Joints Flashcards
Risk Factors of developmental dysplasia of the hip
female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity
what does the Barlow test do
attempts to dislocate an articulated femoral head
What does the Ortolani test do
attempts to relocate a dislocated femoral head
How is developmental dysplasia of the hip investiated
USS of the hip
Management of DDH
- Most unstable hips will spontaneously stabilise by 3-6 weeks of age
- Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
- Older children may require surgery
Normal RR age 0-6 months
30-60
Normal RR 6-12 months
24-30
Normal RR >12 mo
20-30
Signs of increased resp effort in an infant
crackles in the chest. nasal flaring. chest indrawing. cyanosis. oxygen saturation of 95% or less when breathing air.
Features of growing pains
- never at the start of the day after the child has woken
- no limp
- no limitation of physical activity
- systemically well
- normal physical examination
- motor milestones normal
- symptoms are often intermittent and worse after a day of - vigorous activity
what are growing pains also known as
‘benign idiopathic nocturnal limb pains of childhood’
what age range do growing pains occur
3-12 years
equal in boys and girls
Features of Slipped capital femoral epiphysis
hip, groin, medial thigh or knee pain
loss of internal rotation of the leg in flexion
bilateral slip in 20% of cases
Investigations for ? Slipped capital femoral epiphysis
AP and lateral (typically frog-leg) views are diagnostic
Management of Slipped capital femoral epiphysis
Internal fixation: typically a single cannulated screw placed in the center of the epiphysis
What is the triad of Henoch-Schnlein Purpura
- Purpura: legs, buttocks, arms
- Arthralgia: ankles and knees
- Abdo pain
What often triggers HSP
- Follows group A strep URTI
What must you ALWAYS rule out in Henoch-Schnlein Purpura
- Testicular torsion
- Intussuception
Who get’s neonatal Jaundice
- 50% babies
- Not worrying unless >2 weeks
- Boys > girls
- Check baby is well
Neonatal jaundice history
- When did it start
- Incompatability: Maternal/fetal blood group, Anti-D?
- Sepsis: Fever, maternal infectons, Abx at labour etc
When is neonatal jaundice always pathological
<24 hours old
What are the symptoms of neonatal jaundince
- 2-3 days old (5-7 if prem)
- more common in breast fed
- Head, face then chest an stomach
- Itchy
- Poor feeding
- Sleepiness
- Dark urine/pale stools
What are the features of hypermobility of the spine
back pain if parspinal muscles are weak and sore stability is poor
What is the management of hypermobility
physiotherapy to built muscle strength around the joints
At what age is hypermobility a normal variant
5-8years
Features of marfans syndrome
tall archynodactyly pectus excavatum high arched palate can be myopic
Which further assessments should be done with a diagnosis of Marfans
cardiac review with echo
Family history of sudden early death from aortic aneurysmal dissection/rupture
opthalmology
Features of Ehlers Danlos
hyperextensibility of skin
poor wound healing
blue sclera
What cardiac risk are associated with Ehlers Danlos
aortic regurgitation
Dissection of the Aorta
What inheritence pattern do both Ehlers Danlos and Marfans syndrome have
autosomal dominant
Causes of scoliosis
- postural - weak muscles due to hypermobility
- growth in puberty
- congenital
- Heavy school bag!!
- muscular dystrophies
- cerebral palsy
- neurofibromatosis
What features lead you away from a structural cause of scoliosis
asymmetrical skin creases
correction of scoliosis on bending forward
What is the first line imaging of scoliosis
- spinal anteriorposterior (AP) and lateral spines
2. MRI - if red flags or painful scoliosis
What is the management of a true structural scoliosis
- referral to spinal team
- physiotherapy
- spinal bracing
- corrective surgery if necessary
What are the investigations for a toddler/young child presenting with back pain
- low threshold for MRI imaging
- urinary catecholamines and catecholamine metabolities to rule out spinal/bone tumour or neuroblastoma.
What is enthesitis related arthritis
- Subgroup of juvenile idiopathic arthritis
- Boys >10
- Can be HLAB27 positive - autoimmine
What are the features of enthesitis related arthritis
- long term lower back pain
- hip and buttock pain while walking
- tenderness on palpation of achilles tendon
- can get skin/intestinal and opthalmalogical symptoms
What is the management of enthesitis related arthritis
- referral to rheum
- anti-inflam
- may require biologics
Causes of chronic back pain in children
- hypermobility
- biomechanical
- chronic pain
- spondylosis
- inflammatory arthritis - ERA
- Disc degeneration
- tumuours
- osteoporosis
Which joints do you mainly assess for hypermobility
Beighton score
- thumb + fingers
- elbows
- knees
- lumbar spine flexion
features of Alport syndrome
- glomerulonephritis
- hearing loss
- eye abnormalaties
how does systemic juvenile idiopathic arthritis usually present
- high intermittent fever
- widespread lace like rash (levido reticularis) resolves when fever
- joint pain
- hepatoplenomegaly
- lyphadenopthy
- weight loss
What do investigations of ystemic juvenile idiopathic arthritis usually show
- Very high CRP and ESR
- thrombocytosis
- RF and ANA negative
Features of psoriatic arhtritis
- psoraitic rash
- nail pitting
- dactlytis
- FH of psoraisis
- joint pain
- RF negative
What is oligarticular arthritis
- less than 4 joints affected
- Onset usually 2-5
- 50% of al juvenile idiopathic arthritis
What are the blood results of oligoarticular arthritis
- RF ngative
- ANA positve
Features of Kawasaki
fever >5 days + - bilateral conjunctivitis - polymorphous exthanma (rash) - mucosal changes of mouth and lips - oedema/erythema to hands and feet - lymphadenopathy (Induration of BCG scar)
What it the management of kawasaki
- aspirin
- immunoglobulins
- follow up Echo
