Locomotor Flashcards
What types of joint are normally affected in septic arthritis?
Weight bearing joints (knee in >50% cases)
What pathogens usually cause septic arthritis?
Blood-borne - S. aureus (80-90%)
Also group B streptococci and H influenzae
Clinical features of septic arthritis?
Hot, red, swollen, tender joint
Limited range of movement - very painful
Fever, rigors
neonate will hold limb still - pseudo-paralysis
Investigations for septic arthritis?
FBC - WCC
ESR and CRP increased
Joint aspirate –> culture and microscopy
Ultrasound - narrowed intra-articular space, joint effusion, rapid osteoporosis
What criteria can be used as a diagnostic tool for septic arthritis?
Kocher criteria - 4/4 = 99% chance, 3/4 = 93% chance, 2/4 = 40%
- non-weight bearing on affected side
- Fever
- ESR > 40mm/hr
- WCC > 12
How does systemic juvenile idiopathic arthritis (JIA) normally present?
Joint symptoms may present late or be overlooked
Child appears ill - remitting fever, variable rash, hepatospenomegaly, anaemia, weight loss and abdo pain
How does polyarticular JIA present?
Joint swelling in both large and small joints - usually in a symmetrical pattern
Morning stiffness
Poor weight gain and anaemia may occur
Who does pauciarticular JIA tend to affect and how does it present?
Girls <5 yrs
Joint swelling in <5 joints - elbow, knee, hip and ankle
What is iridocyclitis and which type of JIA is it most likely to be a complication of?
it is inflammation of the inner eye which can lead to blindness
Pauciarticular JIA can develop this complication
management of JIA?
NSAIDS to control inflammation
In severe JIA can use hydroxychloroquine, pencillamine, gold injections and methotrexate injections
In severe systemic disease can use systemic corticosteroids
Physio/occupational therapy used to mobilise joints = daily exercises and night splints
Psychosocial support
What is reactive arthritis?
A post infectious transient sero-negative inflammatory joint condition that lasts <6 weeks
–> polyarthritis (particularly large joints and back)
Also: malaise, fatigue, low grade fever, erosions of tongue/soft palate, pustules on the underside of the feet, subungal keratosis (under nails)
Self limiting but can treat with NSAIDS
What is reiter’s syndrome?
A sub-type of reactive arthritis:
- Conjunctivitis
- Urethritis
- Arthritis
What is DDH and when is it diagnosed?
Developmental dysplasia of the HIP - usually detected at baby checks (midwife and GP)
W/o treatment –> arthritis, hip pain and develop a limp
Can do Barlow test - hip dislocates when hip is adducted and pushed down on
or ortolani test
Management of DDH?
<3 weeks - double nappies
3 weeks-6mo = splint hips
6-18mo = Examination under GA + arthogram - surgery (closed reduction)
>18mo = Open reduction
What is transient synovitis?
AKA irritable hip - benign condition that typically affects boys between the ages of 2-8 (most common cause of limp in 2-12yrs) –> painful hip on movement –> limp and reduced movement
NB. = afebrile condition but mild UTI may precede hip pain
Investigations in transient synovitis?
X-ray - usually normal or increased joint effusion
Bloods - CRP and acute phase reactants are raised
Management of transient synovitis?
Self-limiting in few days/week (bed rest)
Analgesia and reassurance
Who does slipped capital femoral epiphysis (SCFE) usually affect?
Sedentary teenage boys (10-14) - usually chronic (85%) but an be acute (trauma) - associated with hypothyroidism and hypogonadism
What are the sign and treatment for SCFE?
Signs = restricted internal rotation and abduction of the hip Treatment = surgery (pin in situ)
Complications = perthe’s disease, chondrolysis, recurrence
What is perthe’s disease?
Avascualr necrosis of the femoral head (can be a complication of transient synovitis) –> pain in hip and reduced internal rotation
Bilateral in 10-20% cases
Typically affect boys aged 5-10yrs
Investigations in perthe’s disease?
X-ray - flattening of femoral head +/- fragmentation
or DEXA scan
Management of perthe’s?
<1/2 femoral head = bed rest and skin traction
> 1/2 femoral head = positional (leg in cast) +/- osteotomy
