MSK Flashcards
SELF LIMITING inflammation of HIP most likely viral or immune etiology, Occurs 1-15 years
Toxic synovits
Is toxic synovitis unilateral or bilateral?
Unilateral
Kocher’s criteria elevates what ?
If toxic synovitis VS septic arthritis
- NOn weight bearing
- Fever
- Increased ESR
- Increased WBC
If so = septic
Toxic synovitis is acute or insidious painful limp?
Insidious
Internal rotation of hip causes spasm
Toxic synovitis
Toxic synovitis Tx
Naproxen x 4 weeks / bed rest , Motrin//Tylenol
Septic arthritis is a inflammation of joint due to_____?
Bacterial infection of staph or strep most common
Both septic arthritis and transient (toxic) synovitis are common in ____.
Males
Septic arthritis has ____ onset of _____ or _____ pain. May be red, swollen, warm. Fever is ______. May refuses to bear weight or present _____.
Acute onset Knee or hip pain Fever present May limp Anorexia/ ill appearing
Diagnostics for septic arthritis
ESR elevated
WBC elevated
DX confirmed CT of US guided aspiration
Kocher criteria
TX for Septic arthritis
IV abx
Emergent referral surgical drainage of joint
Solid tumor of bone
Osteoscarcoma
Osteosarcoma common in ages _____to_____.
15-19 years
Local UNILATERAL BONE pain, swelling , tenderness ; increased pain with activity , LIMP, fever, decreased ROM, mass at end of long bone
Osteosarcoma s/s
Dx for osteosarcoma includes:___, ___, ___. Management is chemo and surgery.
CT, MRI
Biopsy
Interruption of blood to femoral head (spiphysis) leading to partial or complete Aseptic or a vascular necrosis of femoral head
LCPD
In leg calve Perthes disease (LCPD) their is a _____ onset of limp with ____ slight pain , and pain may also migrate to ____.
Insidious limp
Limp is with knee pain migrates to groin/lateral hip
More PAINLESS limp
In LCPD is the patient febrile?
No
There is _____ passive INTERNAL ROTATION and abduction of ____ joint in LCPD.
Limited; hip
AP and Lateral radiograph shows ________ in LCPD.
Crescent
LCPD common in ___. Ages ___ to ___.
Males; 4-9
General Treatment for LCPD
Non weight bearing
Bed rest
Observe if full ROM
Aggressive treatment for LCPD is indicated when?
More than 1.5 of femoral head involved ; children >6 years ; poor ROM—- ortho
SCFE has acute pain in knee or hip that is severe and present with inability to ambulated or with limping that may be referred to ____ or ______.
Thigh or knee
Ages for SCFE
12-15
SCFE is common in …..
> Boys
OBESE!!!
Spontaneous dislocation of femoral head (epiphysis) downward and back displacing femoral neck .
Slipped Capital femoral epiphysis (SCFE)
DX of SCFE is radiograph of which view___?
AP pelvis and frog leg lateral
TX of SCFE
Ortho refer
No ambulation —-crutches/wheelchair
Passive internal rotation of hip is limited
LCPD
Inability to flex hip
SCFE
Genu Varum
Bow leg
RUM MAKES KNEES OPEN
Genu varum is normal until what age
2 years
Genu Valgum
“KNees stuck together with GUM”
Knock knees
Genu Valgum is normal until what age ?
7 year olds chew GUM
Normal till 7 — then refer to ORTHO
Genu Valgum has distance between medial malleoli (ankles) of ___.
3 in
What test is used to identify scoliosis ?
Adams forward bend test
Asymmetry of hips, ribs , shoulders and waist
When do you refer for scoliosis?
Pain or curvature >25 degrees
When do you do radiograph for scoliosis?
Cobb angle > 10 degrees
Muscular Dystrophy Duchenne is what?
Progressive INHERITED genetic disorder began in lower extremities and progresses to upper extremities/torso
Muscular Dystrophy Duchenne affects who?
ONLY MALES; 3-5 years
Abnormal gait and posture, inability to keep up with peers, clumsy, firm WOODy calves are symptoms of
Muscular Dystrophy Duchenne— leads to decreased muscle strength and wheelchair dependent by 12 years —- death from cardiopulmonary failure ; intelligence intact
Mom reports her son has started to get up like a crab and walks his hand up his legs to stand this shows what sign?
