msk Flashcards
describe osteogenesis imperfecta. what is the most common type?
- group of collagen metabolism disorders
- autosomal dominant
- causes fragile bones, lots of fractures
- Type 1
describe the signs of type 1 osteogenesis imperfecta
- frequent fractures
- blue sclera
- hearing loss
treatment for osteogenesis imperfecta?
bisphosphonates
which type of osteogenesis imperfecta is lethal and why?
- type 2
- causes multiple fractures in the womb
- stillborn
what is the inheritance pattern of Marfan syndrome?
autosomal dominant
signs of Marfan syndrome?
- tall stature
- long thin digits
- big arm span
- hyperextensible joints
- high arched palate
- dislocated lenses of eyes
- myopia (short-sighted)
- scoliosis
which 2 manoeuvres are used in DDH diagnosis?
- Barlow = dislocating hip from acetabulum posteriorly
- Ortolani = relocating the hip on abduction
how does DDH normally present?
- found on exam (doing B + O manoeuvres)
- limp
- abnormal gait
signs of DDH?
- limping
- abnormal gait
- asymmetrical skin folds around hip
- reduced abduction of hip
- shortening of affected leg
management of DDH?
- splint
- keeps the hip flexed
describe growing pains
- nocturnal idiopathic pains
- might wake them up at night
- lower limbs
- eased by massage
- NO limp or morning pain
- normal physical exam
what are the 2 commonest sites for osteomyelitis?
- distal femur
- proximal tibia
which organism causes most osteomyelitis cases?
staph aureus
presentation of osteomyelitis?
- severely painful, immobile limb
- red, swollen, tender
- pain on movement
- acute fever
investigations for osteomyelitis?
- blood cultures are positive
- WCC raised
- CRP raised
- XR: normal initially, but shows swelling 10 days later
- USS
treatment for osteomyelitis?
- antibiotics
- surgical
- splint and rest
- decompression of subperiosteal space
- surgical drainage
what is Osgood-Schlatter disease?
osteochondritis of the patellar tendon insertion at the knee
who is the demographic for Osgood-Schlatter disease?
physically active teenage boys (esp football)
presentation of Osgood-Schlatter disease?
- knee pain after exercise
- tender knee
- swelling over tibial tuberosity
- hamstring tightness
management of Osgood-Schlatter disease?
- rest
- physio to strengthen quadriceps
- knee immobiliser splint
what is the commonest cause of acute hip pain in children?
transient synovitis
what age group does transient synovitis affect?
2-12 year olds
presentation of transient synovitis?
- sudden hip / limb pain
- no pain at rest
- reduced internal rotation
- often follows viral infection so child may be mildly febrile but well overall
causes of acute, painful limp in 1-3 year olds?
- septic arthritis
- osteomyelitis of hip / spine
- transient synovitis
- trauma (A or NA)
- malignancy
causes of acute, painful limp in 3-10 year olds?
- transient synovitis
- septic arthritis
- osteomyelitis
- overuse injuries and trauma
- Perthes disease
- JIA
- malignancy
differentials for acute, painful limp in 11-16 year olds?
- overuse / sports injuries
- trauma
- slipped capital femoral epiphysis
- Perthes disease
what is Perthes disease?
avascular necrosis of the capital femoral epiphysis of femoral head
what is the M:F in Perthes disease? which age does it present at?
5:1 (much more common in boys), 5-10 year olds
what is the first investigation in Perthes disease and what would it show?
X-ray, shows increased bone density in femoral head, later shows fragmentation
treatment in mild Perthes disease?
- bed rest
- traction
treatment in moderate-severe Perthes disease?
femoral osteotomy
what does SCFE stand for?
slipped capital femoral epiphysis
which demographic does SCFE affect?
8-15 year old obese boys
what might SCFE be associated with?
- hypothyroidism
- hypogonadism
presentation of SCFE?
- limp
- hip pain
- knee pain (referred from hip)
investigation for SCFE?
X-ray
examination findings in SCFE?
- reduced abduction of hip
- reduced internal rotation of hip
what is the crucial differential for transient synovitis?
septic arthritis!!!!!
what is the commonest form of arthritis in childhood?
reactive arthritis
define reactive arthritis
post-infectious joint swelling that lasts <6 weeks
which joints are commonly affected in reactive arthritis?
ankles or knees
what is the main source of reactive arthritis in children?
- following an enteric infection
- e.g. salmonella, shigella, campylobacter
which age group does septic arthritis present in?
< 2 year olds
what causes septic arthritis?
- mostly systemic infection spreading in the blood
- needle puncture site
- chickenpox
what is the commonest causative organism of septic arthritis in anyone older than a neonate?
staph aureus
presentation of septic arthritis?
- red, warm, acutely tender joint
- reduced ROM at joint
- child is acutely unwell and febrile
- infant cries if the limb is moved
which other condition does septic arthritis often coexist with?
osteomyelitis (15% of these cases also have septic arthritis)
investigations and findings in septic arthritis?
- WCC (raised)
- ESR, CRP (both raised)
- USS hip (effusion)
- X-ray (widened joint space, soft tissue swelling)
treatment of septic arthritis?
- long course of antibiotics, initially IV
- surgical drainage if this does not fix it
what is the consequence of untreated septic arthritis?
infection spreads from the joint space to the bone and destroys articular cartilage and bone
what is the commonest chronic inflammatory joint disease?
juvenile idiopathic arthritis (JIA)
define JIA
- persistent joint swelling lasting >6 weeks
- presenting in <16s
- in absence of infection or other defined cause
what is the commonest subtype of JIA?
oligoarthritis
what is the M:F for JIA?
1:5, much more common in girls
history in JIA?
- gelling (feeling stiff after long car rides)
- morning joint stiffness
- widespread joint pain
- fatigue
presentation of JIA in an infant?
- intermittent limp
- irritability
- bad behaviour
- avoidance of activity
why is it difficult to diagnose JIA?
- blood tests initially look normal, with negative rheumatoid factor
- antinuclear factor is quite non-specific
long-term consequences of JIA?
- bone expansion from overgrowth
- leg lengthening
- valgus deformity (knock knees)
- digit length discrepancy
complications of JIA?
- chronic anterior uveitis
- flexion contractures of joints
- growth failure, delayed puberty
- anaemia (of chronic disease)
- osteoporosis
- amyloidosis (rare)
systemic features in JIA?
- fever
- salmon pink rash on limbs
- malaise
management of JIA?
- ibuprofen
- joint injections (first line in oligoarticular JIA)
- methotrexate
- biological therapies (anti-TNF a, where methotrexate fails)
what could a slit lamp exam show in JIA?
chronic anterior uveitis
what is the most common vasculitis in childhood?
Henoch-Schonlein purpura
presentation of Henoch-Schonlein purpura?
- purpuric rash over lower legs and buttocks
- arthritis of ankles or knees
- abdominal pain
- haematuria
- proteinuria
which childhood demographic might SLE present in?
adolescent girls
presentation of SLE?
- malaise
- arthralgia
- malar, photosensitive rash
- other organ involvement
differentials for nocturnal waking with leg pain?
- growing pains
- osteoid osteoma
- leukaemia
- lymphoma
- neuroblastoma (young child)
differentials for a toxic-looking, febrile child with limited ROM at the hip?
- septic arthritis
- osteomyelitis
differentials for sudden limp and unilateral reduced ROM in hip, in an otherwise well child?
- transient synovitis
- Perthes disease
M:F in DDH?
1:6
