MSK Flashcards
risk factors for DDH
girls
breech
multiple pregnancy
oligohydramnios
1st degree FH
1st born
spina bifida
fixed foot deformities
presentation of DDH at new born
newborn screening - Barlows and ortolani
leg length discrepancy
limitation of abduction < 60 degrees
left hip more common
presentation fo DDH older children
- affected leg shorter than other
- waddling gait or tip toe walking
- limitation of hip abduction
- Galeazzi sign - femoral shortening when hips flexed
investigations for DDH
USS hip within 6 weeks if < 4 months old (should be 38-40 corrected gestational age)
if present over >4 months old -> x ray hip
management of DDH
- splinting using Pavlik harness, fit if less than 6 weeks old for 6 weeks then wean for 6 weeks
- if late diagnosis , surgical reduction >6 months
complications of pavlik harness
avascular necrosis of femoral head
accessory nerve palsies
irreducible hip dislocation
definition of JIA
joint inflammation in under 16 y/o for longer than 6 weeks with no other cause found
describe systemic JIA
fever, salmon pink rash with the fever, symmetrical joint pain, hepatosplenomegaly
describe oligoarticular arthritis
MOST COMMON FORM - < 6 y/o, girls
involves < 4 joints (usually lower limb)
uveitis common with ANA +VE (can be asymptomatic and present before joint pain)
describe polyarticular arthritis
> 5 joints involved (smaller joints)
if RF +ve, predicts poorer disease
describe enthesitis arthritis
arthritis plus:
1. sacro-iliac / lumbrosacral pain
2. heel pain
3. acute anterior uveitis
4. lower limbs
HLA-B27 usually +ve
describe juvenile psoriatic arthritis
affects small and large joints asymmetrically
dactylitis
nail pitting
oncholytis
diagnosis of JIA
- raised ESR
- USS - joint fluid and synovial hypertrophy
- ANA +VE in polyarticular, oligoarticular and psoriatic - most important test to predict for blindness
- RF +ve in polyarticular
management of JIA
- physiotherapy
- pain relief
- exercise
- NSAIDs
- steroids (intra-articular 1st line for oligoarticular JIA)
- methotrexate
- biologics
cause of septic arthritis
- staph aureus *
- group A strep
- haemophilus
presentation of septic arthritis
red hot painful swollen joint - usually knee or hip
restricted movement/ non weight bearing
fever
investigations of septic artrhitis
- bloods - raised WCC, raised ESR/CRP, cultures
- joint aspiration for culture
- x ray - widened joint space
management of septic arthritis
- IV antibiotics (cefuroxime) for 4-6 weeks IV
- pain control
cause of osteomyelitis in neonates
group B strep
staph aureus
e.coli
cause of osteomyelitis in children
staph aureus
strep pneumoniae
H.influezna
K.kingae (chronic)
cause of osteomyelitis in children with sickle cell disease
salmonella
affects diaphysis
location of osteomyelitis in neonates vs children
neonates - femur or humerus + destruction of growth plates
children- long bone metaphysis (distal femur)
presentation of osteomyelitis
ACUTE - fever, unwell, limp, red swollen painful limb, limited movement within 1 week
CHRONIC - months of infection, unusual organism (mycobacteria), brodies abscess deep in bone of metaphysis and deep boring pain
diagnosis of osteomyelitis
MRI ** - detects early changes
X ray - late changes
periosteal elevation, radiolucent metaphyseal lesions
Bloods - high WCC, high CRP, high ESR, culture
describe slipper capital femoral epiphysis
displacement or slipping of the proximal femoral epiphysis at the neck
defect in hypertrophic zone on growth plate
risk factors for slipper capital femoral epiphysis
- BOYS and OBESITY
- trauma
- hypothyroidism, hypopituitarism, vit d deficiency, short stature
- contralateral SCFE
presentation of SCFE
pain in hip , groin, medial thigh on walking
limp
limited internal rotation and abduction
Drehmanns sign - external hip rotation
xray findings on SCFE
widened epiphyseal line or femoral head displacement
globular swelling of joint capsule
decalcification of epiphyseal border
management of SCFE
NEED URGENT MANAGEMENT TO PREVENT AVASCULAR NECROSIS OF FEMORAL HEAD
- pain relief
- rest
- surgery - screw fixation across growth plate
goal is to prevent femoro-acetabular impingement, avascular necrosis, recurrence, osteoarthritis
inheritance of ehlers danlos
autosomal dominant
mutation in COL5A12 gene in defective collagen V
presentation of ehlers danlos syndrome
- hypermobile
- hyper extensible skin
- poor wound healing
- blue sclera
- developmental delay
- aortic regurg/ dissection of aorta
describe mucopolysaccharidoses and diagnosis
group of inheritable lysosomal enzyme disorders
autosomal recessive
lead to accumulation of GAGs (glycosaminoglycans) -> detected in urine
cause of rickets
- low vitamin D and calcium - dietary **, malnutrition
- lack of sunlight
- liver disease
- renal tubular loss
- mccune albright syndrome
