common MSK in paeds

Question 1

what are common causes of joint pain in 0-4yrs?

Answer 1

septic arthritis, developmental dysplasia of hip, transient synovitis

Question 2

what are common causes of joint pain in 5-10yrs?

Answer 2

: septic arthritis, transient synovitis, perthes disease

Question 3

what are common causes of joint pain in 10-16yrs?

Answer 3

septic arthritis, slipped upper femoral epiphysis (SUFE), juvenile idiopathic arthritis

Question 4

what are red flags within hip pain?

Answer 4

• Child under 3yrs
• Fever
• Waking them up at night
• Weight loss
• Anorexia
• Night seats
• Fatigue
• Persistent pain
• Stiffness in morning
• Swollen/ red joint

Question 5

what is transient synovitis?

Answer 5

joint pain usually occurring within a few weeks of viral illness

Question 6

what symptoms are seen within transient synovitis?

Answer 6

• Limp
• Refusal to weight bear
• Groin/ hip pain
• Mild low grade temp
• No signs of systemic illness

Question 7

how do you manage transient synovitis?

Answer 7

• Symptomatic  manage pain
• Rule out septic arthritis
• Safety net: if worsen or develop a fever

Question 8

what is the prognosis within transient synovitis?

Answer 8

significant improvement after 24-48hrs
- Symptoms fully resolve within 1-2 weeks without any lasting problems
- Transient synovitis may recur in around 20% pts

Question 9

what is perthes disease?

Answer 9

Disruption of blood flow to femoral head casing avascular necrosis to bone
- Affecting epiphysis of femur which bone is distal to the growth plate

Question 10

who is mostly affected by perthe’s disease?

Answer 10

• Occurs in children aged 4-12yrs but mainly 5-8yrs
• More common in boys

Question 11

what causes perthe’s disease?

Answer 11

no clear cause

Question 12

how does perthe’s disease present?

Answer 12

slow onset
- Pain in hip/ groin
- Limp
- Restricted hip movmrnt
- Referred pain to knee
- No history of trauma –

Question 13

what investigations are needed within Perthe’s disease?

Answer 13

XR but this can be normal
- Blood tests: help exclude others
- Technetium bone scan
- MRI

Question 14

how do you manage Perthe’s disease?

Answer 14

Management: depends on severity
- Bed rest
- Traction
- Crutches
- Analgesia
- Physio – help with range of movements
- Regular XRs
- Surgery: if not recovering within those

Question 15

what is slipped upper femoral epiphysis?

Answer 15

SUFE and AKA are slipped capital femoral epiphysis
- Head of femur is displaced (slips) along growth plate

Question 16

who is SUFE most common in?

Answer 16

• More common in boys
• Typically at 8-15yrs but averages at 12yrs in boys and 11yrs in girls
• More common in obese children

Question 17

how does SUFE present?

Answer 17

adolescent, obese male that is undergoing a growth spurt and history of minor trauma
- SUFE? If pain is disproportionate to trauma
- Hip/ groin, thigh, knee pain
- Painful limp
- Restricted movement of hip
- Will be in external rotation and restricted internal rotation

Question 18

what diagnostics are used within SUFE?

Answer 18

• Bloods: rule out others
• Technetrium bone scan
• CT scan
• MRI scan

Question 19

how do you manage SUFE?

Answer 19

Management: surgery – helps return femoral head to correct position and fix that in place to prevent it slipping further