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CPNP Boards > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

2 inflammatory musculoskeletal disorders seen in pediatrics

A
  1. Osgood-Schlatter disease

2. Toxic synovitis

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2
Q

Osgood-Schlatter disease

A

Inflammation of the tibial tubercle as a result of repetitive stressors (ie avulsion injury) in patients with immature skeletal development

  • athlete that does repetitive stress
  • during a time of rapid growth
  • causes a painful lump below the kneecap
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3
Q

Peak age of Osgood-Schlatter disease

A

11-14 years

**associated with rapid growth spurt

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4
Q

S/S of Osgood-Schlatter disease

A
  1. Pain and tenderness at tibial tubercle (below the kneecap)
  2. Point tenderness
  3. Enlargement compared to unaffected side (lump)
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5
Q

Labs/diagnostics for Osgood-Schlatter disease

A

None: typically diagnosis is made clinically
*make the diagnosis with your thumb

Radiographs can be done to rule out more serious causes of pain

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6
Q

Management of Osgood-Schlatter disease

A
  1. Self-limiting disease
  2. Limit activity to control pain.
  3. Complete activity restriction is not recommended. Need to LIMIt acitivity based on pain in order to decrease pain and bump/inflammation. Once they are done growing/done with growth spurt, the pain will go away.
  4. Knee immobilizers may provide some relief.
    * to decrease vibration of the inflamed tendon
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7
Q

Toxic Synovitis

A

Self-limiting inflammation of the hip that is most likely due to a viral or immune cause.

Often proceeded by URI or other viral illness.

Also called transient synvotitis.

*inner lining of the hip joint is inflamed

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8
Q

Peak age of Toxic Synovitis

A

Occurs most often between 2-6 years, but can occur from 1-15 years old

Males > females

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9
Q

S/S Toxic Synovitis

A
  1. Painful limp
  2. Unilateral involvement
  3. Insidious onset
  4. Internal rotation of hip causes spasm ***
  5. No obvious signs of infection on inspection/palpation (no hotness, warmth, or swelling)

**hurts and limping on 1 hip = unilateral

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10
Q

Labs/diagnostics for Toxic Synovitis

A
  1. Normal radiographs

2. Normal joint fluid aspiration

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11
Q

Management of Toxic Synovitis

A
  1. Analgesics/NSAIDs
  2. Bed rest as needed
  3. Typically benign and self-limiting
  4. Hospitalization should be considered if the patient has a high fever or septic arthritis is suspected.
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12
Q

2 non-inflammatory musculosketal disorders in pediatrics

A
  1. Legg-Calve-Perthes disease

2. Slipped capital femoral epiphysis

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13
Q

Legg-Calve-Perthes disease (LCPD)

A

Aspectic or avascular necrosis of the femoral head

  • no good blood flow to the area
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14
Q

Etiology/Incidence of Legg-Calve-Perthes disease

A
  1. Unknown etiology, possibly d/t vascular disruption
    - - increased risked in sickle cell and those on steroids
  2. Slightly shorter stature or delayed bone age compared to peers
  3. Most common in Caucasian boys, ages 4-9
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15
Q

S/S Legg-Calve-Perthes disease

A
  1. Insidious onset of limp with knee pain; pain may also migrate to groin/lateral hip
    * *pain starts in knee and goes up to groin
  2. Pain less acute and severe than transient synovitis or septic arthritis
  3. Afebrile
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16
Q

Physical findings in Legg-Calve-Perthes disease

A
  1. Limited passive internal rotation and abduction of the hip joint
  2. May be resisted by mild spasm or guarding
  3. Hip flexion contracture and leg muscle atrophy occur in long-standing cases

**any movement of the joint is painful

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17
Q

Labs/diagnostics for Legg-Calve-Perthes disease

A
  1. Radiographic studies

2. No labs necessary

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18
Q

Management treatment for Legg-Calve-Perthes disease

A
  1. Goal: to restore range of motion (ROM) while maintaining femoral head within acetabulum
  2. Observation only
    OR
  3. Aggressive treatment/ortho referral
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19
Q

Observation only in Legg-Calve-Perthes disease if:

A
  1. Full ROM is preserved
  2. Less than 6 years of age
  3. Involvement of less than 1/2 of the femoral head
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20
Q

Aggressive treatment in Legg-Calve-Perthes disease if:

A
  1. Indicated when more than 1/2 femoral head is involved
  2. Children > 6 yo
  3. Refer to orthopedics
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21
Q

Slipped capital femoral epiphysis

A

Spontaneous dislocation of femoral head (capital epiphysis) both downward and backward relative to the femoral neck and secondary to disruption of the epiphyseal plate

