MSK Flashcards
What are the RFs for septic arthritis in a child?
<2yrs DM ImmunoC Renal failure IVDU Prosthetic joint
What are the causes of septic arthritis?
Haem spread Direct inoculation Osteomyelitis <12m: Staph Aureus, Group B Strep 1-5: Staph Aureus, Group A Strep, H. influenza 5-12: Staph Aureus, Group A Strep 12-18: Staph Aureus, Gonorrhoea
How is septic arthritis investigated?
Bloods: FBC, CRP, Culture
USS guided aspirate
MRI
LP
How is septic arthritis treated?
IV Flucloxacillin 2-4weeks then PO
Surgery: Debridement & irrigation
Physio
Immobilise/splint
What is talipes?
Excessively turned
High medial longitudinal arch
What are the causes of talipes?
Gentic Neuromuscular Oligohydramnios Uterine abnormalities Multiple pregnancy
How is talipes investigated?
Standing
Xray: AP lateral
How is talipes managed?
Ponseti method: Stretching & Manipulate feet into correct position
Cast for 5-8w change weekly
Cut Achilles under LA
Boots for 3m nightly until 4-5yo
What is a cephalhaematoma?
Haemorrhage between periosteum & skull in newborn
What are the causes of a cephalhaematoma?
Prolonged second stage
Instrumental delivery
What are the signs & symptoms of a cephalhaematoma?
Doesn't cross fissure lines Usually over parietal bones Jaundice Anaemia Hypotension
How is a cephalhaematoma treated?
Hardens then swelling resolves (may take weeks-months)
Jaundice: Phototherapy
What are the red flags in an MSK exam?
Fever Reduced appetite Weight loss Night sweats Bruising Lymphadenopathy Hepatosplenomegaly
What tool can be used for MSK differentials?
VITAMIN CD Vascular: Bleeding (haemophilia/haemangioma) Infection: Septic arthritis/ TB/ reactive/osteomyelitis Trauma: Inc non-accidental Autoimmune: JIA, Lupus, HSP, IBD Metabolic: Mucopolysaccariodes Iatrogenic Neoplasia: Leukaemia/ Osteosarcoma Congenital Degenerative
What are the differentials for a swollen joint
ARTHRITIS Acute septic arthritis Reactive: to infection Trauma Haematological: Leukaemia/ Haemophilia Rheumatological: JIA/ JDM/ Lupus Immunological: HSP TB IBD Sacroidosis
What are the subtypes of JIA?
Oligoarthritis: 1-4joints, persistent, extended
Polyarthritis: RF +ve/-ve
Systemic onset
Psoriatic arthritis
Undifferentiated
Enthesitis related arthritis- linked to ankylosing spondylitis
What are the signs & symptoms of juvenile idiopathic arthritis?
Gradual onset Limp Swelling Warmth Stiffness Worse after inactivity Irritable infants Sore throat Rash Fever Fhx: Psoriasis, arthritis, Colitis, Rheumatic fever Measure leg length Assess muscle bulk
How is idiopathic juvenile arthritis diagnosed?
Onset <16y
>6weeks of joint swelling, limited RoM, tenderness/pain
How is idiopathic juvenile arthritis investigated?
Diagnosis of exclusion Bloods: Rheumatoid factor, ANA, FBC (anaemia, thrombocytopenia, neutrophilia-systemic JIA) Infective screen Imaging: XR, USS, MRI Culture aspirate
How is idiopathic juvenile arthritis managed?
Avoid deformity: RoM exercises, night splints
School & family support
Monitor growth
3m uveitis screen
Counsel: Methotrexate
Analgesia: Ibuprofen, NSAIDs (Ibuprofen 30-40mg/kg)
Control disease activity: Methotrexate IM 10-15mg/m2/week
What is the pathophysiology of hip dysplasia?
Shallow acetabular leading to tendon laxity
Leads to instability/subluxation
Muscle contracture & progressive acetabular dysplasia
Femoral head becomes hypoplastic
What are the RFs for hip dysplasia?
FHx Female Left hip Breech Swaddled babies Multiple pregnancy Oligohydramnios
What are the signs & symptoms of hip dysplasia?
Normal pregnancy
Delayed walking
Painless limb
Prone to falls
Neonates: Ortolani’s test-Elevat & abduct hip to reduce it, Barlow’s test-Adduct & depress femur vulnerable hip dislocates
Infant: Asymmetric gluteal folds, leg lengths, limited abduction, flex knees w/feet together one shorter
Older: Limp, +ve trendelenburg, exaggerated lumbar flexion
How is hip dysplasia investigated?
USS if <6m
AP Pelvis: Shallow acetabulum, abnormal femoral head position
How is hip dysplasia managed?
<6w: Spont resolves
<6m: Pavlik harness
6-18m: Manipulate & closed reduction
18m-2y: Trial closed reduction/ open reduction +/- pelvic osteotomy & hip spica plaster cast
2-6y: Open reduction +/- femoral shortening +/- pelvic osteotomy & plaster
What are the complications of hip dysplasia?
Redislocation
Avascular necrosis
Early osteoarthritic changes
What is transient synovitis/ reactive arthritis?
Inflammation following an infection
Bacterial/viral anywhere in the body
Different to viral associated arthritis which develops at the same time as the infection & lasts a few weeks
What are the signs of transient synovitis/ reactive arthritis?
Pain Swelling Usually lower limbs Sausage fingers/toes Systemic illness
How is transient synovitis/ reactive arthritis investigated?
Clinical diagnosis
Bloods: FBC, Rheumatoid factor, ANA
Stool sample
How is transient synovitis/ reactive arthritis managed?
Self-limiting Analgesia Rest Heat/ice packs Corticosteroids
What are the components of a normal stance?
Swing phase: 40%
Stance phase: 60% Heel contact, midstance, active propulsion, passive propulsion- Toe off
Types of abnormal gait?
Antalgic: Painful
Trendelenburg
Proximal muscle weakness
Describe Antalgic gait
Most common
Quick soft steps, short stepping
Stance reduced on painful side swing increases
Describe Trendelenburg gait
Hip disorders weakness of abductor muscles (gluteals)
During stance gluteals on ipsilateral side suppose to contract
Problem: hip sinks on contralateral side
Effect: Child leans to one side
e.g weakness on the left hip drop on the right
Describe proximal weakness gait
Use hands & arms to ‘walk up the body’
In what conditions is gower’s sign seen?
Weakness in proximal muscles- Duchenne muscular dystrophy
What form of movement is seen in someone walking who has a spastic gait?
Circumduction
What are the inflammatory/infectious causes of a limp?
Transient synovitis Septic arthritis Osteomyelitis Infectious spondylitis Juvenile Arthritis
What do the investigations show in TS
Bloods: WBC, CRP, ESR NORMAL
Xrays: NORMAL
Osteomyelitis?
Clinical, lab, MRI diagnosis
Radiological signs only after 7-10days
Osteomyelitis treatment?
Abx
