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Sarah Paeds > MSK > Flashcards

MSK Flashcards

1
Q

Which JIA has a particularly poor prognosis?

A

RhF +ve polyarthritis

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2
Q

Which JIA is more common in boys than girls?

A

Ethesitis-related arthritis

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3
Q

DDx for limp in children

A

Traumatic/mechanical

  • Scoliosis
  • Fracture
  • SUFE
  • Sprain/contusion
  • Leg length discrepancy

Inflammatory

  • JIA
  • Transient synovitis
  • Osgood Schlatter’s

Vacular
- Perthe’s

Infectious

  • Osteomyelitis
  • Septic arthritis
  • Reactive arthritis

Malignancy

  • Osteoma
  • Ewing’s sarcoma

Neuromuscular

  • CP
  • Musculr dystrophy
  • Peripheral neuropathy

Metabolic
- Ricket’s

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4
Q

Traumatic/mechanical causes of limp

A
  • Scoliosis
  • Fracture
  • SUFE
  • Sprain/contusion
  • Leg length discrepancy
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5
Q

Infectious causes of limp/joint pain

A
  • Osteomyelitis
  • Septic arthritis
  • Reactive arthritis
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6
Q

Inflammatory causes of limp/joint pain

A
  • JIA
  • Transient Synovitis
  • Osgood-Schlatter’s
  • Reiter’s
  • Lupus
  • Ank spond
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7
Q

Vacular causes of limp/joint pain

A

Perthe’s (AVN)

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8
Q

Three “severities” of DDH

A

Dysplasia, subluxation, dislocation

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9
Q

When is DDH normally picked up?

A

NIPE - in Barlow/Ortolani manoeuvres

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10
Q

Which manoeuvres are used to assess DDH?

A

Barlow and Ortolani

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11
Q

Signs of DDH

A

Asymmetry of skin folds around buttocks and hips. Limited abduction. One leg may be shorter than the other

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12
Q

What is DDH

A

Developmental dysplasia of the hip - ball and socket joint is not formed completely

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13
Q

What happens in most cases of DDH

A

Resolves spontaneously by 3-6 weeks

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14
Q

Mx DDH

A

R/f for ORTHOPAEDIC OPINION

1) Observation - use USS if under 6 months, XR after
2) >6mos. Place in Pavlik harness/splint up to 6mos. Keeps hip flexed and abducted.
3) Surgery if conservative measures have failed - with spica casting

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15
Q

Which infants are at highest risk of DDH? How should they be monitored?

A

Breech
FHx
- Monitored with USS at 6/52

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16
Q

Which imaging modality is best in assessing DDH?

A

USS < 6months

XR > 6mos

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17
Q

Mx of fractures

A

Consider safeguarding

Pain management - PO ibuprofen/paracetamol. IV opioids
Immobilisation

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18
Q

Mx distal radius #

A

Manipulation

K-wire fixation if fracture off-ended

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19
Q

Mx of femoral shaft #

A

ADMIT
Orthopaedic management

0-6 mos: Pavlik’s harness, Gallow’s traction
2-18mos: Gallow’s traction
1-6yrs: straight leg skin traction, hip spica cast
6-12yrs: elastic intramedullary nail
11yrs+: elastic intramedullary nail, end caps, ridid intramedullary nails, submuscular plating

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20
Q

Signs/symptoms of SUFE

A

Acute onset hip/groin pain/referred knee pain

Restricted abduction and internal rotation
- Legs presents as slightly shorter and externally rotated

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21
Q

Commonest age of presentation SUFE

A

Adolescents (10-15 years)

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22
Q

Pathophysiology of SUFE

A

Posterior-inferior slippage after fracture through the growth plate

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23
Q

What is a SUFE?

A

Slipped upper femoral epiphysis - a fracture through the growth plate in the femoral head
Posterior-inferior slippage

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24
Q

Patients at higher risk of SUFE

A

Boys
Obesity
Metabolic abnormalities - hypoCa, hypothyroid, hypogonad

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25
Q

What views should be requested in SUFE XR?

A

AP

Frog lateral

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26
Q

Mx of SUFE

A

Surgical repair - screw fixation

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27
Q

Age of presentation Perthe’s

A

5-10 years

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28
Q

What is Perthes?

A

AVN of capital femoral epiphysis of femoral head due to interruption of the blood supply, followwd by revascularisation and ossification over 18-36 months

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29
Q

Signs/symptoms of Perthes

A

Insidious limp, hip pain

Referred knee pain

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30
Q

What percentage of Perthes is bilateral

A

10-20%

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31
Q

Ix requested in suspected Perthes

A

AP
Frog lateral
(+MRI/bone scan)

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32
Q

Findings on XR Perthes

A

Increased density in femoral head
Fragmented/irregular femoral head
Widening of joint space

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33
Q

Most important factor in Perthes prognosis?

