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MSK Flashcards

1
Q

How does talipes equinovarus (clubfoot) occur?

A

intrauterine compression

can be secondary to oligohydramnios during pregnancy (e.g. spina bifida)

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2
Q

How would you treat Talipes Equinovarus?

A

Ponsetti method (plaster casting and bracing)

If very severe (corrective surgery)

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3
Q

What are examples of abnormal feet posture?

A 
talipes equinovarus
vertical talus
talipes calcaneovalgus
flat feet
tarsal coalition
pes cavus
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4
Q

What are the methods used to identify developmental dysplasia of the hip? When is it done?

A

Barlow manoeuvre
Ortholani manoeuvre

during the neonate exam

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5
Q

What is the Barlow manoeuvre?

A

checks if an unstable hip can be dislocated posteriorly out of the acetabulum

adduction on hip and posterior force on knee

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6
Q

What is the Ortholani manoeuvre?

A

to see if the dislocated hip can be relocated into the acetabulum

abduction on hip and anterior force on femur

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7
Q

How does developmental dysplasia of the hip present?

A

limp or abnormal gait

asymmetrical skinfolds of hip

limited abduction of hip

shortening of affected leg

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8
Q

If DDH is suspected, what investigation should be carried out? What is being looked for ?

A

USS

subluxation (partial dislocation) or dislocation

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9
Q

How would you treat DDH? what risk is associated with this treatment?

A

splint or harness

must be done properly or risk necrosis of femoral head

if fails surgery

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10
Q

What are some risk factors for DDH?

A

female

breech position

c-section

1st child

prematurity

oligohydramnios

family history

club feet

spina bifida

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11
Q

What is scoliosis? What are the consequences of scoliosis?

A

lateral curvature in the frontal plane of the spine

most changes - mild, pain-free and primarily cosmetic

if severe - cardiorespiratory failure from distortion of chest

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12
Q

What are the causes of scoliosis?

A

idiopathic - most common (early onset or late onset) mainly teenage girls

congenital (spina bifida)

secondary (neuromuscular imbalance, neurofibromatosis, Marfan)

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13
Q

What would you see on examination of scoliosis?

A

Inspection of child while they stand straight

  • irregular skin creases
  • differences in shoulder height

examine back when bent forwrd - if scoliosis disaapears on forward bending is is POSTURAL

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14
Q

How would you treat scoliosis?

A

mild - resolve spontaneously

severe - X-Ray - bracing, surgery (bilateral rod stabilisation) indicated if severe

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15
Q

What is torticollis? what is the most common cause in infants?

A

wry neck - sternomastoid tumour which presents in first few weeks

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16
Q

How do growing pains present?

A

3-12 years old

episodes of generalised pain in the lower limbs

pains symmetrical in lower limbs which aren’t limited to joints

pains never present at start of the day

doesn’t limited

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17
Q

How does hypermobility present?

A

musculoskeletal pain mainly confined to lower limbs, which is worse after exercise

joint swelling usually absent or transient

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18
Q

Hyper mobility effects which joints?

A

hyperextension of thumbs and fingers

elbows and knees hyperextended beyond 10 degrees

palms placed flat on floor with knees straight

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19
Q

Hypermobility is a features of what conditions?

A

Down’s, Marfan’s and Ehlers-Danlos

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20
Q

What is complex regional pain syndromes? Who does it normally affect?

A

Most dramatic MSK pain

usually adolescent females

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21
Q

What are some general features of complex regional pain syndromes?

A

most dramatic MSK pain, usually in adolescent females

triggered by minor trauma

hyperaesthesia

allodynia

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22
Q

What are differences between the localised and diffuse forms of complex regional pain syndromes?

A

Localised form - usually unilaterally foot and ankle (affeted part cool, swollen and mottled)

Diffused form - severe widespread pain and disturbed sleep patterns, feeling exhausted during the day, extreme tenderness over soft tissues

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23
Q

What is osteomyelitis? What is normally affected?

A

infection of metaphysis of long bones - most commonly distal femur and proximal tibia

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24
Q

What organisms most commonly cause osteomyelitis?

A

Staph Aureus
Streptococcus
Haemophilus Influenzae

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25
Q

How does osteomyelitis present?

