MSK Flashcards
What age group is transient synovitis (irritable hip) occurs in and what is it preceded with
2-12 years old. Following a viral infection
Presentation of transient synovitis
Pain only during movement in hip or limb (may be referred to knee). Decreased ROM.
What is an important differential of transient synovitis
Septic arthritis - send to A&E if suspect. Children with transient synovitis don’t have a high fever and are otherwise well.
Mx of transient synovitis
bed rest, simple analgesia -NSAID.
What is Perthes disease, who mainly affect
disruption of blood flow to femoral head, avascular necrosis of the bone. Boys between 5-10 years of age.
Px of Perthes
Slow onset of pain in hip or groin, decreased ROM. No history of trauma. Leg length discrepancy is a late sign
Dx of Perthes
Xray - joint space widening
Tx of Perthes
Dependent on diagnosis. Early diagnosis: bed rest + traction. Late: May need crutches, surgery.
What does Slipped Capital/upper femoral epiphysis mean
Where the head of the femur is displaced (slips) along the growth plate
Typical Px of SCFE
adolescent, obese 10-15 year old male undergoing a growth spurt. Vague pain - hip, groin, thigh or knee pain. Restricted ROM.
Ix + Mx of SCFE
xray. Surgery - return femoral head to correct position.
Px of reactive arthritis
arthritis, urethritis, conjunctivitis.
Causes of reactive arthritis
Usually follows infection. Enteric bacteria - shigella, campylobacteria, salmonella. Adolescents - STI. Fever usually low grade.
What is septic arthritis and who does it commonly affect
Refers to infection inside a joint. Can occur any age but most commonly under 2 Years.
Most common causes of septic arthritis
Staph aureus infection. Less common gonorrhoea, gp A strep (neonates), haem. Influenza.
Look for scratches, infected chicken pox.
Px of septic arthritis
hot, red, swollen joint. Affecting a single joint - often a knee or hip. Reduced ROM. Fever, lethargy, sepsis.
Ix + Mx of septic arthritis
- Blood cultures,CRP.
- Aspiration of joint - gram staining, crystal microscope, culture.
- Antibiotics - local guidelines + surgical debridement.
What is JIA
chronic autoimmune inflammation in the joints before 16 years of age
Px of JIA
joint pain, swelling and stiffness (chronic i.e. 2m) Systemic JIA (Stills disease): pink rash, fever, weight loss, lymphadenopathy (swollen lymph nodes).
Ix of JIA
Raised ESR/CRP but other Ix are normal. ANA and RhF antibodies negative.
In children that have fevers for more than 5 days what are the key non-infective differentials to remember?
Kawasaki, Stills disease, rheumatic fever and leukaemia.
Mx of JIA
- Initially NSAID (ibuprofen)
- Steroids - oral or intramuscular
- DMARDS (methotrexate) or biologics (Infliximab - TNFi)
what is Osteogenesis imerfecta
= brittle bone syndrome. genetic condition that results in brittle bones that are prone to fractures.
(genetic mutations affect collagen formation)
Px of OI
- recurrent, unusual fractures (normally make you consider safeguarding)
- hypermobility of joints
- BLUE/grey SCLERA
- Short, deaf, dental problems, joint/bone pain
Dx + Mx of OI
- clinical diagnosis, xrays can be useful in diagnosing fractures.
- genetic condition cant be cured but:
- bisphosphate to increase bone density
- vit D to prevent deficiency
- Physio/occupational therapy
What is Osgood-Schlatter disease
- caused by inflammation at the tibial tuberosity where the patella ligament inserts
- common cause of anterior knee pain in adolescents
Px of Osgood Schlatter
- typically in 10-15 years
- usually unilateral
- visible or palpable hard and tender lump at tibial tuberosity
- pain in anterior aspect of the knee, worse with activity
Mx of Osgood-Schlatter
- reduce physical activity
- Ice
- NSAIDS
- symptoms will usually resolve over time.
What is DDH
- structural abnormality in the hips caused by abnormal development of fetal bones during pregnancy.
- leads to instability in hips and a tendency for subluxation or dislocation
How is DDH usually diagnsed
During the NIPE.
- different leg lengths
- restricted hip abduction on one side
- difference in knee level when hips flexed
- Ortolani test: gentle pressure used to abduct hips and see if hips will dislocate anteriorly
- Barlow test: pressure placed on knees through femur to see if will dislocate posteriorly
- clunking of hips on special tests
Mx of DDH
- Pavlik harness if baby presents at less than 6 months of age.
- Surgery if fails or after 6 months of age