A

Early diagnosis - if 1/2 femoral head affected, bed rest and traction

If >1/2 affected, plaster/calipers to keep femoral head close to acetabulum to use as mould for reossification

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34
Q

Mx for Perthes

A

Supportive care (analgesia, ice packs, etc.)
Continued activity
Physical therapy - stretching and strengthening of quads and hamstrings

Surgical treatment if fail to resond to conservative measures

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35
Q

Commonest chronic inflammatory joint disease in children/adolescents

A

JIA

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36
Q

What is JIA?

A

Juvenile idiopathic arthritis - persistent joint swelling for more than 6 weeks before 16 years old. Absence of an infecive cause.

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37
Q

How many subtypes of JIA? exist? Give examples

A 
7 
Poly (>4 joints)
Oligo (<4 joints)
Systemic (if ever presents with rash)
RhF/B27 tissue subtypes
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38
Q

What percentage of JIA diagnoses are distinct from RhA in adulthood?

A

95%

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39
Q

Signs/symptoms of JIA?

A

“Gelling” - stiffness after rest/in morning
Swollen joints - swelling of the joint fluid, inflammation, thickening of synovium.

  • High fever (paroxysmal)
  • Malaise
  • Salmon rash
  • Raised APPs (ESR)

Difficulty eating - TMJ involvement
Intermittent limp
Behavioural/mood change

40
Q

What are the features of uncontrolled JIA?

A

Overgwoth of inflammed synovium = limb/digit length discrepancy, valgus deformity

Chronic anterior uveitis
Flexion contractures of joints
Growth failure
Osteoporosis (non weight bearing, steroids)

41
Q

Management of JIA?

A

Specialist paediatric rheum MDT
PTOT
Continued activities such as cycling and swimming

Medical: analgesia, NSAIDs, STEROIDS (IV, PO, intra-articular)
DMARDs - if failure to respond. Methotrexate and sulfasalazine
TNF-alpha inhibitors

42
Q

Complications of reduced activity due to MSK conditions

A

Deconditioning
Disability
Decreased bone mass –> osteoporosis

43
Q

Which DMARDs can be used in JIA failing to respond to conventional treatments?

A

Methotrexate

Sulfasalazine

44
Q

Why are steroids avoided in JIA if possible?

A

Growth suppression

Osteoporosis

45
Q

DDx joint swelling

A 
JIA 
Transient synovitis 
Lupus 
Reiter's 
Septic arthritis 
Reactive arthritis
46
Q

What is transient synovitis?

A

“Irritable hip” - inflammation of the synovium

47
Q

Commonest cause of acute hip pain in children

A

Transient synovitis

48
Q

Age of presentation transient synovitis

A

2-12 years

49
Q

Major differences between transient synovitis and septic arthritis

A

SA: fever, hip held flexed, severe pain, High WCC, Raised APPs, widened joint space

50
Q

Common features of transient synovitis

A

Often a preceding viral infection (but tend to be afebrile at the time of presentation)
Sudden onset hip pain/limp
No pain at rest
Reduced ROM, particularly internal rotation
Normal WCC/APP

51
Q

Ix for transient synovitis

A

USS (fluid in joint)
XR (normal)
Joint aspiration - only if fears of septic arthritis

52
Q

Mx of transient synovitis

A

Conservative

  • Analgesia (paracetamol/NSAIDs)
  • Bed rest
53
Q

How long does it take for transient synovitis to self resolve?

A

2-3 days

54
Q

Mx of ricket’s

A 
Vitamin D (Ergocaliciferol (D2), Cholecalciferol (D3).
Calcium
55
Q

What is Osgood-Schlatter’s syndrome?

A

Osteochondritis of the patellar tendon insertion at the knee.

56
Q

Commonest demographic presentation of OSS?

A

Adolescent, physically active males (particularly running/jumping)

57
Q

Signs/symptoms OSS?

A

Knee pain after exerise. Localised tenderness.
Tibial tuberosity tenderness
Hamstring tightness

OFTEN BILATERAL

58
Q

What percentage of OSS is bilateral?

A

25-50%

59
Q

Mx OSS

A
  • Pain relief: paracetamol, NSAIDs, ice packs, protective knee pads
  • Stretching
  • Reduce quad-heavy activity, e.g. running and jumping
  • Increased quad-light activity e.g. swimming, cycline
60
Q

Commonest organism in psoas abscess

A

S.aureus

61
Q

Mx for psoas abscess

A

Drainage and abx

62
Q

Which joints does reactive arthritis most commonly affect?

A

Knees and ankles

63
Q

What is reactive arthritis?