A

painful, immobile limb with an acute febrile illness

swelling and exquisite tenderness

sterile effusion of an adjacent joint

*presentation may be more insidious in infants

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26
Q

What investigations would you carry out for osteomyelitis?

A

blood cultures usually positive

WBC and acute phase reactants are raised

MRI - allows differentiation of bone from soft tissue infection

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27
Q

How would you treat osteomyelitis?

A

parenteral abx - flucloxacillin

aspiration or surgical decompression of subperiosteal space may be needed

surgical drainage if no response to abx

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28
Q

If there is knee pain why would you assess the hip?

A

Hip pain is often referred pain to the knee

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29
Q

What is osgood-schlatter? Who does it normally affect?

A

osteochondritis of the patellar tendon

affecting adolescent males who are physically active

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30
Q

How does Osgood-Schlatter present?

A

Knee pain after exercise

Localised tenderness

sometimes swelling over tibial tuberosity

often hamstring tightness

bilater in 25-50%

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31
Q

How would you treat Osgood-Schlatter?

A

reduced activity and physio for quad muscle strengthening

hamstring stretches

32
Q

Back pain in very young is a symptom of concern. What are some red flags which would indicate worrying pathology ?

A

high fever - infection

night waking, persistent pain - osteoid osteoma or tumours

painful scoliosis - infection or malignancy

focal neurological signs - nerve root irritation, loss of bowel.bladder control

weight loss, systemic malaise - malignancy

33
Q

What are some causes of a limp?

A

transient synovitis

Perthe’s

Slipped Capital Femoral Epiphysis

DDH

34
Q

What age group is normally affected by transient synovitis? When is normally contracted?

A

most common cause of acute hip pain in (2-12 y/o)

follows or is accompanied by a viral infection

35
Q

How does transient synovitis?

A

sudden onset of pain in hip/limp

no pain @ rest

decrease ROM, particularly internal rotation

child is afebrile

36
Q

What investigations would you carry out to differentiate transient synovitis vs septic arthritis?

A

Joint aspiration

blood cultures

37
Q

In some cases what does transient synovitis precede?

A

Perthe’s Disease

38
Q

How would you treat transient synovitis?

A

bed rest

skin traction (rare)

39
Q

What are some ways you would differentiate septic arthritis from transient synovitis?

A

In septic Arthritis

moderate/high fever

child looks ill

hips held felxed

pain at rest

raised ESR

doesn’t resolve by itself

40
Q

What is Perthe’s disease? Who does it normally affect?

A

avascular necrosis of capital femoral epiphysis of femoral head

mainly affects boys, 5:1 (5-10 y/o)

41
Q

How does Perthe’s present?

A

onset of limp

hip/knee pain

bilaterally in 10-20%

42
Q

What would you be seen on X-ray of patient with Perthe’s?

A

X-ray both hips - increased density of femoral head which becomes fragmented and irregular

if X-ray is normal, either repeat or bone scan and MRi if symptoms persist

43
Q

How would you treat Perthe’s disease?

A

If early - bed rest and traction

if Late/severe - plaster/calipers or femoral/pelvic osteotomy

44
Q

What is SCFE? What can it lead to?

A

slipped capital femoral epiphysis

displacement of epiphysis of femoral head postero-inferiorly

can lead to avascular necrosis

45
Q

What groups of patients normally affected by SCFE?

A

10-15 y/o, during growth spurt, particularly if obese

associaed with metabolic endocrine abnormalities (hypothyroid and hypogonadism)

46
Q

How does SCFE present?

A

limp/hip pain which may be referred to nee

onset acute, following minor trauma

on examination - restricted abduction and internal rotation

47
Q

Treatment for SFCE?

A

surgery

48
Q

How would you define arthritis?

A

pain, swelling, heat, redness and restricted movement in a joint

49
Q

What are some causes of arthritis?

A

infection (bacterial, viral, rheumatic fever)

inflamm. bowel disease

vasculitis (henoch-schonlein purpura, Kawasaki)

haematological (haemophilia, sickle-cell)

malignant - leukaemia, neuroblastoma

connective tissue disorder - JIA, SLE, PAN

50
Q

What is reactive arthritis?

