MSK Flashcards
Perthes disease
Def, sx, ix, mx
Perthes disease involves disruption of blood flow to the femoral head, causing avascular necrosis of the bone. This affects the epiphysis of the femur, which is the bone distal to the growth plate (physis). The full name is Legg-Calvé-Perthes disease. It occurs in children aged 4 – 12 years, mostly between 5 – 8 years, and is more common in boys.
Sx: (slow onset)
Pain in the hip or groin
Limp
Restricted hip movements
There may be referred pain to the knee
Ix:
X-ray
Bloods
Technetium bone scan
MRI
Mx:
Bed rest
Traction
Crutches
Analgesia
Physio
Regular X-rays
Surgery
Developmental dysplasia of the hip
Def, rf, sx, ix, mx
a condition where there is a structural abnormality in the hips caused by abnormal development of the fetal bones during pregnancy. This leads to instability in the hips and a tendency or potential for subluxation or dislocation. These structural abnormalities have the potential to persist into adulthood leading to weakness, recurrent subluxation or dislocation, an abnormal gait and early degenerative changes. DDH is either picked up during the newborn examinations or later when the child presents with hip asymmetry, reduced range of movement in the hip or a limp.
Rf:
First degree family history
Breech presentation from 36 weeks onwards
Breech presentation at birth if 28 weeks onwards
Multiple pregnancy
Findings that may suggest DDH are:
Different leg lengths
Restricted hip abduction on one side
Significant bilateral restriction in abduction
Difference in the knee level when the hips are flexed
Clunking of the hips on special tests
Ix:
- Ortolani test is done with the baby on their back with the hips and knees flexed. Palms are placed on the baby’s knees with thumbs on the inner thigh and four fingers on the outer thigh. Gentle pressure is used to abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly.
- Barlow test is done with the baby on their back with the hips adducted and flexed at 90 degrees and knees bent at 90 degrees. Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly.
- ultrasound
- x-rays
Mx:
Treatment typically involves a Pavlik harness if the baby presents at less than 6 months of age. The Pavlik harness is fitted and kept on permanently, adjusting for the growth of the baby. The aim is to hold the femoral head in the correct position to allow the hip socket (acetabulum) to develop a normal shape. This harness keeps the baby’s hips flexed and abducted. The child is regularly reviewed and the harness is removed when their hips are more stable, usually after 6 – 8 weeks. Surgery is required when the harness fails or the diagnosis is made after 6 months of age. After surgery is performed, an hip spica cast is used to immobilises the hip for a prolonged period.
Idiopathic arthritis
Types, mx
The key features of inflammatory arthritis are joint pain, swelling and stiffness.
five key subtypes:
Systemic JIA
Polyarticular JIA
Oligoarticular JIA
Enthesitis related arthritis
Juvenile psoriatic arthritis
Mx:
NSAIDs, such as ibuprofen
Steroids, either oral, intramuscular or intra-artricular in oligoarthritis
Disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, sulfasalazine and leflunomide
Biologic therapy, such as the tumour necrosis factor inhibitors etanercept, infliximab and adalimumab
Septic arthritis
Cause, sx, ix, mx
Staph aureus is most common cause
Sx (rapid onset):
Hot, red, swollen and painful joint
Refusing to weight bear
Stiffness and reduced range of motion
Systemic symptoms such as fever, lethargy and sepsis
Ix:
Joint aspiration and sample sent for testing
Mx:
Empirical IV antibiotics
Surgical drainage and washout
Slipped Upper Femoral Epiphysis
Sx, ix, mx
The typical exam presentation is an adolescent, obese male undergoing a growth spurt. There may be a history of minor trauma that triggers the onset of symptoms. Suspect SUFE if the pain is disproportionate to the severity of the trauma.
Presenting symptoms can be vague. These can be:
Hip, groin, thigh or knee pain
Restricted range of movement in the hip
Painful limp
Preference of hip in external rotation
Ix:
X-ray (primary)
Bloods
Technetium bone scan
CT
MRI
Mx:
Surgery
Transient synovitis
Cause, sx, mx
It is caused by temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis). It is the most common cause of hip pain in children aged 3 – 10 years. It is often associated with a recent viral upper respiratory tract infection. Children with transient synovitis typically do not have a fever. Children with joint pain and a fever need urgent management for septic arthritis.
Sx:
Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature
Mx:
Symptomatic
Rickets
Cause, sx, ix, mx
Rickets is caused by a deficiency in vitamin D or calcium.
Sx:
Lethargy
Bone pain
Swollen wrists
Bone deformity
Poor growth
Dental problems
Muscle weakness
Pathological or abnormal fractures
Bone deformities that can occur in rickets include:
Bowing of the legs, where the legs curve outwards
Knock knees, where the legs curve inwards
Rachitic rosary, where the ends of the ribs expand at the costochondral junctions, causing lumps along the chest
Craniotabes, which is a soft skull, with delayed closure of the sutures and frontal bossing
Delayed teeth with under-development of the enamel
Ix:
Serum 25-hydroxyvitamin D
X-ray
Serum calcium (low)
Serum phosphate (low)
Serum alkaline phosphate (high)
PTH (high)
Mx:
Ergocalciferol
Vit d and calcium supplements
Cerebral palsy
Causes, types, sx, mx
Causes-
Antenatal:
- Maternal infections
- Trauma during pregnancy
Perinatal:
- Birth asphyxia
- Pre-term birth
Postnatal:
- Meningitis
- Severe neonatal jaundice
- Head injury
Types:
- Spastic: hypertonia (increased tone) and reduced function resulting from damage to upper motor neurones
- Dyskinetic: problems controlling muscle tone, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. This is the result of damage to the basal ganglia.
