the ligamentus flavum and spinal cord you notice a strange mass in the vertebral body, what would you likely rule out of your differential diagnosis?
A) breast cancer metastasis
B) pancretic cancer metastasis
C) osteoid osteoma
C- osteoid osteoma is more common in 4-25 y/o patients and among men and tend to resolve spontaneously and usually are found in long bone.
A and B are very real possibilities and you should follow up with CBC and ESR labs
What are the 8 red flags for indicating a possible need for an x-ray or MRI of the spine?
Of these 8 which conditions are more likely to predispose to infection?
Age >50
History of malignancy*
Fever or Weight loss or elevated ESR (inflammation blood test)
Trauma*
Motor defect
Litigation / compensation
Steroid use (corticosteroids)*
Drug abuse*
If a patient with low back pain has no red flags then you can generally do what in regard to their immediate treatment plan?
wait 3-4 wks to see if they improve
What are some red flags in a low back pain evaluation related to the patients history?
Duration >6wks
age 50: tumor, intra-abdominal process (aneurysm), infection, compression fracture
Trauma young, minor in old- fracture (may indicate osteoporosis in the elderly)
Night pain: tumor or infection
Unremitting even when laying down: Tumor or infection, aortic aneurysm
What are some red flags for cauda equina syndrome/ spinal cord compression?
Incontinence, saddle anesthesia, rapidly progressive neurologic deficit. Perianal sensory loss. Refer for surgery
What are some red flags regarding nerve root compression /radiculopathy and fracture during PE?
Compression-motor weakness
Fracture- Tender points to percussion
You have a patient comes in with extreme LBP which of the following should you not consider as a likely diagnosis on this basis alone?
A) Radiculopathy
B) Abdominal Aortic Aneurysm
C) Nephrolithiasis
D) Acute infection
A) Radiculopathy usually leads to numbness or tingling, but much less likely extreme pain which are classic signs of the other answer choices.
What’s the difference between spondylolysis and spondylolisthesis? How should you treat the former if their only red flag is the duration of their pain?
Spondylolysis is the fracture of the posterior part of the vertebrae whereas spondylolisthesis is the slippage of one vertebral body on the next as a result of vertebral fracture
Conservative treatment, OMT, PT, NSAIDs and patient eduaction about weight bearing lifting and bending.
You patient presents will LBP with no red flags and you send them home with an appointment to follow up in 4 wks. They do and the pain is still unresolved. After 3 months with out resolved pain they still have no red flags for any other serious conditions. How should you proceed?
OMT, encourage exercise and working through the pain, hot and cold packs on the sore spot etc.
Do not need to do unnecessary imaging, especially when it may lead to confounding factors unrelated to the problem.
The majority of back pain is what type, and may be the result of what cause?
Mechanical
may be the cause of somatic dysfunction which means you can treat it with OMT.
What should you screen for prior to performing OPP on a patient with LBP?
catastrophic issues-cauda equina, fractures etc
When taking a medical history for someone with LBP what should you be aware of?
Medical problems that could be related to LBP
Surgeries esp when dealing with viserosomatic reflex
Chronic pain management issues (don’t prescribe opioids when someone else is managing the patients long term pain)
OBGYN-difficult labors, pregnancy
Traumatic history
Ergonomics
Birth trauma-patient themselves not their children
What are the 8 major red flags you might seen upon physical examination? What should you do?
Fever Writhing in pain Bowel of bladder incontinence Saddle anesthesia Decreased or absent anal sphincter tone Perianal sensory loss Severe or progressive neurologic defect Major motor weakness
Acute onset new symptoms need eval in the ER!!
When might you use a CT scan?
abdominal or visceral problems. These may also refer pain and appear to be spinal in origin
what are the criteria for treating a patient with OMM?
No apparent acute & potentially pathologic or catastrophic problem
Pathology present, but patient has a physician, covering this area, that has cleared patient for OMT.
If they don’t meet this criteria proceed with caution…
What should I think of when I hear the word “radiating” in the context of LBP?
Radiculopathy, spinal stenosis, or cauda equina syndrome-strait leg test results? MRI.
Sacroiliac joints
Piriformis muscle-posterior thigh pain, trauma or overuse=inflammation and spasm
What are some common LBP disorders that may be treated with OMT?
Lumbar spine-type I & 2 dysfunctions
Coccydynia-tailbone pain
Thoracolumbar junction, pelvis, and SI joint
Thoracic inlet
What considerations do you have when treating the thoracolumbar region of the spine, related to OMT treatment?
Think of the abdominal and pelvic diaphragms and the role these play in fluid return form the lower extremity. This falls under the respiratory/circulatory model of care.
If you’re treating a condition of the pelvis related to a functional short leg, leading to sacral base unleveling, what should you remember to do first?
Treat somatic dysfunction before initiating lift therapy so the problem doesn’t return
Describe an innominate dysfunction and a pubic symphysis dysfunction.
Innominate dysfunction is usually described in these terms-Superior/inferior shear
Anterior/posterior rotation
Inflare/outflare
Treat innominate before sacrum
Public symphysis dysfunction-
Superior/inferior shear
Often overlooked
Common after childbirth
What are the common findings of psoas syndrome and in what order to you treat it?
Shortened hypertonic psoas m.
L1 or L2 flexed, rotated to same side of tight psoas (type II)
Tenderpoint medial to ASIS on same side
Classic forward posture with listing to side of dysfunction
Side shifting of pelvis to side opposite
Piriformis m. hypertonicity on side opposite
Posterior thigh & buttock pain, side opposite
Treat lumbar dysfunction first!