Gowers sign ; Muscular Dystrophy Duchenne
What labs are indicated for Muscular Dystrophy Duchenne?
CREATINE KINASE — elevated (shows degree of muscle wasting) ; ECG; muscle biopsy ; DNA analysis of gene —dx made
Stretch or tear in ligament
SPrain
Stretch or tear in muscle/tendon
Strain
Ligaments attach to ____ to Bone, ____ attach muscles to bone.
Bone to bone ; tendons
Sprains are graded ___ to ___.
1-3
Remember sprain is ligament tear.
Sprain grade 1 symptoms
STRETCHING no TEAR
Kid is like I sprained my ankle no biggie…
Local tenderness Edema minimal Bruising absent or barley their FULL ROM Can weight bear
Sprain grade 2 symptoms
PARTIAL TEAR
Pain immediately, localized swelling, bruising , ROM limited
Sprain grade 3 symptoms
COMPLETE TEAR
Severe pain
Edema significant and bruising —- all the colors
No weight bearing
NO ROM
OTTAWA ankle rule
Ankle sprain rule
is pain near ankle (malleoli) + bone tenderness+ unable to bear weight 4 steps at time of injury —-then X-RAY
Decreases amount of X-ray in kids
Ankle sprain Mangement
RICE + NSAID
Rest, ice compression (min edema and stabilize) , elevate
Pain, POINT TENDERNESS, swelling, bruising/ erythema
S/s fracture
Diagnostics for fracture
AP/L X-ray, CT, MRI complex injury
Fracture occurs in growth plate of long bone during development during traumatic injury
Salter Harris fracture —- unique to Peds
BOYS >GIRLS
SALTER Harris fracture classification
S A L T/T R
Slipped
Above
Lower
Through/transverse
Rammed/ruined
Salter Harris fracture Tx
X-ray, CT Pain meds RIE —no compression Closed reduction 1-2 casting/splint Open reduction 3-4
Child refuses to use arm after brother was playing tug of war and pulled on her arm hard. She now holds arm across body.
Radial head subluxation —-NURSE MAID ELBOW
Is nurse maid elbow a fracture?
No popped ligament over bone wrong way ( ligement bone-bone)
What age group for nurse maid elbow
1-4
TX nurse maid elbow
Reduction makeup—hyperpronation or supination/flex \ion
Point tenderness at costal cartilages along eternal boarder , sharp dull pain that exacerbates with cough, sneeze, or deep inspiration.
Costochondritis
Acute or gradual onset
Chest pain
Crowing rooster or horizontal traction can be done to reproduce this pain
Chest pain in Costochondritis
Costochondritis Mangement
NSAIDS
Bilateral lower extremity pain
Growing pains
Can be INTERMITTENT and Increases and NIGHT
Growing pain occur at what age?
3-5 years and 8-12 during rapid growth
Growing pain TX
NSAID, massage, heat/cold rest
Mild aching pain , joint stiffness, swelling of joint, warmth, loss rom (may limp)
JIA symptoms
Can have fever salmon colored skin rashes, increased WBCs, adenopathy
Joint stiffness in JIA is worst when
In morning after rest
JIA is more common in ____.
Girls
Poly arthritis
> 5 joints inflamed
Oligoartheritis
<5 joints inflamed
JIA diagnosis requires arthritis that is _____ for more than ____weeks in a patient ages ____.
Persistant; 6; <16 years
Juvenile idiopathic artheritis (JIA) Tx
No diagnostics test — useful labs (CBC, ESR, CRP, LFTs, Lyme , ANA+ = opthmology refer)
Refer Peds rheum NSAIDS Corticosteroids PT Methotrexate —anti rheum drug
In developmental hip dysplasia
You concur that a child has a positive Galeazzi finding what is the treatment
Identify during the newborn period
High incidence of spontaneous improvement
Treat before six months of age Pavlik harness
Restore contact between the femoral head and acetabulum if devices not affective then surgery
Metatarsus adductuctus / Varus
Pigeon toed treatment
Adductus —- parents stretch 4 foot with each diaper change for 4 to 6 months
Varus —-foot adducted and inverted ; limited rom
Serial casting are bracing first year of life; straight laced fitted shoes for daytime; surgery if child older than four years
Which of the following disorders is usually associated with adduction of the forefoot?
