MSK Presentations in Children Flashcards
What are the broad differential diagnoses for the limping child?
- Traumatic
- Infectious
- Neoplastic
- Inflammatory
- Congenital
- Neuromuscular
- Developmental causes
What are the characteristics which help to distinguish between benign and malignant MSK conditions in children?
What questions should be asked when a limping child presents?
- Duration and progression of limp
- Recent trauma and mechanism?
- Associated pain and its characteristics
- Accompanying weakness?
- Time of day when limp is worse?
- Can the child walk or bear weight?
- Has the limp interfered with normal activities?
- Presence of systemic symptoms like fever or weight loss?
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Beware the limitations of paediatric hx and the possibility of non-accidental injury.
- History of trauma?
What are the differential diagnoses of an antalgic gait in children:
- <4 years?
- 4-10 years?
- >10 years?
What are the differential diagnoses of a nonantalgic limp in children?
What can alter a normal gait?
- Pain
- Mechanical problem
- Neuromuscular problem
What are the types of limp?
- Antalgic gait
- Equinus gait
- Trendelenburg gait
- Circumduction gait
Describe antalgic gait and state the variants.
- Painful limp.
- Shortened stance phase on affected side.
- Variant of the classic antalgic gait is the cautious gait of a child with back pain. For example, a child with diskitis will lose the normal rhythmic flexion and extension of the lumbar spine.
- Another variant is the complete refusal to walk.
- This pattern is seen most often in toddlers and may indicate a condition causing pain that cannot be avoided by any of the possible gait alterations.
What are the common causes of antalgic gait?
- Trauma
- Overuse syndrome
- Inflammation - transient synovitis, JIA
- Infection - septic arthritis
- Perthes disease
- SUFE
What are the common causes of equinus gait?
- Idiopathic toe walking
- Calf muscle contracture
- Cerebral palsy
- Late presentation DDH
- Late presentation CTEV
- DMD
Desribe the clinical picture of late presentation DDH.
- Motor delay especially infant girl.
- Unilateral equinus foot posture in stance.
- Asymmetric thigh creases.
- Asymetric / limited hip abduction.
- Shortening.
- Parental concern.
What are the common causes of Trendelenburg gait in children?
- Hip dysplasia
- Cerebral palsy
- Later stages of Perthes disease
- Longstanding SUFE
What is circumduction gait?
What are its common causes?
- During swing phase, circumduction gait allows a functionally longer limb to progress forward.
- May be associted with ‘vaulting’ over the long limb during stance.
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Common causes:
- Structural or functional leg length inequalities.
- Painful foot conditions - reduce ankle movement.
What physical manifestations would cause you to have a higher index of suspicion of non-accidental injury?
What are the signs of scoliosis in children?