MSK Flashcards
What is osteogenesis imperfecta?
AD genetic condition leading to bone weakness, brittle bones and fractures
What causes osteogenesis imperfecta?
Mutation affecting type I collagen
What is the presentation of osteogenesis imperfecta?
Recurrent fractures, hypermobility, blue/ grey sclera, triangular face, short stature, dental problems, bone deformities, bone pain
What is rickets?
Defective bone mineralisation causing soft and deformed bones
Give 4 risk factors for rickets
Darker skin, low exposure to sunlight, colder climates, long time indoors
What are some causes of rickets?
Deficiency in vitamin D or calcium, dark skin, northern latitudes, vegan diets, coeliac disease, cystic fibrosis, fanconi syndrome
What is vitamin D?
A hormone created from cholesterol in the skin in response to UV radiation
What is vitamin D essential in?
Calcium and phosphate absorption from the intestines and kidneys
Regulating bone turnover
Promoting bone reabsorption to boost calcium
What is the presentation of rickets?
Lethargy, bone pain, bone deformity, poor growth, dental problems, muscle weakness, swollen wrists
What are some bone deformities of rickets?
Bowing of legs
Knock knees
Rachitis rosary - end of ribs expand causing chest lumps
Kyphoscoliosis
Craniotabes
What is craniotabes in rickets?
Soft skull with delayed closure of the sutures and frontal bossing
What is gold standard diagnosis for rickets?
X-ray
What are the two investigations that are high in rickets?
PTH and alkaline phosphatase
What is transient synovitis?
Irritable hip - temporary irritation and inflammation in the synovial membrane of the hip
Associated with a recent viral URTI
What is the presentation of transient synovitis?
No fever, limp, hip pain, refusal to weight bear
What is septic arthritis?
Infection inside the joint usually from haematogenous spread
What are the causes of septic arthritis?
Staph aureus - most common
Neisseria gonorrhoea - sexually active teens
Strep pyogenes
Hib
Staph epidermis - prosthetic joints
What is the presentation of septic arthritis?
Single joint, hot, swollen, red and painful
Stiffness and reduced range of motion
Refusal to weight bear
Fever, lethargy and sepsis
What is the management of septic arthritis?
Aspirate and send for crystal microscopy, gram staining and culture
Blood cultures
Empirical antibiotics
Surgical drainage and clearance
What is osteomyelitis?
Infection in the bone and bone marrow typically metaphysis of long bones
What is the most common site of osteomyelitis?
Distal femur and proximal tibia
What is the most common cause of osteomyelitis?
Staph aureus
What is the presentation of osteomyelitis?
Painful, immobile limb, swelling, tenderness, hot, refusal to weight bear, fever
What is the 1st line and gold standard diagnosis for osteomyelitis?
X-ray and MRI
What is the treatment for osteomyelitis?
6 weeks IV flucloxacilin and Rifampicin for first 2 weeks
What is Perthes Disease?
Disruption in blood flow to the femoral head causing avascular necrosis of the bone followed by revascularisation and reossification
What are the risk factors for Perthes Disease?
ADHD, deprivation, passive smoking, low birth weight
What does Perthes Disease affect?
Epiphysis of the femur
What is the main complication of Perthes Disease?
Soft and deformed femoral head leading to early hip osteoarthritis
What is the presentation of Perthes Disease?
Slow onset
Pain in hip or groin
Limp
Reduced ROM of hip
What are some investigations for Perthes Disease?
X-ray
Blood tests
Technetium bone scan
MRI
What is discoid meniscus?
Developmental abnormality of the meniscus
It can be complete where the tibia is completely covered by the meniscus
What is the presentation of discoid meniscus?
Visible or audible palpable snap on terminal extension
Pain
Swelling
Locking
Meniscal tear
Click during movement
What is the diagnosis for discoid meniscus?
MRI
What is the treatment for discoid meniscus?
Arthroscopic partial menisectomy
What is slipped capital femoral epiphysis?
The head of the femur slips along the growth plate from a fracture through the growth plate
Who is slipped capital femoral epiphysis most common in?
Boys, 8-15 years during a growth spurt
Also obese children
What is the presentation of slipped capital femoral epiphysis?
History of minor trauma triggering onset
Hip, groin, thigh or knee pain
Painful lump
Reduced hip ROM
What are the investigations for slipped capital femoral epiphysis?
X-ray (lateral frog view)
Bloods
Technectium bone scan
MRI and CT
What is Osgood Schlatters?
Inflammation at the tibial tuberosity where the patella ligament inserts.
What is the presentation of osgood schlatters?
Visible or palpable hard lump on tibial tuberosity
Pain in anterior aspect of knee
What is a rare complication of osgood schlatters?
Full avulsion fracture where tibial tuberosity is separated from the rest of the tibia requiring surgery
What is developmental dysplasia of the hip?
Structural abnormality in the hips caused by abnormal development of foetal bones in pregnancy
Instability in hips with tendency for subluxation or discloation
What are some risk factors for developmental dysplasia of the hip?
Family history
Breech presentation
Multiple pregnancy
Females
First child
When is developmental dysplasia of the hip screened for?
NIPE
What are the special tests for developmental dysplasia of the hip?
Barlow (dislocate) and Ortolani (relocate)
What are the investigations for developmental dysplasia of the hip?
USS, X-ray
What is the management of developmental dysplasia of the hip?
Pavlik harness
Surgery
What is JIA?
Autoimmune mediated inflammation which occurs within the joints
What are some features of systemic JIA/ Stills?
Systemic illness, salmon-pink rash, high fevers, weight loss, joint inflammation and pain, splenomegaly, muscle pain, pericarditis
What are the investigations for systemic JIA?
ANA and RF negative
Raised CRP, ESR, platelets and ferritin
What is a complication of systemic JIA?
Macrophage Activation Syndrome - massive inflammatory response causing DIC and low ESR
What are features of oligoarticular JIA?
4 or less joints, usually large
More in girls under 6
Anterior uveitis is classic
What are some features of polyarticular JIA?
5 or more joints usually hands and feet
Symmetrical
RA in children basically
What is torticollis?
Neck muscles spasm and your neck twists to the side
What is the most common cause of congenital torticollis?
Sternocleidomastoid tumour
Name some causes of acquired torticollis
JIA, meningitis, osteomyelitis, discitis, URTI, otitis media, CNS or bone tumours
What are some investigations for torticollis?
Cervical spine plain x-ray
USS
CT or MRI neck
List some causes of limp in a child under 4
Toddlers fracture
NAI
Osteomyelitis
Septic arthritis
Developmental dysplasia of the hip
List some causes of a limp in a child 4-10 years
Trauma
Transient synovitis
Osteomyelitis
Septic arthritis
Perthes Disease
What is the treatment for transient synovitis?
Rest
Physio
NSAIDs
What investigations should you do if you suspect Septic Arthritis?
What would these investigations show?
Blood cultures positive
Raised WCC and CRP
X-ray shows delayed bony changes not evident for 14-21 days
Which criteria is used to identify a child with septic arthritis?
Kocher’s criteria
Fever over 38.5
Cannot weight bear
ESR over 40 in 1st hour
WCC over 12
What test can be used to identify Perthes Disease?
Roll test
What are the signs of DDH?
Unequal leg length
Asymmetrical skin creases in thigh or buttock
