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PAEDIATRICS > MSK Problems > Flashcards

MSK Problems Flashcards

1
Q

MSK S+S

A

Limp
Joint pain and swelling
Remember that hip pain may be referred to the knee
Morning stiffness
Gelling - stiffness following period of inactivity
Weakness and instability

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2
Q

Associated systemic symptoms

A

Fever
Reduced feeding or growth
Rash
Poor sleep

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3
Q

DDx:

General

A

Must exclude trauma and infection

Consider general causes of MSK pain such as growing pains and hyper mobility.

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4
Q

DDx:

< 5 yrs old - acute and chronic

A

Irritable hip, neuroblastoma, leukemia

Developmental dysplasia of the hip, talipes, cerebral palsy, juvenile idiopathic arthritis (JIA)

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5
Q

DDx:

5-10 yrs old - acute and chronic

A

Irritable hip, pethes disease, osteosarcoma, leukaemia

JIA, Perthes, Duchenne, Cerebral palsy

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6
Q

DDx:

> 10 yrs old - acute and chronic

A

Slipped upper formal epiphysis (SUFE), reactive arthritis, osteosarcoma, leukaemia

JIA, SUFE, Osgood-Schlatter’s disease (inflammation of the tibial tuberosity)

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7
Q

Inherited skeletal problems:

How do they present?

Achondroplasia - what does it result in?

S+S?:

  • Limbs
  • Fingers
  • Hands
  • Head
  • Nose
  • Spine
A

Growth problems
Bone deformities
Motor delay

Dwarfism

Short limbs causing short stature
Short fingers and broad hands
Large head and frontal bossing with flattened nasal bridge
Lumbar lordosis

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8
Q

Inherited skeletal problems:

Osteogenesis Imperfecta - another name?
What is it?
Presentation?

A

Brittle bone disease

Collagen defect

Freq fractures
Hearing loss

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9
Q

Developmental dysplasia of the hip:

What is it?

2 causes?

Who is it more common in?

Uni/bilateral?

A

Hip instability and dislocation

Lose joint capsule or intrauterine problem such as being breeched/oligohydraminios

Girls

Usually unilateral

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10
Q

Developmental dysplasia of the hip:

S+S:

  • Length
  • Gluteal folds
  • Abduction
  • Gait
  • Spine
A

Leg length discrepancy

Asymmetrical gluteal folds

Reduced abduction

When older, waddling gait and hyperlordosis

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11
Q

Developmental dysplasia of the hip:

Investigations:
2 tests
Imaging and when

Management if < 6 months and > 6 months

A

Newborns screening with Ortolani’s test and Barlow’s test
USS < 6 months
Hip XR > 6 months

Pavlik harness - highly effective if started early

Surgery

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12
Q

Paediatric fractures:

Incomplete fractures - what is it?

A

Increased flexibility of children’s long bones mean that longitudinal stress (e.g. from FOOSH) may result in bending/buckling of the bone without complete fracture.

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13
Q

Paediatric fractures:

What is a …?

Buckle (aka torus) fracture

Greenstick fracture

How are they managed?

A

No fracture line but buckle/bulge cortex which may be seen

Fracture line on inner cortex which does not extend to the opposite cortex

Cast/splint

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14
Q

Paediatric fractures:

Salter-Harris fractures

How is a mild fracture managed?

How is a severe fracture managed?

A

Fractures that involve the cartilaginous growth plate classified from 1-5

Closed reduction and cast/splint

Open reduction and internal fixation - risk of growth impairment and arthritis otherwise

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15
Q

Paediatric fractures:

Toddler’s fracture

what is it
when
where

X-ray - what do you see, when is it apparent that the fracture has occurred?

Management

A

Undisplaced spiral fracture of the tibial shaft in ambulatory toddler - 9-36 months

Normal with injury only apparent from new periosteal bone formation 7-10 days later

Cast/splint

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16
Q

Irritable Hip

AKA TSOH - what does that stand for?

Presentation:
Site and onset of pain?
Where may pain be referred to?
What is reduced?
What might it have been triggered from?
What should be considered if multiple joints are affected?
A

Transient synovitis of the hip

Sudden onset of hip pain (on movement) and/or limp
Pain my be referred to knee
Reduced internal rotation
May be triggered by viral infection so there may be history of fever

JIA

17
Q

Irritable hip

Investigations:

What may USS show?

What about XR?

How is TSOH diagnosed?

Management - conservative?

When does it resolve?

A

May show fluid

Normal

Diagnosis of exclusion so if imaging and bloods are negative (ruling out septic arthritis), TSOH, more likely.

Rest and ibuprofen until able to mobilise

1-2 wks

18
Q

Perthes Disease:

What is it?

Who does it usually affect?

Age of onset?

A

Avascular necrosis of the femoral head

Boys

5-10 yrs old

19
Q

Perthes Disease:

S+S:
Sites and onset of pain and limp
Where may it radiate to?
Exacerbating factors 
How may it initially appear?
A

Gradual onset of hip and knee pain and limp

Groin and buttocks

Activity

Transient synovitis

20
Q

Perthes Disease:

Investigations:

What might you see on hip XR? - 4

What can be used for early disease if XR is normal?

A

Widening joint space
Sclerosis
Fragmentation
Flattening of femoral head later on

MRI or bone scan

21
Q

Perthes Disease:

Management

A

Simple analgesia and rest

Plaster or surgery to secure femoral head in acetabulum

22
Q

Slipped Upper Femoral Epiphysis (SUFE)

What is it?
Who does it usually affect?
Age of onset?
Risk factors - 2

A

Displacement of the rounded head of the femur

Boys

10-16 yrs

Obesity
Hypogonadism - causes delayed bone maturation

23
Q

Slipped Upper Femoral Epiphysis (SUFE):

S+S:
Where is the pain?
What is reduced?
Onset?

Investigations - what would you see on XR?

Management

A

Pain in groin, thigh and/or knee and limp

Internal rotation

Gradual

Displacement of femoral head

Surgical fixation to prevent further slippage and avascular necrosis of the femoral head

24
Q

Juvenile Idiopathic Arthritis:

What is it also known as?

How is it defined?

Subtypes:

A

Juvenile RA (JIA)

Persistent >6 wks joint swelling in children < 16 yrs old

Oligoarticular JIA
Polyarticular JIA
Systemic-onset JIA
Psoriatic JIA

25
Q

Juvenile Idiopathic Arthritis:

Signs and Symptoms

A 
Pain
Reduced function 
Leg length discrepancy 
Flexion contracture 
Systemic symptoms - malaise, fever
26
Q

Juvenile Idiopathic Arthritis:

Investigations

What is done?

A

Inflammatory markers
X-rays
Autoantibodies

27
Q

Juvenile Idiopathic Arthritis:

Stepwise Treatment - Step 1, 2, 3, 4

A

1 - Regular NSAID’s - ibuprofen, naproxen
2 - Steroids - intra-articular injections
3 - DMARDS - methotrexate
4 - Biologics - etanercept

PAEDIATRICS (49 decks)

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