Limp - Pitcher - SRS Flashcards by Stephen Schaffner

What is the most important part of the pe for a limping child?

The GAIT

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At what age should a child walk with out support?

12-15 months

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When should there be coordination with reciprocal arm swing?

by 2 yrs

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Normal gait requires musculoskeletal development of lower back, pelvis & lower extremities and neurologic growth coordination/balance which is dependent upon?

•Myelinization in cephalocaudal pattern

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When should an adult gait pattern be attained by?

8-10 yrs

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The stance phase of the gait is the weight bearing phase, what are the components of this phase?

•Heel strike –> Plantar flex –>Toe-off

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The swing phase involes the toe off –> heel strike. What goes down with the pelvis, lumbar spine and abdomen during this phase?

Pelvis rotates and tilts

Lumbar spine and abdomen tense and stabilize

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Define

–Antalgic

–Trendelenburg limp

–Waddling

–Stiff-legged

–Toe walking

–Steppage

–Stooped

–Generalized muscle weakness

–Antalgic = limping gait

–Trendelenburg limp = glut medius on standing leg is compromised during swing phase

–Waddling =

–Stiff-legged = frankenstein gait

–Toe walking

–Steppage = have to bring leg up before taking step to avoid toe drag

–Stooped = pelvic or core issues

–Generalized muscle weakness

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ddx for a 0-4 yr old with limp?

0-4 yrs

Developmental

Hip dysplasia

Trauma

Toddler’s fracture

Physeal fracture

Puncture wound

Sprain

Contusion

Infectious

Osteomyelitis

Septic arthritis

Transient/toxic synovitis

Discitis

Neoplasm

Various

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Developmental hip dysplasia is an abnormal formation of the hip joint d/t an unkown cause. In what patients is this more common?

females 5-9x more common

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What are four risk factors for developmental hip dysplasia?

breech

+FMH

First born

Oligohydramnios

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What are the tests for hip dysplasia?

Barlow and ortolani

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What is this test called/for?

Barlow - hip dysplasia

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What is this test called and for?

Ortolani - hip dysplasia

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What is this sign?

Related to what condition?

Galeazzi sign

hip dysplasia

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What is this treatment called?

How long must it be done?

Pavlik harness for hip dysplasia

6- 8 months

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What is this x-ray from a child under 5yrs?

“toddlers” fracture - spiral fracture of tibia under age 5

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What causes a toddler’s fracture?

What is the problem with imaging here?

Sudden twisting of the tibia

Often difficult to visualize on x-ray d/t subtle signs, and typically 7-10 days need to elapse before calcification renders it visible. Also no displacement.

Your 4 yr old patient presents with pain, refusal to walk, minor swelling/warmth over site, pain with palpation. What should you do to tx??

Toddler’s fx treated by •long-leg cast; heal within 3-4 wks

Physeal fractures are growth plate injuries and occur in boys 0-18 yrs and girls 0-16. This is the weakest area of growing bone. What is the classification scheme for this?

•Salter-Harris I classification

What are the salter-harris classes I-V?

Pneumonic: SALTR

I.S: Slip (epiphysis separated from shaft)

II.A: Above

III.L: Lower

IV.T: Through (epiphysis & metaphysis)

V.R: Rammed

Classify these fractures with salter-harris

left to right, I-V

This fx is common between 10-18 yrs and presents with pain that increases with weight bearing, reduced with rest, and tenderness to touch. W

What is it?

Where is it most common?

tx by?

Stress fracture - small crack in bone

2nd and 3rd metatarsal is most common

tx: rest, possible surgery depending on site

This patient presents with local inflammation & fever, irritability, lethargy, bone tenderness & dec. ROM. The location of the pathology is at the metaphysis and reveals inflammation of bone marrow and adjacent bone.

What is the typical spread of this disease process for both kids and adults?

Osteomyelitis

In children, hematogenous spread

Adults - subacute and chronic forms exist and are secondary to open wounds.

What is the treatment for osteomyelitis?

IV antibiotics 4-6 weeks minimum

Infection by bacteria, fungi, viruses or parasites may cause this pathology which presents with monoarticular, erythema, swelling, pain, dec. ROM. What is the result of this process? Where is the most common location this presents in the body?

Septic Arthritis * Intense synovitis is the result of the inflammatory response * Knee most common

Septic arthirits occurs at all ages, and presents with inability to bear weigh in addition to monoarticular, erythema, swelling, pain, dec. ROM. What is the treatment protocol for this?

IV/PO antibiotics for 4-6 weeks

What is shown here? tx?

Gonococcal arthritis - septic arthritis via N.g. infection •Dx/Tx: aspiration of joint fluid; IV/PO antibiotics (at least 1 week)

This patient presents with "irritable hip/knee syndrome" - acute hip pain and decreased rom. Moving the hip through flexion, abduction and ext. rotation produces pain. What is this? How is this diagnosed? tx?

Transient/toxic synovitis ## Footnote * Dx of exclusion; 30% limps * Tx: self limited (5-7 days), NSAIDS

This is a noninflammatory condition common between 10-14 yrs and most commonly in overweight boys. It can be unilateral but will eventually become bilateral in may cases. What is this condition? What are disorders associated with this apart from obesity?

Slipped capital femoral epiphysis (SCFE) ## Footnote •1° hypothyroid and HGH/pituitary deficiency

SCFE often presents with insidious or acute hip pain and a limp. What is the treatment dependent on? What should the treatment usually include?

Depends on severity of course! tx with immediate non-wt bearing and surgical stabilization. Prognosis generally good

This is more common at 4- 10 yrs. What causes this condition?

Legg-Calve-Perthes disease (LCP) - lack of blood flow to the femoral head leads to necrosis

LCP is also known as?

•aka Perthes disease or idiopathic osteonecrosis of the femoral head

Describe the radiologic finding in this image.

LCP - shows collapse of femoral head with flattening

How should you dx LCP?

X-ray if early disease expected, but MRI is better

Juvenile idiopathic arthritis (JIA) involves chronic joint pain for minimum 6 weeks and age of onset under 16 years. What sx will you see?

Joint effusion pain limited rom warmth over joint

What is the cause of JIA? What is it definitely not?

Cause is unkown, but there is inflammation. It is NOT an infection

In JIA what markers/tests are we going to get? Which is more likely positive?

CBC Inflammatory markers **ANA** RF - usually absent x-ray

An 8 y/o from wisconsin regularly plays in the woods behind his home. He has had a progressive limp worsening over the past several months or even years. What is the cause of this?

Lyme arthritis d/t borrelia burgdorferia - may occur months or years after infection

If a child presents with intermitten non-articular pain that typically comes on at night and limited to the calf, thigh or shin, what should cross your mind if you can't find anything on PE?

Growing pains

When will growing pains be absent during the day? What relieves the pain?

During the waking hours ## Footnote –pain is short-lived and resolved with heat, massage, or mild analgesics

What is the treatment for growing pains?

reassurance to the parents and child.