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22
Q

Etiology/Incidence of Slipped capital femoral epiphysis

A
  1. Unknown etiology; perhaps precipitated by puberty-related hormone changes
  2. Generally occurs withOUT severe, sudden force or trauma
  3. Typically during growth spurt and prior to menarche in girls
  4. Rare: 1-8:100,000
  5. Males and African American adolescents most common
  6. Incidence greater among OBESE adolescents with sedentary lifestyles!!!
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23
Q

S/S Slipped capital femoral epiphysis

A
  1. Pain in the groin and often referred to thigh/and or knee

2. When acute onset, pain will be severe with the inability to ambulate or move hip

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24
Q

Physical findings in Slipped capital femoral epiphysis

A

Unable to properly flex hip as femur abducts/rotates externally

May observe limb shortening, resulting from proximal displacement of metaphysis

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25
Q

Labs/diagnostics for Slipped capital femoral epiphysis

A

Accurate history combined with knowledge of etiological factors

Radiographs

Typically no labs

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26
Q

Management/Treatment for Slipped capital femoral epiphysis

A
  1. IMMEDIATE referral to orthopedist
  2. No ambulation permitted
  3. Monitor other hip for same problem
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27
Q

3 structural musculoskeletal disorders seen in pediatrics

A

Genu varum

Genu valgum

Scoliosis

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28
Q

Genu varum

A

Bowleg

Lateral bowing of the tibia, often due to joint laxity

Considered a normal variant until age 2 years; most common in toddlers

29
Q

S/S Genu varum

A
  1. It is acceptable for bowing that does not increase after walking
  2. Retains FROM
30
Q

Labs/diagnostics for Genu varum

A

None

31
Q

Management of Genu varum

A
  1. None necessary under age 2 years if appear as normal variant
32
Q

Refer Genu varum to orthopedics if:

A
  1. Continues after age 2 years
  2. Unilateral
  3. Gets worse with walking
  4. Becomes progressively worse after first year
33
Q

Genu Valgum

A

Knock-Knee

Knees are abnormally close and ankle space is increased

Typically evolves to normal alignment by 7 years of age

Preschool most common age

34
Q

S/S of Genu Valgum

A
  1. Knees close together
  2. Distance b/w medial malleoli (ankles) in > 3 inches
  3. No pain
  4. FROM
  5. Walk or run may be awkward
35
Q

Labs/diagnostics for Genu Valgum

A
  1. None necessary

2. Radiographs if over age 7 years of if unilateral involvement is present

36
Q

Management of Genu Valgum

A
  1. None necessary

2. Refer if lasting after age 7 or if unilateral involvement

37
Q

Scoliosis

A

Lateral curvature of the spine that is idiopathic and most common in adolescence.

Other types are congenital (ie infancy) or neuromuscular (a/w conditions).

Females > males 8:1

70% of cases are familial

38
Q

S/S of Scoliosis

A
  1. May occur at any age
  2. Rarely painful
  3. Asymmetry of shoulder, ribs, hips, and waistline (Adam’s Forward Bend Test)
    * *if asymmetry seen in any of the places = scoliosis
39
Q

Labs/diagnostics for Scoliosis

A

Radiographs for further evaluation

**put on x-ray order: “quantification of scoliosis” in order to see the degree of curvature

40
Q

Management of Scoliosis

A
  1. Further evaluation in any degree if pain occurs
    - - possible PT to increase muscle tone and decrease pain
  2. Observe if no pain exists and if less than 25 degree curvature
  3. REFER if painful or greater than 25 degree curvature
41
Q

Muscular Dystrophy (Duchenne)

A

Chronic progressive disorder

Progressive genetic disorder beginning in the lower extremities and progressing to the upper extremities and torso

*The most common inherited neuromuscular disease in children.

Affects 1:3,500 MALES

Average age of diagnosis is 3-5 years

42
Q

S/S of Muscular Dystrophy

A
  1. Abnormailities of gait and posture
    * always leaning on something
  2. Developmental clumsiness
  3. Cannot keep up with developing peers
  4. Gower’s sign
  5. Firm, large, woody calves (healthy muscle replaced by degenerative tissue)
  6. Decreased proximal muscle strength
    * loose core muscles first and then loose peripheral
  7. Wheelchair dependent by age 12 years
  8. Eventual death from cardiopulmonary failure

**intellect NOT affected

43
Q

Gower’s sign a/w Muscular Dystrophy

A

Child “walks” hands up to legs to attain standing position when getting up

Suggest pelvic girdle weakness

44
Q

Labs/diagnostics for Muscular Dystrophy

A

Creatine kinase: Markedly elevated in affected males (15,000-35,000 IU/L) – measures muscle death/damage
***only 1 you need to do in primary care – then refer to palliative care b/c it is a progressive disease

