MSK Flashcards
Causes of septic arthritis
Common <2 y/o
Usually due to haematogenous spread but also due to puncture wounds
Staph aureus
S+S septic arthritis
Red, warm, tender joint Reduced range of movement Joint effusion
Pathology of DDH + which hip is more common, what % is bilateral?
Congenital dislocation of the hip
Acetabular dysplasia can cause it
Left more common
20% are bilateral
Test for DDH + when its screened for
Barlows (posterior dislocation) Ortolanis (relocation)
Newborn exam + screening at 6-8 weeks
RF for DDH + long term complications
Breech
+FHx
Girls
Oligohydraminos
More common in cultures that swaddle
Complications: OA + lower back pain
S+S DDH
Asymmetry of skin folds Limp or abnormal gait
Management of DDH + risks of surgery
Most stabilise spontaneously by 2-6 weeks - so USS at 6-8 weeks
USS - infant placed in harness/ brace (Pavlik harness) to keep hip flexed + abducted - worn full time for 6 weeks
If over 6 months: need surgery: closed reduction + spica casting
Surgery is 2nd line after bracing
Risks of surgery: re-dislocation, stiffness + avascular necrosis
What is irritable hip?
Follows viral infection
Sudden onset pain in hip or limp
Decreased ROM: internal rotation + abduction affected
Child doesn’t appear to be ill
What is reactive arthritis?
Caused by enteric bacteria + viral infections
Transient joint swelling of ankles or knees
Usually follows infection
What is juvenile idiopathic arthritis + the types?
Persistent joint swelling >6 wks before 16 y/o Polyarthritis >4 joints (any age, symmetrical) Oligoarthritis <4 joints (young children, muscle wasting, antinuclear Ab positive)
S+S JIA
Gelling (stiffness after rest) Morning joint stiffness Pain Intermittent limp
What is Stills?
Systemic JIA Pre-school children, generally unwell, high fever, splenomegaly + lymphadenopathy Salmon pink rash, high CRP
Complications of JIA
Chronic anterior uveitis Growth failure Osteoporosis
Management of JIA
NSAIDs Methotrexate weekly Systemic corticosteroids Cytokine modulators
Causes of acute painful limp in 1-3 y/o
Septic arthritis Transient synovitis Leukaemia Neuroblastoma
Causes of acute painful limp in 3-10 y/o
Transient synovitis Septic arthritis Perthes disease JIA Leukaemia
Causes of acute painful limp in 11-16 y/o
Slipped capital femoral epiphysis Necrosis of femoral head Reactive arthritis JIA Septic arthritis Bone tumours
Causes of chronic/ intermittent limp in 1-3 y/o
DDH Talipes JIA Cerebral palsy
Causes of chronic/ intermittent limp in 3-10 y/o
Perthes Duchenne’s JIA
Causes of chronic/ intermittent limp in 11-16 Y/O
SIipped femoral epiphysis JIA
What is Perthe’s disease?
Avascular necrosis of femoral head due to interruption of blood supply
Followed by revascularisation + reossification - abnormal none growth
Misshapen femoral head
Presents with insidious limp
What is a slipped femoral epiphysis + how does it present?
Displacement of femoral head postero-inferiorly
Presents with acute limp/ hip pain
Can follow minor trauma or be insidious in onset
Patient unwell with acute limp: what investigations to do?
Bloods
USS or X ray
Describe transient synovitis
Acute onset hip pain +- refusal to weight bear
No pain at rest
Child otherwise well - commonly toddlers
Preceded by URTI
Treat with rest + analgesia
Resolves in 2 weeks
Effusion + thickening around joint = inflammation
RF for Perthe’s
Boys
Caucasian
Low birth weight
4-10 y/o
+FHx
Presentation + investigations for Perthe’s
Hip/ knee pain + effusion
12% bilateral
X ray = joint widening (early) + femoral head collapse (late)
MRI may be needed
Management of Perthe’s
Children <8 or bone age <6 = conservative (physio + strengthening)
Fails: surgery = proximal varus osteotomy
Surgery if >6y/o
Management of slipped femoral ephiphysis + complications
Immediate bed rest + analgesia
Surgical closure of epiphysis - percutaneous screws
Complications: chondrolysis + avascular necrosis
Types of slipped femoral epiphyseal?
Pre slip = wide epiphyseal line, no slippage
Acute = sudden slip, usually spontaneous
Acute on chronic = acute pain on chronic slip
Chronic = progressively worse
RF for slipped femoral epiphysis?
Obesity
Pelvic RT
Trauma
Hypothyroidism
10-17
Males
Describe Osgood Schlatters disease
Pain + swelling below knee, worse in active children
Happens during growth spurts - muscle grows faster than bone
Describe Marfans disease
high arched palate, tall + thin, arachnodactyly (abnormally long fingers + toes), aortic regurg, dilatation + aneurysms
What does Reiters syndrome cause?
urethritis, conjunctivitis, arthritis
Describe rheumatic fever
group A strep causing vasculitis (arthritis, carditis, chorea, skin changes, rashes, high CRP + ESR) treat with Pen V
Describe osteomyelitis
Infection of the bone - commonly long bones
Describe osteochondritis
Inflammation of cartilage or bone
