Musculoskeletal Flashcards
Torticollis
wryneck; d/t fibrosis and shortening of sternocleidomastoid muscle secondary to abnormal intrauterine positioning or birth trauma. palpable swelling within muscle. head tilt toward affected side with rotation of chin to opposite side. do gentle passive stretching exercises and positioning crib to help distract them toward the opposite side. if not, surgery.
DDH
femoral head/acetabulum improper alignment. risk: female, family history, high birth weight, breech, in utero postural deformities. exam every visit until walking. Barlow/Ortolani in neonates. Klisic/Galeazzi for older infant screening. most identified resolve by 2-8weeks. s/s: short leg, assymmetry of folds. + trendelenburg sign, limping, limited abduction. Dx: US when 6weeks of age. Tx: observation, referral, if not Pavlik harness > surgery with spica cast.
Equiniovarus
clubfoot. pointed toe, inverted sole, convex shape of forefoot. cannot be manually corrected to neutral. x-rays. refer. taping, strapping, serial casting (Ponseti method); most need tenotomy of heel cord with long leg cast. full time bracing 3 months, nightly 3-5 years.
Metatarsus adductus/vaus
adduction of forefoot relative to hind foot. most common cause is intrauterine molding. sometimes with spreading of toes. assess for DDH too. Tx: stretching with each diaper change, reverse shoe/splint. if no improvement 4-6w, serial plaster casts. corrective shoes afterward. surgery at 4-6 years old. refer.
tibial torsion
twisting of long bone, rotation over 23 degrees. 90% resolves by 8 years old, often noted initially at 6-12 months old. observe gait, TFA -10 to -20, screen for hip dysplasia and CP. tx: observe/monitor, refer if significant, may need surgery.
genu varum and valgus
varum = leg bowing. physiologic or pathologic, normal until 3 years old. >15degree angle in infants, not decreasing in 2nd year, asymmetric, with short stature, progressing, then pathologic like Blount, rickets, tumor, neurological issue, infection, etc. dx: x-ray. tx blount with bracing; may need osteotomy if pathologic. Valgum = knock knees. improves by 4-6 years of age. Pathologic issues: rickets, renal osteodystrophy, skeletal dysplasia, physical arrest, tumors, infection. Joint pains/stiff gait, knee pain. dX: clinical. Tx: surgery.
transient synovitis of hip/perthes
3-8 year olds, mild to mod fever, mild irritability, resolves in 1 week; limited hip motion, ESR <25. tx with rest. d/t inflammatory reaction
osgood schlatter disease
microtrauma in patellar tendon. often in adolescents after rapid growth spurt, boys >girls ages 10-15 years old or 8-12. girls. s/s: recent physical activity; pain increases during/after activity, running/jumping etc exacerbates it, pain reproduced by extending knee against resistance, stressing quadriceps, or squatting with knees in flexion. focal swelling, heat, point tenderness. Dx: exam. Diff: osteosarcoma, hip problems. Tx: self-limiting. avoid/modify activities; use ice, stretching exercises, NSAIDs sometimes, sleeve, bracing with limited weight bearing for a few weeks, avoid overuse.
growing pains
nonarticular, located in shins, calves, thighs, popliteal fossa; usually bilateral. appears late in day/nocturnal, waking child. lasts minutes to hours. check vD levels. peak 4-8 years old. dx with exclusion. diff: restless leg, neoplastic lesions, leukemia, sickle cell, JA, osteomyelitis. Tx: symptomatic with heat/analgesia. refer if pain is localized, has swelling/other s/s, increasing in severity, or alters gait.
sports injuries - knee, elbow, hip
Slipped capital femoral epiphysis SCFE
salter-harris type I fracture of proximal femoral physics. @risk of necrosis. often during puberty, in overweight or skeletally immature boys; higher risk African Americans. if <10 years old, maybe hypothyroid, panhypopit, hypogonadism, renal osteodystrophy, GH abnormalities. Maybe have trauma, pain, intermittent limping* with short leg, mild atrophy of thigh/gluteal muscles, limited abduction/extension. X-ray. refer immediately; non weight-bearing. need surgery; high incidence contralateral SCFE in 6-12 months so follow closely.
JRA
until 16 years old. fever, rashes, increased WBCs, iritis, joint stiffness/swelling, s/s >3 months, mono/polyarticular arthropathy; + ANA, increased ESR. tx: NSAIDs > sulfasalazine, methotrexate, steroids, joint replacements.
Osteomyelitis
any age toddler and up; varied findings, malaise, low to high fever, severe constitutional s/s, toxicity, refusal to walk or move, limping, tenderness, takes 7-10days to see radiography bony changes, increased WBCs, increased CRP. likely S. aureus. tx with abx 7 days IV but 3-4 weeks total.
Muscular Dystrophy
Lupus
