MSK Flashcards
Traumatic clavicular fractures in older children (not neonates) are treated how?
Nondisplaced: Figure-of-8 splint
Displaced: surgically reduced
What is important to ask for monoarticular arthritis?
Rashes - indicative of several pathologies, including:
Lyme
Juvenile arthritis (evanescent, macular, salmon-colored rash)
Serum sickness (pruritic rash)
What are oligoarticular and polyarticular juvenile idiopathic arthritis both characterized by?
May be complicated by uveitis
Sex ratio F > M
What is a typical sign of oligoarticular JIA?
Pain worse in the morning in a toddler (age <5), with joint swelling most commonly of large joints
What muscle weakness does Trendelenburg sign indicate?
Gluteal muscle of the contralateral side to hip drop
Slipped capital femoral epiphysis results in what position of leg?
Externally rotated foot - due to decreased abduction and internal rotation
Quadriceps and gluteus muscle disuse –> atrophy
Which direction is the femoral head in SCFE?
Femoral head (epiphysis) posteriorly displaced from metaphysis
Where is pain in patellar tendinitis?
Inferior pole of patella
How does patellofemoral pain feel?
Patella - sensation of instability or buckling at the knee
Overuse injury from running, squatting
Where is pain of Osgood-Schlatter disease? How is it diagnosed and treated?
Apophysitis of tibial tubercle
Traction apophysitis from quadriceps muscle pulling –> elevation and chronic avulsion of tibial tubercle
Pain is reproduced by knee extension against resistance or squatting
Diagnosis is clinical, treatment is supportive
Why does hypothyroidism predispose to SCFE?
Thyroid hormone normally promotes ossification of growth plate
These kids would have SCFE at earlier age (<10) and more likely bilateral
What is diagnostic for SCFE?
Frog-leg lateral hip x-ray
What is transient synovitis?
Inflammatory hip condition in children age 3-8 yo with hip pain and limp following viral illness
Legg-Calve-Perthes disease treatment
Conservative - bracing/splinting
Surgery - if femoral head is not well contained within acetabulum
Transient synovitis hip is held in which position to relieve pain?
Flexed and everted to maximize the joint space
US may show small, unilateral or bilateral hip effusions
Myositis ossificans cause and location
Trauma or neurologic events (TBI, stroke)
Quadriceps, brachialis
Myositis ossificans labs and imaging
Alk phos and inflammatory markers
Eggshell calcification representing heterotopic ossification
What are the prenatal positioning disorders related to intrauterine crowding?
Congenital muscular torticollis
Developmental dysplasia of the hip
Metatarsus adductus
Clubfoot
X-linked hypophosphatemic rickets presents with what on x-ray?
Metaphyseal fraying with widened physes
Beaking of the proximal tibial metaphyses
What does a metaphyseal corner fracture suggest?
Child abuse - forcible pulling or twisting of an extremity
What is Blount disease? What are signs/symptoms?
Pathologic cause of bowlegs due to abnormal cartilage growth
Leg length discrepancy, asymmetrical bowing, lateral thrust with ambulation
How would developmental dysplasia of hip affect skin fold?
Asymmetric; extra skin fold on affected side
Down syndrome atlantoaxial instability diagnosis and treatment
Diagnosis - lateral cervical x-rays showing compression of spinal cord due to increased mobility between C1 (atlas) and C2 (axis) (due to excessive laxity in posterior transverse ligament)
Treatment - surgical fusion of C1 to C2
Treatment for osteoid osteoma
NSAIDs
Spondylolysis pain worsens with what movement?
Lumbar extension of lower back
What inheritance is Duchenne muscular dystrophy? What is the mutation?
X-linked recessive - markedly reduced or absent dystrophin in muscle fibers
What is congenital myotonic dystrophy?
CTG repeat in myotonia dystrophy protein kinase (DMPK)
Big sign is sustained muscle contraction with inability to relax (myotonia)
Myotonic dystrophy signs if presenting in childhood (by age 10); shows earlier than muscular signs
Cognitive (intellectual impairment)
Behavioral (ADHD, mood disorder)
Sleep disturbances (excessive daytime sleepiness)
Which neoplasm is in epiphysis, lytic area with “soap bubble” appearance?
Giant cell tumor of bone - benign
What is a unicameral bone cyst?
Proximal femur/humerus fluid-filled lesion with well-defined margins
Presents as pathologic fracture most commonly
Describe clubfoot. What to do?
Forefoot adduction + internal rotation
Fixed plantarflexion
Underdeveloped calf
Serial molding cast application to feet to gently manipulate and stretch, followed by long-term bracing
Surgical correction for refractory or recurrent cases
Achondroplasia signs
Limb shortening, tibial bowing, frontal bossing
Gross motor delay
Rickets - what signs at metaphysis?
Concavity (cupping)
Indistinct margins (fraying)
Excess non-mineralized osteoid alters diameters, stability, and organization of physis and metaphysis
Palpable click with manipulation of the hip
Iliopsoas bursitis
Where is a branchial cleft cyst located?
Anterior to sternocleidomastoid muscle
Tract may extend to tonsillar fossa (2nd branchial arch) or pyriform recess (3rd branchial arch)
Klumpke palsy is associated with what syndrome?
Horner syndrome (ptosis, miosis)
What are the two benign neonatal rashes that can be treated if severe?
Miliaria rubra - not present at birth - erythematous, papular rash on occluded and intertriginous areas - topical steroids if severe
Neonatal cephalic pustulosis - age 3 weeks - erythematous papules and pustules on face/scalp only - topical steroids or ketoconazole if severe
Systemic JIA vs polyarticular/oligoarticular
Systemic JIA has macular rash with quotidian fever (daily fever)
Oligo often ANA+
Polyarticular RF- but sometimes RF+
Systemic has no ANA or RF
Scheuermann kyphosis
Due to abnormal anterior vertebral wedging
Diagnose with lateral x-rays showing >40 degree curvature and >5 degree anterior wedging in at least 3 vertebrae
Pain worse with flexion, activity; better after rest
Constitutional growth delay vs familial short stature
Delayed bone age (vs normal bone age) until 11 girls or 13 boys, after which ideal height is achieved
Ewing sarcoma translocation
t(11;22)
Osteosarcoma vs Ewing - which more likely to have systemic symptoms?
Ewing - fever, anorexia, fatigue
Duchenne vs Becker muscular dystrophy
Becker is qualitative dystrophin protein abnormality, later age of onset and better life expectancy, CK only 5x normal (vs 10-20x)
Developmental dysplasia of hip - treatment based on age
<6 mo: rigid brace, Pavlik harness splint
6-18 mo: spica cast
>18 mo: open reduction followed by spica cast
Legg-Calve-Perthes vs SCFE
LCP is painless, SCFE is painful
LCP may resolve on own or can consider bracing/cast/osteotomy if extensive necrosis or decreased ROM; SCFE should have immediate surgical screw fixation and no weight-bearing until stabilized