A

Transient joint swelling and pain after preceding extrarticular infection (<6 weeks)

64
Q

How long does reactive arthritis usually last?

A

<6 weeks

65
Q

Which infections does reactive arthritis often follow?

A

Enteric: salmonella, shigella, campylobacter (children)

STIs

Mycoplasma

Lyme

66
Q

Signs/symptoms of reactive arthritis

A

Joint pain/swelling after extra-articular infection
Low grade fever
Normal or mildly elevated APPs

67
Q

XR findings reactive arthritis

A

Normal

68
Q

Mx reactive arthritis

A

Self-resolving

Pain relief: NSAIDs, paracetamol
Steroids if severe
DMARDs if ongoing - methotrexate, sulfasalazine

69
Q

Where is the infection in osteomyelitis?

A

Metaphysis (commonly of long bones). Often distal femur/proximal tibia

70
Q

Why is joint destruction from osteomyelitis less common younger children than adolescents?

A

The growth place limits spread.

But can lead to growth arrest

71
Q

Signs and symptoms of osteomyelitis

A

Limp
Limb/joint pain/swelling - painful and immobile
Fever

Sterile effusion of adjacent joint

72
Q

Complications osteomyelitis

A

Spread to cause septic arthritis

73
Q

Ix and results osteomyelitis

A

FBC (rasied WCC, APPs)
BC: positive
XR: initially normal but subperiostal new bone formation shows after 7-10 days + localised bone rarefaction
MRI: to distinguish between bone and soft tissue infection

74
Q

Acute osteomyelitis mx

A

High dose empirical IV abx (2-4 weeks) - depending on culture from MC&S

Can swith to PO once clinical recovery

Immobilise affected limb
Analgesia

Surgical debridement/decompression if dead bone

75
Q

When should blood cultures be taken in osteomyelitis/septic arthritis?

A

BEFORE STARTING ABX

76
Q

Septic arthritis

A

Infection of joint space

77
Q

Commonest causative organism septic arthritis (after neonatal period)

A

S. aureus

78
Q

Signs/symptoms infective arthritis

A 
Acute onset joint pain/swelling
NON-weight bearing  
High grade fever 
Erythematous, warm 
Pseudoparesis (hip held in flexed position) - severe pain at rest
79
Q

Septic arthritis Ix

A

FBC (Raised WCC, ESR, CRP)
BC: positive (MC&S)
XR: widened joint space
USS: joint fluid

JOINT ASPIRATION UNDER USS

80
Q

Septic arthritis mx

A

Prolonged abx

  • 2 weeks IV
  • 4 weeks PO

(+ve: vanc; -ve: cef)

Joint aspiration/washing out/drainage

81
Q

Appropriate abx in septic arthritis gram +ve

A

Vancomycin

82
Q

Appropriate abx in septic arthritis gram -ve

A

Ceftriaxone

83
Q

Osteoid osteoma

A

Benign tumour
Adolescent boys
Femur, tibia, spine
More painful at night

84
Q

Osteoid osteoma common sites

A

Femur, tibia, spine

85
Q

Inheritance pattern of achondroplasia

A

AD

86
Q

Features of achondroplasia

A 
Short stature (due to short limbs)
Large head 
Frontal bossing 
Depressed nasal bridge 
Lumbar lordosis
87
Q

What is the pathophysiology osteogenesis imperfecta?

A

Disorder of collagen metabolism leading to bone fragility

88
Q

Features of T1 osteogenesis imperfecta

A

Childhood fractures
Blue sclera
Hearing loss

89
Q

Mx osteogenesis imperfecta

A

Bisphosphonates

90
Q

Features of hypermobility

A

Knees “giving way”
Flat foot w/ arch on tip toes
Younger female girls
Mechanical joint/muscle pain

91
Q

Features of growing pains

A 
Nocturnal idiopathic pain 
Symmetrical 
Not limited to joints 
NEVER present at start of day 
No limp 
Physical acitvity not limited 
Physical examination normal
92
Q

Commonest cause torticollis

A

SCM tumour (mobile, non-tender nodule) Restriction in head turning/tilting

93
Q

Pes cavus

A

High arch - indicative of neuromuscular disorders

94
Q

Positional talipe

A

Club foot caused by intrauterine compression
Normal size foot, corrected by manipulation

Passive exercises from physio

95
Q

Equinovarus talipe

A

Entire foot inverted and supinated
Shorter foot with thinner calf muscles

Often BILATERAL

96
Q

Signs and symptoms of chrondromalacia patellae

A 
Young adults (overuse in physical activity)
Passive movements usually painless 
Repeated extension = grating/crepitus/small effusion
97
Q

Pathophysiology chrondomalacia patellae

A

Degeneration of the articular ligament on the posterior surface of the patella

Sarah Paeds (20 decks)

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