Then psoas, then others
home exersise and strech psoas
If disc cause RICE, viseral treat underlying cause
Question stem will likely relate to someone sitting in a car for a long period of time.
How do you decide what type of OMT technique to use?
Use one that works, you’re comfortable with, and is good for the patient.
When treating someones LBP with OMT how often should you perform a clinical assessment to determine if they’re improving or responding to treatment, exercises, medications?
every visit and continue to watch for red flags
How would you describe fibromyalgia?
Generalized pain syndrome
Chronic and includes fatigue, multiple tender points in the soft tissue.
Hypersensitivity to pain-diagnostic criteria “widespread pain”
Exact cause is unknown may be related to sleep disturbances, but no obvious pathology.
How would you discriminate between myofacial pain syndrome, fibromyalgia and chronic fatigue syndrome?
Fibromyalgia-multiple t.p., 10:1 f/m, sleep disturbance, widespread pain
myofacial pain syndrome-trigger points (radiate), 1:1 f/m, no sleep prob, regional pain
Chronic fatigue syndrome- preceded by viral illness, pain NOT widespread, no t.p, sleep disturbance…..
You have a 36 y/o f patient come into the clinic c/o difficulty sleeping, tenderness, and some regional pain. She presents you with some blood work that she just got back from the lab which was ordered by an urgent care Dr. who suspected a viral infection. Blood work shows an elevated ESR, and is neg for RF. An x-ray in her EMR rules out osteoarthritis. What condition among the following list is most likely?
A) Rheumatoid arthritis
B) Gout
C) Chronic fatigue syndrome
D) Fibromyalgia
C) chronic fatigue syndrome
Although this can appear to be similar to fibromyalgia no widespread pain was present, and her urgent care doctor suspected a resent viral etiology which is more consistent with chronic fatigue syndrome.
A) neg RF
B) no indication
D) Similar but not the best choice- classified as MIXED on the scheme
A 42 y/o f c/o headache, TMJ pain, with a history of IBS comes into your clinic. Her EMR shows results from a previous sleep study that were abnormal, suggesting she has inadequate rest. She was referred by a friend (medical student) who noticed multiple t.p. while attempting to treat some widespread pain she was feeling.
What’s her most likely condition? What medications do you suspect her previous doctor had her on?
Fibromyalgia
Probably low dose antidepressants for pain
You have a patient referred to you with Fibromyalgia, how should you treat them? Can you use OMT?
Encourage exercise that isn’t too rigorous
Continue patient on low dose antidepressants for pain, or consider higher dose for potential depression and anxiety.
OMT goals- balance hypersensitivity associated with sympathetic system and support lymphatic flow and circulation of fluids. Light touch, soft tissue tech, counter-strain, lymphatic flow tech.
When a child is unable to stand or refuses to walk and you consider the cause what scheme should come to mind?
Child with a limp
pain-
weakness
structural
A 3 y/o boy presents to the clinic with a limp. The parents say he has a problem with his knee. You observe the child in the exam room walking about and decide to begin the PE. Which structures should you examine?
A) Knee
B) Hips and Knee
C) Knee and Lower legs
D) Back, hip, knee, lower legs, and feet
D) is correct- always include
why? small children can’t localize pain, it often radiates and parents may give a misleading history.
If the patient did have knee pain with hip pathology you might suspect some nerve involvement- like the obturator nerve
Normal synchronous gait requires which criteria?
A) Normal neurologic growth
B) Myelinization in the cephalocaudal pattern
C) Proper Nutrition
D) A & B
Why is recognition of symptom patterns in children as well as gait abnormalities important?
D) is correct.
This will help physicians to triage effectively and make accurate diagnoses
A child in the clinic is limping which the secretary described as walking slowly with short steps. What type of gait is this?
A) Trendelenburg gait
B) Antalgic gait
C) Steppage gait
D) Stiff-legged gait
B) is correct- this is a gait characterized by lower extremity or back pain.
A) Trendelenburg gait- is the runway gait due to weak hip abductor and leads to swaying back and forth
C) Steppage gait- results from difficult dorsiflexion, could be the result of damage to the superficial fibular nerve=foot drop
D) Stiff-legged- knee extension and circumduction with pelvic elevation on affected side
What’s the most common cause of childhood limping? What would the blood work of a child with this condition reveal?
Transient synovitis- acute, self limiting inflammation of synovial lining characterized by pain, stiffness, and limp. Unilateral hip pain is common presentation. Usually no signs of illness and no temp.
Etiology unclear
Blood work- elevated ESR, CRP, CBC
How do you distinguish between transient hip synovitis and septic arthritis?
Predictive probability for septic arthritis = 97.3% when:
T>37˚
ESR>20 mm/h
CRP>1.0 mg/dl
Serum WBC> 11,000 cells/ml
positive FABER test in the hip test SI joint
joint aspirate confirm
mean age-5.5 y/o
Transient hip synovitis- no temp, but elevated blood tests
mean age 6.5 y/o
What’s another name for avascular necrosis of the head of the femur?
Legg-calve-perthes: can happen in persons with sickle cell, or other conditions.
Musculoskeletal sepsis can be ruled out with 99% certainty in a child with none of which 3 predictors?
1 Duration of Symptoms at Presentation
greater than 1 but less than 5 days
2 Temperature on Admission
>37.0C
3 ESR
>35 mm/hr
What are some of the signs of DDH?
Developmental dysplasia of the hip
Shallow acetabulum
Subluxation
Dislocations
Signs and symptoms
usually f, uneaqual gluteal folds, and restricted Abduction
Which is an abnormal finding of scoliiosis?
A) Pain
B) unequal scapula
C) unequal hips
D) development in early childhood
A) pain- this could be caused by an underlying condition such as a tumor
