Musculoskeletal Flashcards
What is metatarsus varus?
adduction of the forefoot on the hind foot
What is the treatment for metatarsus varus?
possible splinting if rigid
What are the four deformities seen on physical exam of a child with clubfoot?
- C: midfoot Cavus
- A: forefoot Adductus
- V: hindfoot Varus
- E: hindfoot Equinus
What is the preferred treatment for clubfoot? What is associated with success?
Ponseti method (most successful if started in first month of life)
What is talipes equinovarus?
club foot
What is talipes calcaneovalgus?
excessive dorsiflexion at the ankle and eversion of the foot due to intrauterine positioning which usually responds to stretching
At what age does genu varum usually resolve?
12-18 months
At what age does genus valgus usually resolve?
6 to 7 years old
When should Blount’s Disease (tibia vara) best suspected?
persistent bowing of knees after 2 years old
What is the treatment for Blount’s Disease?
osteotomy of the proximal tibia and fibula
What is the Galeazzi test?
Flexing hips and knees to assess knee heights
What is the Barlow test?
Trying to dislocate the hip by pushing posteriorly on a flexed and adducted leg
What is the Ortolani test?
Trying to relocate a dislocated hip by putting anterior pressure over the greater trochanter in the hip with limited abduction.
What is the most commonly affected side in congenital torticollis?
the right side
What 2 conditions should be excluded in a child presenting with congenital torticollis?
cervical hemivertebrae, atlantoaxial rotary subluxation
What is the most common cause of congenital torticollis?
fibrosis of the SCM
What should also be suspected in a child with congenital torticollis?
developmental hip dysplasia
What is the treatment for congenital torticollis?
stretching the neck 4-6 times per day (every diaper change)
What determines if facial asymmetry will resolve in a child with congenital torticollis?
If normal range of motion is obtained by 1 year old it should resolve
When is surgical intervention considered for congenital torticollis?
no improvement by 18-24 months
How is a subluxation of the radial head reduced?
with supination and extension or the opposite movement
What causes medial elbow pain in a young baseball pitcher?
medial epicondylar apophysitis
What is the most common cause of limping and hip pain in children?
transient synovitis of the hip
What age range typically suffers AVN of the proximal femur (Legg-Calve-Perthes)
4 - 10 years old
What age range typically suffers SCFE?
9 - 15 years old
What hip motion is limited in transient synovitis, ATN, and SCFE?
internal rotation
When can full activity resume in a patient with acute transient toxic synovitis?
When the hip is pain free
Treatment for ATN of the hip?
rest and weight bearing in abduction brace
Most common hip disorder in preadolescents-adolescents?
SCFE
When does juvenile scoliosis present?
3 - 10 years old
Most common curve in adolescent scoliosis?
right thoracic
What diagnostic test should all children with congenital scoliosis have?
a renal US
When can surgery be considered for neuromuscular scoliosis?
when Cobb angle is over 20 degrees
What is an isthmic spondylolisthesis?
slippage due to fracture of the pars
What is the most common level for spondylolisthesis in children?
L5-S1
What are two causes of dysplastic spondylolisthesis?
pars elongation or facet joint malformation
When is surgical fusion generally recommended for spondylolisthesis?
slippage over 50% or progressive neurological deficits
What level scoliosis can a TLSO be used for?
Curve apex of T9 or lower
What is Klippel-Feil syndrome
congenital fusions of the cervical vertebrae
What is the underlying abnormality in osteogenesis imperfecta?
defective collagen synthesis
What is the most severe type of osteogenesis imperfecta?
type III
Besides long bone fractures, what are 4 other features of osteogenesis imperfecta?
aggressive scoliosis, joint laxity, aortic dilatation, and hearing loss
What are two orthopedic deformities that toe-walkers are at risk for?
mid-foot collapse and external tibial torsion
What physical exam finding can differentiate mild diplegia from idiopathic toe walking?
ankle clonus (few beats)
Toe-walking after what age may not improve?
6
What is the goal range of motion with heel-cord lengthening in a toe walker?
10 deg of dorsiflexion with knee extended
When is toe-walking a red flag for a neuromuscular condition?
presentation over 3 years old
How does arthrogryposis present in utero?
absence of fetal joint movement in setting of polyhydramnios
In what three areas can contractures be seen in arthrogryposis?
jaw, spine, extremities
What is the survival of those with arthrogryposis?
normal
How is arthrogryposis defined?
two or more joint contractures present at birth
What should be ruled out before starting therapy in an infant with arthrogryposis?
fracture
What is group 1 arthrogryposis?
total body involvement (Larsen syndrome) with significant ligament laxity, myelopathy and joint dislocations
What is group 2 arthrogryposis?
distal involving hands and feet
What is group 3 arthrogryposis?
involves pterygium syndrome with webbing across flexor creases (axilla, elbow, knee)
Why are unilateral hip dislocations in the setting of arthrogryposis often treated surgically?
