MSK Flashcards
What is osteogenesis imperfecta?
Genetic cdtn that results in brittle bones that are prone to fractures (brittle bone syndrome). This happens due to mutations that affect collagen formation.
Sx of osteogenesis imperfecta?
- Blue/grey sclera
- Hypermobility
- Triangular face
- Short stature
- Joint + bone pain
- Bone deformaties (bowed legs + scoliosis)
Ix for osteogenesis imperfecta?
- Clinical diagnosis
- Xrays
- Genetic testing
Mx of osteogenesis imperfecta?
No cure but can be mx by:
* Bisphosphonates - inc. bone density
* Vit D supplementation - prevent deficiency
* Physio
What is rickets?
Defective bone mineralisation causing “soft” + deformed bones
Causes of rickets?
MC - Deficiency in vit. D or calcium
Rarely - Genetic (hereditary hypophosphataemic rickets - x-linked dominant)
What are bone deformities that can occur in rickets?
- Bowing of legs (leg curve outwards)
- Knock knees (leg curve inwards)
- Rachitic rosary (ribs expand at costochondral junctions causing lumps along chest)
- Craniotabes (soft skull)
- Delayed teeth (enamel underdevelopment)
Vit D deficiency/rickets sx?
- Lethargy
- Bone pain
- Swollen wrists
- Bone deformity
- Dental problems
- Muscle weakness
Ix for rickets?
- Serum 25-hydroxy vitamin D
- Xray
- Serum calcium, phosphate, PTH, alkaline phosphatase
- Bloods - FBC, ESR, CRP, LFTs
Mx of rickets?
Vit D supplement:
* 400 IU per day for children + young people
If vit D deficiency - Vitamin D (ergocalciferol):
* If between 6 mths and 12 yrs give 6000 IU per day for 8-12 wks
What is transient synovitis?
Temporary (transient) irritation + inflammation in synovial membrane of joint (synovitis).
Sometimes referred to as irritable hip + often associated with recent viral URTI but typically do not have a fever.
Sx of transient synovitis?
Often occurs within a few wks of viral illness:
* Limp
* Refusal to wgt bear
* Groin or hip pain
* Mild low grade temp
Mx of transient synovitis?
Simple analgesia + safety net if sx get worse i.e. worsen or develop fever to attend A&E immediately
What is septic arthritis?
Infx inside a joint leading to systemic illness.
What are the common bacteria that causes septic arthritis?
MC - staph aureus
Other:
* N. gonorrhoea
* Group A strep
* H. influenza
* E.coli
Sx of septic arthritis?
Usually only affects a single joint (often knee or hip). Presents with:
* Hot, red, swollen and painful joint
* Refusing to weight bear
* Stiffness + reduced ROM
* Systemic sx i.e. fever, lethargy and sepsis
Ix for septic arthritis?
Joint aspiration for gram staining, crystal microscopy and culture
Tx of septic arthritis?
Empirical IV antibiotics
If severe - sugical drainage + joint washout
What is osteomyelitis?
Infx in bone + bone marrow typically in metaphysis of long bones. The infx may be introduced directly into the bone i.e. during open frax or travel to bone through blood.
What is the MC bacteria that causes osteomyelitis?
Staph aureus
RF for osteomyelitis?
- Open bone frax
- Ortho surgery
- Immunocompromised
- Sickle cell anaemia
- HIV
- TB
Sx of osteomyelitis?
- Refusing to use limb or weight bear
- Pain
- Swelling
- Tenderness
Ix for osteomyelitis?
- 1st line - Xrays
- GS - MRI
- Bloods - CRP + ESR + WBCs
- Bone marrow aspiration
Mx of osteomyelitis?
Abx
Surgery if severe - drainage
What is Perthes disease?
Disruption of blood flow to the femoral head causing avascular necrosis of bone. This affects epiphysis of femur.
- Avascular necrosis = the death of bone tissue due to a lack of blood supply.
- Epiphysis of femur = the end of the femur that connects with the hip consists of a “ball”
Sx of Perthes disease?
Slow onset of:
* Pain in hip or groin
* Limp
* Restricted hip movements
* Knee pain
Note - there will be no history of trauma.
Ix for Perthes disease?
- 1st line - Xray
- Bloods
- Technetium bone scan
- MRI scan
Mx of Perthes disease?
- Initial - conservative (bed rest, crutches, analgesia)
- Physiotherapy
- If severe - surgery
What is slipped upper femoral epiphysis (SUFE)?
When head of femur is displaced (slips) along the growth plate. It’s MC in obese children.
Sx of slipped upper femoral epiphysis?
- Hip, groin, thigh or knee pain
- Restricted hip ROM
- Painful limp
- Pts prefer to keep hip in external rotation
Typical exam presentation - adolescent, obese boy undergoing growth spurt
Ix for slipped upper femoral epiphysis?
- 1st line - xray
- Bloods - infl. markers
- CT/MRI
- Technetium bone scan
Mx of slipped upper femoral epiphysis?
Surgery - return femoral head to correct position + fix it in place to prevent further slipping.
What is osgood-schlatter?
Infl. at tibial tuberosity where patella ligament inserts
What causes osgood-schlatter?
Stress from running, jumping and other movements at same time as growth in epiphyseal plate.
Sx of Osgood-Schlatter?
- Visible or palpable hard + tender lump at tibial tuberosity
- Pain at anterior aspect of knee
- Pain exacerbated by physical activity, kneeling + on knee extension
Mx of Osgood-Schlatter?
- Ice
- NSAIDs
- Reduce physical activity
- Physio + stretching once sx settle
What is juvenile idiopathic arthritis?
Arthritis that affects children and young individuals under 16 yrs where the aetiology is unknown.
Sx of juvenile idiopathic arthritis?
- Arthritis lasting for 6 wks or more
- Can affect single or multiple joints
- Joint swelling + pain
- Morning stiffness
- Limited ROM
Ix for juvenile idiopathic arthritis?
- Primarily clinical dx
- Bloods - exclude causes
- USS/MRI of affected joints
- Joint aspiration - rule out infx or malignancy
Mx of JIA?
- NSAIDs
- Steroids - control infl.
- Steroid-sparing agents - methotrexate or biological agents
What is discoid meniscus?
Abnormality in knee joint where meniscus is shaped more like a disc than crescent shape
Sx of discoid meniscus?
- Popping knee sounds
- Knee pain + swelling
- Limited ROM
- Instability
What is scoliosis?
When spine curves abnormally to the side forming “S” or “C” shape. Usually appears during growth spurt just before puberty.
Sx of scoliosis?
- Visible curvature of spine
- Uneven shoulders or hips
- Protruding shoulder blade
- Back pain
- Restricted ROM
Ix of scoliosis?
- Forward bend test
- Xrays
- MRI/CT scans
What is torticollis?
Cdtn where neck muscles contract involuntarily causing head to twist or tilt to one side