Electromyography (EMG): Myopathy

EKG: Abnormal

Muscle biopsy: Necrotic degenerating fibers

DNA analysis of gene: to diagnosis

45
Q

Management of Muscular Dystrophy

A
  1. Symptomatic care to delay progression and maintain strength and mobility
  2. Genetic testing
46
Q

Ankle Sprain

A

Stretching or tearing of the ligaments around the ankle, typically involving the lateral ligament complex

  • most common sports injury
  • most common musculoskeletal injury
  • usually a forced inversion (lateral ankle) or eversion (medial ankle)
47
Q

S/S of Grade I ankle sprain

A

= stretching but no tearing of ligament; no joint instability

  • local tenderness
  • minimal edema
  • ecchymoses typically insignificant or absent
  • FROM remains although it may be uncomfortable
  • patient retains weight bearing ability
48
Q

S/S of Grade II ankle sprain

A

= partial (incomplete) tearing of ligament; some joint instability but definite end-point laxity

  • pain immediately upon injury
  • localized edema and ecchymosis
  • significant pain with weight bearing
  • ROM is limited and painfull
49
Q

S/S of Grade III ankle sprain

A

= complete ligamentous tearing; joint instability with no definite endpoint to ligamentous stressing

  • severe pain immediately upon injruy
  • significant edema along foot and ankle
  • profound ecchymosis d/t hemorrhage; worsens over several days
  • patient cannot bear weight
  • No ROM to ankle

**usually go to UC or ER right after injury

50
Q

Labs/diagnostics for ankle sprain

A

Radiograph is indicated according to Ottawa Ankle Rules if:

a. There is pain near the malleoli AND
b. Bone tenderness is present at the posterior edge of the distal 6 cm or the tip of either malleolus OR
c. The patient is unable to bear weight for at least 4 steps at the time of injury and evalution

51
Q

Management for ankle sprain

A
  1. RICE: All grades including III (unless severe grade) respond well

Rest: Avoid weight bearing for first several days

Ice: Should be applied on top of the compression dressing as quickly as possible following the injury: 30 minutes on and off alternately

Compression: Immediate secure compression (will minimize edema and support stability of the ankle)

Elevation: For several days following injury (reduces pain and swelling and promotes recovery)

  1. NSAIDs for pharmacologic relief for pain and support`
52
Q

Salter-Harris fracture

A

Uniqure to pediatric patients of varying ages, Salter-Harris fractures occur in the growth plate of long bones during development

Boys are twice as likely as girls to sustain a Salter-Harris fracture

53
Q

S/S of Salter-Harris fracture

A
  1. Traumatic injury ***
  2. Localized joint pain with warmth, swelling, and tenderness
  3. Limited ROM and weight-bearing capability
  4. Bone displacement
54
Q

Labs/diagnostics for Salter-Harris fracture

A
  1. Diagnosis based on clinical findings as radiographs may appear normal
  2. X-ray
  3. CT scan
  4. US (in infants)
55
Q

Salter I

A

Slipped - fracture line extends through physis (growth plate)

56
Q

Salter II

A

Above - most common fracture; extends through both the physis and metaphysis

57
Q

Salter III

A

Lower - intra-articular fracture extending from the physis and epiphysis

58
Q

Salter IV

A

Through/transverse - intra-articular passing through epiphysis, physis, and metaphysis

59
Q

Salter V

A

Rammed/ruined - rare, with severe crushing or compression injury that extends through epiphysis and physis

60
Q

Management of Salter-Harris fracture

A
  1. Prescription pain medicine
  2. Rest, elevation, ice
  3. Closed reduction and casting or splinting for Salter I and II
  4. Open reduction internal fixation for Salter III and IV
61
Q

Elbow fracture

A

Often a/w injuries resulting from straight, outstretched arm falls

62
Q

S/S of Elbow fracture

A

Fat pad sign

  • no fracture is visible on x-ray
  • the lateral view demonstrates elevation of the anterior and posterior fat pads
  • even if fracture cannot be visualized on radiograph, the fat-pad sign suggest the presence of an occult fracture
63
Q

Labs/diagnostics for Elbow fracture

A

Follow-up radiographs with an oblique view

64
Q

Management of Elbow fracture

A

Refer to orthopedics to be treated as a fracture

65
Q

Nursemaid elbow

A

Common injury in young children resulting from shining or pulling child’s arm

= radial head subluxation

66
Q

S/S of Nursemaid elbow

A
  1. Inability/refusal to use affected arm
  2. Pain with supination ***
  3. Holds arm across body with thumb up
  4. Significant swelling and bruising justifies X-ray
67
Q

Labs/diagnostics for Nursemaid elbow

A

X-ray will read as normal and is usually not done

68
Q

Management of Nursemaid elbow

A

Pop it back in place

Supportive care at home with NSAIDs

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