A

transient joint swelling that lasts less than 6 weeks often of ankles and knees

usually follows extra - articular infection

51
Q

What is the most common form of arthritis in childhood?

A

reactive arthritis

52
Q

What organisms usually causes infection that precedes reactive arthritis?

A

salmonella, shigella, campylobacter and yersinia

STIs in adolescents

53
Q

What would you see on investigations of reactive arthritis?

A

low grade fever

acute phase reactants are normal/mildly elevated

X-rays normal

54
Q

How would you treat reactive arthritis?

A

NSAIDs

55
Q

In what age group is septic arthritis most commonly seen?

A

<2 y/o

56
Q

How is septic arthritis normally contracted?

A

Usually haematogenous

puncture/infected skin lesions

may spread from adjacent osteomyelitis

57
Q

Most common organism for septic arthritis?

A

Staph Aureus

58
Q

How does Septic Arthritis present?

A

erythematous, warm, acutely tender joint, decrease in ROM, acutely unwell febrile child

59
Q

How would you investigate septic arthritis?

A

increased WCC

increased acute-phase reactants

blood cultures

USS of joints

X-ray to exclude trauma - will show normal then widening of joint space and soft tissue swelling

Aspiration of joint space - culture

60
Q

How would you treat septic arthritis?

A

IV course of abx (penicillin, flucloxacillin)

washing out of joint or surgical drainage

61
Q

What is JIA?

A

Juvenile Idiopathic Arthritis

persistent joint swelling >6 weeks, which presents before 16 y/o

62
Q

How is JIA is classified?

A

> 4 joints = polyarthritis

4 joints = oligoarthritis

if with fever and rash = systemic

further subtype = rheumatoid factor and HLA B27

63
Q

What would you find on history of JIA?

A

gelling

morning joint stiffness and pain

intermittent limp

poor behaviour and mood

avoidance of enjoyed activities

64
Q

What would you find of examination of JIA?

A

swelling, inflammation and proliferation

pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss

long term - bone expansion from overgrowth

            - in knee leg lengthening or valgus deformitiy
            - in hands - discrepancy in digit length, 
            - in wrists - advancement of bone age
65
Q

If patient has suspected JIA but has systemic features, what must be considered?

A

Sepsis and Malignancy

66
Q

What complications can arise from JIA?

A

Chronic anterior uveitis - can lead to visual impairment

flexion contractures of joints

growth failure

osteoporosis

67
Q

How would you treat JIA?

A

physical therapy

opthalmology, dentistry and ortho

NSAIDs

joint injections

MTX

systemic corticosteroids

cytokine modulators

68
Q

How many JIA sufferes will have the disease in adulthood? What is the consequence of this?

A

1/3

joint replacement

visual impairment

osteo fractures

psychosocial morbidity

69
Q

What is JIA when it has systemic symptoms?

A

Still’s disease

70
Q

What is osteoporosis in children?

A

1 or more vertebral crush fractures

OR

size-adjusted bone density 2.0 SDS + 2 or more long bone fractures by 10/3 or more long bone fractures by 19

71
Q

Causes of osteoporosis in children?

A

Osteogenesis imperfecta

Galactosemia

Idiopathic

Steroid-induced

Malabsorption

Immobilisation

72
Q

What is osteogenesis imperfecta?

A

BRITTLE AND FRAGILE
Bone fragility, fractures and deformity

AD inheritance

defects in Type 1 collagen

73
Q

How does osteogenesis imperfecta present?

A

bone pain

impaired growth
deafness

blue sclera

‘wormian’ bones

74
Q

How would you classify Osteogensis Imperfecta?

A

Sillence classification

I - mild

II - lethal

III - progressively deforming, severe

IV - moderate

75
Q

How would you treat OI?

A

bisphos - pamidronate

76
Q

What is rickets? How does Rickets present?

A

FAILURE TO MINERALISE NEW BONE

metaphyseal swellings

bowing deform

slowing of linear growth

motor delay

hypotonia

fractures

resp distress

77
Q

Causes of rickets?

A

vit D deficiency - maternal vit d insufficient, lack of sunlight, lack of vit d in diet

Paeds (13 decks)

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