Internal femoral torsion
Genu valgum
Talipes equinox arid congenita
Internal tibial torsion
Talipes equinox arid congenita ___club foot
Radiographic findings of disease progression and sphericity of the femoral head is helpful in the diagnosis and follow up of
leg calve perches disease
Or Slipped capital femoral epiphysis??
LCPD
Does toxic synovitis have fever?
low grade
What would be the most appropriate initial management of a newborn diagnosed with developmental dysplasia of the hip?
Observant examined at two week well child visit
Triple diapering in nursery
Pavlik harness
Surgical reduction
The Pavlik harness is an appropriate initial management for subluxation and reduction of hip dislocation
Club foot findings
The ankle is in the Equinus (foot is an pointed toe position) Forefoot adduction Deep crease on medial border a foot Small foot with limited dorsiflexion Atrophy of calf muscles
Iliotibial bands not involved!!!
Diagnostic marker for juvenile idiopathic arthritis
Anti-nuclear antibody’s(ANA) Sero positivity for Antibodies
Consist of immunoglobulins directed against structures within the cell found in various autoimmune diseases
Dislocation in the hip of a child six months or older may typically present with
Positive Galeazzi sign—-Candis picked a leg length discrepancy and children with dislocated her hips
Duchenne muscular dystrophy is characterized by which of the following signs and symptoms?
At birth infants are notably hypotonic floppy babies
Earlier symptoms refusal to bear weight
Unable to keep up with their peers when running at school-age
Abnormalities of gate and posture become evident during preschool years and during gross motor development
Abnormalities of gate And posture become evident during preschool years and during gross motor development
Most children with Duchenne muscular dystrophy become wheelchair dependent by what age?
7 to 12
Obese 13-year-old male with two days of right knee pain without trauma illness has exam of significant pain upon right hip motion he maintains his leg in an external rotation and adduction. Based on these findings the most likely diagnosis is
SCFE
Osteomyelitis management
Antibiotic treatment for identified pathogen’s 4-6 weeks is recommended
Aspiration usually indicated
Surgery if abscess is present
The most common symptom is persistent pain that may be referred to the medial aspect of the ipsilateral me or to the lateral thigh
Leg calf perthe‘s disease
Tibial torsion involves twisting of the long bone along its long axis, resulting in an increased internal rotation. Treatment is:
Observation
Contracture of the sternocleidomastoid muscle
Torticollis
A 14 years diagnosed with JIA , he is not up-to-date on his immunizations it is currently on methotrexate. What vaccinations would be cautioned in this cause?
Vericella, risk for developing serious complications from the varicella zoster infection and JIA patients receiving antirheumatic drugs. Varicella zoster immune status should be checked before starting such therapy
Systemic onset JIA is most commonly associated with
Highly daily intermittent spiking fevers and rash
Referred to an orthopedist as early as possible ideally in the newborn nursery because joints are most flexible in the first hours and days of life in this disorder
Equinovarus of feet—- club foot
An injury at this part of the bone that will most likely result in a bone length discrepancy
Epiphysis
Bone length occurs at the epiphyseal plates where blood supply enters
Torticollis symptoms
Irritability when lifted, asymmetrical moro reflex, spasm along the right sternocleidomastoid muscle
Enlarged anterior fontanelle with delayed closing, enlarged costochondral junction or architecture sign
Are classic signs of what
Rickets
After one year of conservative treatment for torticollis a child still experiences limited neck rotation what is the PNP‘s next step?
Referral for surgery
Torticollis should resolve by one year
While completing a hip exam on a newborn infant you are able to just locate the infants right hip. The appropriate management plan would be to
Refer to orthopedic specialist for pavlik harness
Swaddling in the prone position and triple diapering or not I thought to be effective
Galeazzi/Allis sign
Shows Unequal height of legs confirming hip dysplasia
Ortolani maneuver is not an appropriate indicator for hip dysplasia after what age
6 months
Elevated white blood cells fever and refusal to bear weight are common in both osteomyelitis and transient toxic Synovitis.
What is a differentiating factor between these two
Osteomyelitis is associated with local trauma where is toxic Synovitis is commonly associated with recent respiratory illness
Nurse maid elbow ____pronation method or _____/______ method.
Hyperpronation or supination/flexion