- Ataxic: problems with coordinated movement resulting from damage to the cerebellum
- Mixed: a mix of spastic, dyskinetic and/or ataxic features
Sx:
- Failing to reach milestones
- Failure to outgrow primitive reflexes
- Fidgety movements
- Hypotonia
- Spasticity
- Dystonia
- Feeding difficulties
- Hand preference before 18 months
Gait:
- Hemiplegic / diplegic gait: indicates an upper motor neurone lesion
- Broad based gait / ataxic gait: indicates a cerebellar lesion
- High stepping gait: indicates foot drop or a lower motor neurone lesion
- Waddling gait: indicates pelvic muscle weakness due to myopathy
- Antalgic gait (limp): indicates localised pain
Mx:
- physio
- OT
- SALT
- dietician
- baclofen
- anti-epileptics
Muscular dystrophies
Types, sx, ix, mx
Types:
Duchennes muscular dystrophy (defective dystrophin from x-chromosome)
Beckers muscular dystrophy
Myotonic dystrophy
Facioscapulohumeral muscular dystrophy
Oculopharyngeal muscular dystrophy
Limb-girdle muscular dystrophy
Emery-Dreifuss muscular dystrophy
Sx:
- gowers sign (proximal muscle weakness)
- calf pseudohypertrophy
- missing motor milestones
- milestone regression
Ix:
- Raised CK
- Genetic testing
- EMG
- Muscle biopsy
Mx:
- steroids
- physio
- OT
- manage complications
Reactive arthritis
Def, triggers, sx, ix, mx
Reactive arthritis is a form of inflammatory arthritis that develops in response to an infection, usually in another part of the body. It commonly affects the joints, eyes, urinary tract, and skin. It is also part of a group of conditions known as spondyloarthropathies, which primarily affect the spine but can involve other areas as well.
Triggers:
The condition usually follows an infection, often gastrointestinal (such as Salmonella, Shigella, or Campylobacter) or genitourinary infections (such as Chlamydia).
Sx:
• Joint pain and inflammation: Most often affecting the knees, ankles, or feet, causing swelling and pain.
• Eye inflammation: Conjunctivitis or uveitis (red, painful, and irritated eyes).
• Urinary symptoms: Painful urination, urinary frequency, or inflammation of the urethra.
• Skin rashes: Skin lesions, particularly on the palms, soles, or around the genitals.
Ix:
• History of recent infection (especially gastrointestinal or urinary).
• Physical examination of joint inflammation, eye issues, or skin changes.
• Laboratory tests: To rule out other causes of arthritis, including testing for infections and markers like HLA-B27, a gene associated with reactive arthritis.
Mx:
• Antibiotics: If an underlying infection is still present.
• Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line of treatment for joint pain and inflammation.
• Steroids: Sometimes corticosteroid injections are used for severe joint inflammation.
• Physical therapy: To maintain joint mobility and strength.
Acute kidney disease (AKI)
Causes, sx, ix, mx
Causes:
- dehydration
- sepsis
- heart failure
- shock
- glomerulonephritis
- HUS
- nephrotoxic meds
- kidney stones
- tumour
Sx:
- low urine output
- oedema
- fatigue
- nausea/vomiting
- HTN
- SOB
- confusion
Ix:
- bloods- creatinine high
- urine dip and culture
- US
Mx:
- fluids and electrolytes
- dialysis
- antibiotics if needed
Chronic kidney disease (CKD)
Stages, causes, sx, ix, mx
Stages:
Stage 1: GFR ≥90, kidney damage with normal or high GFR.
Stage 2: GFR 60-89, mild reduction in kidney function.
Stage 3: GFR 30-59, moderate reduction in kidney function.
Stage 4: GFR 15-29, severe reduction in kidney function.
Stage 5: GFR <15, end-stage kidney disease (ESKD), requiring dialysis or transplant.
Causes:
- Congenital abnormalities of the kidneys or urinary tract (CAKUT)
- Focal segmental glomerulosclerosis (FSGS)
- Nephrotic syndrome
- Glomerulonephritis
- Polycystic kidney disease (PKD)
- Infections
Sx:
• Fatigue and weakness
• Poor growth and failure to thrive (due to impaired ability to maintain normal nutrition)
• Nausea and vomiting
• Loss of appetite
• Swelling (edema), especially around the eyes, hands, or feet
• HTN
• Anemia (due to reduced production of erythropoietin, a hormone that stimulates red blood cell production)
• Bone deformities (as a result of disrupted calcium and phosphate metabolism)
Ix:
1. Blood tests: To measure kidney function (creatinine and GFR) and to assess electrolytes, hemoglobin, and other markers of kidney health.
2. Urine tests: To check for protein, blood, or other abnormalities.
3. Ultrasound or other imaging: To assess kidney size, structure, and detect abnormalities or obstructions.
4. Kidney biopsy: In some cases, to determine the specific cause of kidney damage.
Mx:
• ACE inhibitors or ARBs: To control blood pressure and reduce protein loss in urine.
• Erythropoietin: To treat anemia.
• Vitamin D and calcium supplements: To prevent bone disease.
• Phosphate binders: To manage high phosphate levels.
• Low sodium: To control blood pressure.
• Adequate calories and protein: To support growth, but sometimes restricted in advanced CKD.
• Limit potassium and phosphorus: To prevent complications related to electrolyte imbalances.
• Dialysis: When CKD reaches stage 5 (ESKD), dialysis may be needed to filter blood. Two types are used in children:
• Hemodialysis (usually at a dialysis center).
• Peritoneal dialysis (often done at home).
• Kidney transplant