- X linked dominant hypophosphatemic rickets - 80% inherited forms of ricket (give phosphate to treat) + 50% deelop nephrocalcinosis
vitamin D metabolsim
- UV lights absorbed through skin and turned into vitamin D3
- Converted in the LIVER to 25-VITAMIN- D (calcidiol)
- converted in the KIDNEY to 1,25-VITAMIN D (calcitriol)
presentation of rickets
wrist, knee, costochondral joint swelling, tender
delayed walking, delayed gross motor development
genu varum (bow legs)
skull bossing
poor growth
enamel hypoplasia
dilated cardiomyopathy
abdominal pain
hypotonia
irritable
x ray changes of rickets
cupping, splaying and fraying of metaphysis
costochondral swelling
looosers zones (areas of weajness)
blood tests of nutritional rickets
low vit d
Low calcium
low phosphate
high ALP and PTH
diagnosis and presentation of SLE
> 4/11 of the following
S - serositis
O - oral ulcers
A - arthritis - symmetrical
P - photosensitivity
B - blood disorder e.g. thrombocytopenia, haemolytic anaemia
R - renal e.g. lupus nephritis
A - ANA +ve 95%
I - immunological - anti DsDNA, anti smooth muscle, anti phospholipid disease
N - neurological disease e.g. seizures, psychosis
M - malar rash ‘butterfly facial rash”
D - discoid rash “sun exposed areas, scaling”
which is the most specific blood test for SLE
anti Ds DNA * + anti- smith
indicates more severe disease
management of SLE
- sun protection, exercise
- NSAIDs
- glucocorticoids
- hydroxychloroquine
- azathioprine or methotrexate
- biological therapies
maternal spread of lupus to baby by…
anti Ro and anti La antibodies
cause heart block in 5% babies + 70% have skin lesions + thrombocytopenia
describe type 1 osteogenesis imperfecta inheritance
autosomal dominant
mutation in COL1A1 gene - abnormal production of alpha chain in type 1 collagen
presentation of osteogenesis imperfecta type 1
blue sclera
easy bruising
fractures
hearing loss
list properties of bone in children
- more porous
- low mineral content
- wider haversian canals
- increased incidence of bucule and greenstick fractures
- periosteal sleeve thick
what is perthes disease
avascular necrosis of femoral head
interruption of blood supply causing asvascular necrosis of capital femoral epiphysis of the femoral head - followed by revascularisation and reossification over 18-36 months
presentation of perthes disease
boys 4-11 y/o
pain
limitation of movement on internal rotation and abduction
small for age
afebrile
management of perthes disease
containment - by abduction bracing and osteostomy
describe osgood schlatter disease
inflammation of patellar ligment at the tibial tuberosity
prominent in boys and sport
describe ankylosing spondylitis
common in boys
linked to HLA-B27
seronegative spondyloarthropathy
presentation of ank spon
low back pain , radiating to back of legs
stiffness - worse in morning, relieved by exercise
aortic regurg
pulmonary fibrosis
IBD
nephrotic syndrome
x ray signs in ank spon
1st sign = loss of costal margins/blurring of verterbal and thoracolumbar junction,
widening of joint space, anterior squaring of the vertebra
late signs = marginal sclerosis, narrowing and fusion
presentation of achondroplasia
marked short stature
large head with frontal bossing
depression of nasal bridge
delayed motor milestones and hypotonia
complications: OSA, hydrocepahlus, otitis media
presentation of reactive arthritis
preceded by gonorrhoea/ chlamydia
- arthritis
- conjunctivitis
- urethritis
+ keratoderma, blennorhagica balanitis
associated hLA with reactive arthritis
HLA B27
associated hLA with behcets disease
HLA B5
presentation of behcets disease
- uveitis
- oral and genital ulcers
- eryethma nodosum
+ Thrombophlebitis, neuropathy, psychiatric
describe scheurmanns disease
13-16 y/o
deep notches on anterior corner of vertebra
causes kyphosis
most common form of scoliosis
idopathic late onsent/ adolescent scoliosis
painless in 70%, 20% have FH
signs of tuberculous arthritis
hip *
x ray - rarefaction of bone, narrowing of joint spaces
x ray of perthes disease
flattened femoral head
presentation of drug induced lupus
sudden onset
after onset of drug e.g. anti fungal, antibiotics (rifampicin), valproate, biologics
investigations of drug induced lupus
anti single stranded DNA (instead of double stranded DNA in SLE)
anti histone antibodies
normal complement
signs of hypocalcaemia
brisk tendon reflexes
tetany
paraesthesia
prolonged QT -> arrthymias
petechiae
larynospasm - complication
bloods of hypophosphataemic rickets
low phosphate
normal/ low Ca
high ALP
normal PTH
bloods of vitamin D dependent rickets type 2
AR
alopecia, tooth decay
low calcium and phosphate
high ALP
high PTH
high vitamin D
how does sjogren present
bilateral painless salivary gland enlargement
dry skin
role of vitamin D
increase calcium reabsorption and increase phosphate reabsorption from gut
describe colles fracture
distal radius fracture
damages median nerve
‘dinner fork’ deformity’
