MSK disorders Flashcards
What is genu varum?
Bow legs.
The normal toddler has a broad-based gait.
A pathological cause is rickets.
What is pes planus?
Flat feet, common in toddlers.
Marked flat feet is common in hypermobility.
What are the presenting symptoms of DDH if it is not detected on neonatal screening?
Limp or abnormal gait
Asymmetry of skin folds around the hip.
Limited abduction of the hip
Shortening of the affected leg
What is scoliosis?
Lateral curvature in the frontal plane of the spine
What are the causes of scoliosis?
Idiopathic
Congenital
Secondary (neuromuscular imbalance e.g. cerebral palsy, muscular dystrophy
What are the clinical features of scoliosis?
Irregular skin creases and difference in shoulder height.
How do you treat scoliosis?
Mild - self-resolving
Bracing should be considered
If severe, surgery
What are the clinical features of growing pains?
Age 3-12 years.
Pains symmetrical in lower limbs and not limited to joints.
Pain never present at the start of the day after waking.
Physical activités not limited; no limp
Physical exam normal and otherwise well
What is genu valgum?
Knock knees - the feet are wide apart when standing with the knees held together. It is seen in many young children and usually resolves spontaneously
What are the three features of in-toeing?
Metatarsus varus (front part of the foot points inwards)
Medial tibial torsion (inward twisting of the tibia)
Persistent anteversion of the femoral neck (inward twisting of the thigh bone)
What is the differential to consider in bow legs?
Rickets
Osteogenesis imperfecta
What is the differential to consider in knock knees?
Juvenile idiopathic arthritis
What is the differential to consider in flat feet?
Hypermobility
What are the differentials to consider in in-toeing?
Tibial torsion, femoral anteversion
What are the differentials to consider in out-toeing?
Hypermobility
Ehlers-Danls
Marfans
What are the differentials to consider in toe walking?
Spastic diplegia (CP)
Muscular dystrophy
Juvenile idiopathic arthritis
What is talipes equinovarus?
Clubfoot.
The entire foot is inverted and supinated, the forefoot adducted and the heel is rotated inwards and in plantar flexion. The affected foot is shorter and the calf muscles thinner than normal
Is talipes equinovarus often bilateral and can you fix it?
The foot is fixed, it cannot be corrected completely.
It is often bilateral
What are the risk factors for talipes equinovarus?
Being male Familial link Oligohydramnios Neuromuscular disorder such as spina bifida DDH
How do you treat talipes equinovarus?
Treatment is started promptly with plaster casting and bracing (Ponsetti method) which may be required for many months.
What is the role of US in DDH?
Allows detailed assessment
Quantifies the degree of dysplasia
Whether there is subluxation or dislocation
What are the pathological clinical features of hypermobility?
MSK pain mainly confined to the lower limbs, often worse after exercise
How do you treat hypermobility?
Advice about footwear
Exercises
Occasionally orthotics
What disorders are associated with hypermobility?
Down syndrome
Ehlers-Danlos syndrome