MSK Flashcards
What is developmental dysplasia of the hip?
When is it screened for?
This is a spectrum of disorder of the hip ranging from
- dysplasia (abnormal growth)
- Subluxation (partial disclocation)
- frank dislocation of the hip
Screened for in newborns and at the 6 week screen
How is the developmental dysplasia of the hip screened for?
What are some of the risk factors?
- Barlow manoeuvre - attempt to dislocate hip posteriorly out of acetabulum
- Ortolani manoeuvre - attempt to relocate it back into acetabulum (can be done if hip dislocated)
How does developmental hip dysplasia present?
What investigation can be done?
What is the management of developmental hip dysplasia
- asymmetrical skin folds around hip
- limited abduction of hip
- abnormal gait/limp
- leg length discrepancy
Investigation: ultrasound
Management
- most unstable hips resolve spontaneoulsy between 3-6 weeks
- Pavlik harness for under 6 months, kept on for 6 months, keeps hip fixed in abducted and flexed position
- surgery for older children
What is transient synovitis?
Which age range is it most common in?
What does it usually follow or accompany?
- A self limiting inflammation of the hip
- Most common in 2-10 year olds
most common hip condition of childhood - Following or accompanied by viral or bacterial infection
How does transient synovitis present?
- child is afebrile or mild fever, appears well
- sudden onset pain in hip, groin, thigh or limp
- recent URTI or other infection
- refusal to weight bear
- no pain at rest, decreased range of movement particularly internal rotation
What investigations would you do for transient synovitis and what are the results?
What is the management for transient synovitis?
- FBC, ESR
- Blood culture - differentiate from septic arthritis
- Joint aspiration - differentiate from septic arthritis
- Xray
- US
Management
- bed rest, NSAIDs
- improves within a week
What is Perthes Disease?
What is the initial stage followed by?
How long does the process take?
Which age range and gender does it affect?
- avascular necrosis of the femoral head epiphysis due to interruption of blood supply
- Followed by revascularisation of re-ossification
- takes 18-36 months
- affects mostly 5-10 yr old boys
What is Perthes disease associated with?
What is the presentation?
- possibly associated with abnormal clotting factors, protein s and c deficiency, thrombophilia
Presentation
- hip stiffness: loss of internal rotation and abduction
- gait disturbances: antalgic/trundleburg
- limb length discrepency
What investigations can be done for Perthes disease?
What is the management?
What is the prognosis?
- X-ray
- MRI and bone scan
- roll test: guarding spasm, esp. with internal rotation
Management
- symptoms: NSAIDs, crutches, rest
- ROM: physio, muscle lengthening
- Surgery - osteotomy
prognosis good for under 6
When does slipped capital femoral epiphysis commonly occur?
What are the risk factors?
- at the onset of puberty
RF
- puberty
- afrocaribean
- boys
- fhx
How does slipped capital femoral epiphysis present?
What investigations are done and what do they show?
Presentation
- intermittent Hip, thigh, knee, groin pain
- insidious onset of several weeks
- may cause painless limp
- may be able to weight bear but painful
- reduced ROM
- obligatory ER on flexion
Investigations
- XR- widening and irregularity of femoral epiphyseal plate
How do you manage slipped capital femoral epiphysis?
- surgical pinning of hip
- fixation of contralateral hip needed if slip occurs under 10, obese or endocrine disorders
What is septic arthritis, how can it occur?
Which age range is it most common?
What is the most common infecting organism?
- general
- neonates
- adolescents
- serious infection of the joint space due to direct inoculation (infected skin lesion, surgery) or haematogenous seeding
- can be result of adjacent osteomyelitis
- most common in children under 10 years
- most common infecting organism =
general- staph aureus
neonates - Group B strep
adolescents - neisseria gonorrhoea
What are the symptoms
What are the signs
Symptoms
- acute pain, even at rest
- systemically unwell (febrile)
- limp, refusal to bear weight
Signs
- localised swelling
- erythematous, warm, tender, effusion
- position of comfort - flex and abducted
- severe pain with passive movement
- unwilling to move joint
What are some things to ask if concerned about septic arthritis?
What investigations would you do?
- recent local trauma or infection?
- vaccine history - haemophilus influenza
- are they on any antibiotics now or recently (may mask symptoms)
Investigations
- FBC, CRP, - raised WCC, CRP
- aspiration of joint
- blood cultures
- USS
- Xray to exclude trauma
What is the diagnosis criteria?
What is the management?
Kocher’s criteria
- Fever >38.5
- inability to weight bear
- ESR >40 in 1st hr
- WCC >12
Management
- Washing out of joint, needle aspiration
- IV abx Flucloxacillin (IM ceftriaxone if neisseria gonorrhoea)
How does osteomyelitis occur?
What can it do at the hip?
What are the most common causative agents?
in sickle cell?
- direct inoculation through wound or trauma or haematogenous spread
- can cause septic arthritis at the hip
- staph. aureus most common
- in sickle cell, slamonella most common
- step and h.influenza can also cause
How does osteomyelitis present?
What investigations should you do?
- painful immobile limb
- swelling and tenderness, erythematous, warm
- movement causes pain
Investigations
- MRI best
- Blood culturs
- FBC: raised WCC.
- raised CRP
- USS periosteal elevation
How should you manage osteomyelitis?
- IV abx until ESR/CRP reduced, oral therapy weeks after
- surgical drainage may be needed
- fluclox or clindamycin (if pen allergic)
What is juvenile rheumatoid arthritis?
What are the subtypes?
autoimmune condition
- Oligoarthritis (50%)
- polyarticular RF-ve
- polyarticular RF +ve
- Systemic JIA
- Juvenile psoriatic arthritis
- Enthesitis related JIA
What are the 11 ACR classification criteria
• 1- Malar rash: fixed erythema, spares nasolabial folds.
• 2- Discoid rash: erythematous patches, keratotic scaling and follicular plugging, atrophic scarring.
• 3-Photosensitivity.
• 4- Oral or nasopharyngeal ulcers: painless
• 5- Arthritis: 2 or more.
• 6- Serositis: Pleuritis or pericarditis
• 7- Renal Disorder: Persistent proteinuria >3+, or cellular cast
• 8- Neurologic disorder: seizure or psychosis.
• 9- Haematologic disorder: haemolytic anaemia, or leukopaenia (<4), or lymphopaenia on two or more occasions. Or thrombocytopaenia <100
• 10. Immunologic disorder:
o Anti-Sm: presence of antibody to Sm nuclear antigen
o Anti- ds-DNA: antibody to native DNA in abnormal titre.
o False positive serologic test for syphilis.
o Positive finding of antiphospholipid antibodies
• 11. Antinuclear antibody: abnormal titre at any point.
