MSK

Question 1

What is the prevalence of DDH?

Answer 1

1.5 per 1000 birth but 6 in 1000 will be detected in neonatal screening

Question 2

What are the risk factors for DDH?

Answer 2

• girls (6x more likely)
• FH
• Breech presentation
• Neuromuscular disorder

Question 3

What are the screening tools used for DDH?

Answer 3

Routine exam of the newborn infant

US exam of the hip joint

Question 4

How does DDH present?

Answer 4

• Barlow manoeuvre – hip dislocated posteriorly out of the acetabulum
• Ortolani manoeuvre – dislocated back into the acetabulum

•If not found on screening, present with limp or abnormal gait, asymmetry of skin folds around hip, limb abduction of the hip or shortening of the affected leg

Question 5

How is DDH managed?

Answer 5

• Splint or harness to keep hip flexed + abducted for several months
• Progress monitored by US or XR
• Surgery required if conservative measures fail

Question 6

Are flat feet normal?

Answer 6

•Toddlers learning to walk usually have flat feet due to flatness of the medial longitudinal arch + presence of foot pad (disappears with time)

Question 7

What are the causes of flat feet?

Answer 7

hypermobility

congenital tarsal coalition

Question 8

What is the treatment for flat feet?

Answer 8

Orthopaedic opinion needed for congenital tarsal coalition
Footwear advice
Occasionally arch support

Question 9

What are the causes and treatment of forefoot adduction?

Answer 9

• Metatarsus varus
• Medial tibial torsion
• Persistent anteversion of femoral neck

most don’t need treatment unless persistent after 5 years and symptomatic

Question 10

What causes scoliosis?

Scoliosis – lateral curvature in the frontal plane of the spine

Answer 10

idiopathic
congenital - defect in the spine
secondary - NM imbalance, disorders of bone

Question 11

What is the significance of scoliosis?

Answer 11

• Usually mild, pain-free and primarily cosmetic problem

* If severe, distortion of chest leading to cardiorespiratory failure

Question 12

What is the management of scoliosis?

Answer 12

• Mild – resolves spontaneously or progresses minimally
• Severe
• Severity + progression determined by XR
• Managed in specialist spinal centres
• Bracing considered
• Surgery only if severe or coexisting pathology e.g. neuromuscular or respiratory disease

Question 13

What is torticollis?

Answer 13

flexion, extension or twisting of muscle in neck that allows neck to move beyond normal position

Question 14

What are the causes of torticollis?

Answer 14

First few weeks of life
SCM tumour (congenital muscular torticollis) - Resolves in 2-6 weeks

Later in childhood 
o Muscular spasm
o Secondary to ENT infection
o Spinal tumour (e.g. osteoid osteoma
o Cervical spine arthritis or malformation
o Posterior fossa tumour

Question 15

What is the management of acute torticollis?

Answer 15

•Exercise of neck + remaining active important to stop neck stiffening
•Painkillers, poss add muscle relaxant but caution needed
Heat packs + good posture
If persistent, poss botox
•Surgery only for very severe cases