Due to scoliosis risk
Why should upper extremity surgery, if appropriate, be done early in arthrogryposis patients?
to avoid joint adhesions
In Legg-Calve-Perths disease, when is surgery usually required?
More than 50% involvement of the capital femoral epiphysis (Catterall III or IV)
In Legg-Calve-Perths disease, under what age is management non-surgical (NSAIDS)?
6
What needs to be excluded in acute transient synovitis?
septic arthritis
Why are many patients with SCFE initially misdiagnosed?
It often presents as knee pain
What is Scheuermann’s disease?
osteochondrosis of vertebral endplate with 3 or more consecutive segments wedged more than 5 degrees
What it the treatment for Scheuermann’s disease?
TLSO or Milwaukee brace for up to 3 months
What is the most common cause of discitis?
staph aureus
How does femoral anteversion present on exam?
more than 70 degrees internal rotation and less than 20 degrees external rotation
At what age does in-toeing generally resolve?
8
What is the prognosis for infantile scoliosis (under 3 yo)?
often spontaneously resolves
When is a scoliosis curve unlikely to progress?
Less than 40 degrees in a skeletally mature patient
Why is the medial meniscus at risk for injury with a MCL tear?
Their fibers are contiguous
Would you expect joint effusion with an isolated MCL or LCL tear? Why?
No, they are extraarticular
What is the mechanism for a patellar dislocation?
twisting on an extended knee
In what direction do most patellar dislocations occur?
Greater than 90% are lateral
Why is there commonly rapid knee swelling with a patellar dislocation?
There is hemarthrosis from tearing of the medial patellofemoral ligament and medial patellar retinaculum
What is someone who suffer a quadriceps contusion at risk of developing?
myositis ossificans
What is turf toe?
tearing of the first MTP joint capsule due to hyperextension of the toe
What should be suspected in an athlete with mid foot pain with weight-bearing?
Lisfranc injury
What imaging should be pursued in a suspected Lisfranc injury?
bilateral weight bearing x-rays
In football, what direction does the shoulder typically dislocate?
anterior direction
What is a type II AC joint injury?
complete AC joint tear, CC joint sprain
When should electromyographic evaluation be done after a stinger?
If symptoms last greater than 3 weeks
What range of motion asymmetry can be seen in the shoulder of baseball players?
Glenohumeral internal rotation deficit (GIRD)
How does GIRD present on exam?
Increased shoulder external rotation coupled with decreased internal rotation in the painful throwing arm
What is the provocative test for the labrum. How is it done?
O’Brien’s test. Shoulder is put in 90 deg flexion and 10 deg adduction. Arm is internally rotated with the thumb down. Patient resists downward pressure. Positive test is pain in first position received when the arm is supinated.
What is Little Leaguer’s shoulder?
proximal humeral physes stress injury
How do stress injuries to growth plates present on X-ray?
asymmetric widening of the physis
What is the treatment for Little Leaguer’s shoulder?
discontinuation of overhead throwing for at least 6 weeks followed by rehab
What should be suspected in a pitcher with pain during the acceleration phase of throwing?
UCL sprain
What diagnosis should not be missed when a throwing athlete presents with lateral elbow pain?
OCD of the capitellum
What can cause ulnar sided wrist pain and reduced grip strength in a baseball player?
hamate fracture
What is Osgood-Schlatter disease?
traction apophysitis of the tibial tuberosity
What is Sinding-Larsen-Johansson syndrome?
traction apophysitis of the inferior patellar pole
What commonly causes anterior knee pain in a runner?
patellofemoral stress syndrome (PFSS)
What 5 anatomic varients contribute to the miserable malalignment syndrome that contributes to PFSS?
widened Q-angle, femoral anteversion, genu valgum, external tibial torsion, overpronation
What age range does OCD of the knee present?
10 to 20
Where does OCD of the knee most commonly present?
lateral aspect of the medial femoral condyle
How does presentation of a tibial stress fracture differ from tibial stress syndrome?
a stress fracture presents with pain at a focal site on the tibia and pain at rest
Who commonly gets Sever’s disease?
Boys aged 8 to 13 during period of rapid growth
When do the sesamoids fully ossify?
7 to 10 years old
What causes pain at the plantar aspect of the first MTP joint of the foot during toe-off?
sesamoiditis
What is Gymnast’s wrist?
distal radius physis stress injury
What is the primary stabilizer of the distal radioulnar joint?
triangular fibrocartilage complex (TFCC)
When should surgery be considered in spondylolisthesis?
More than 50% slippage
Tenderness at which 4 sites warrant an X-ray in an ankle injury?
medial malleolus, lateral malleolus, navicular, base of 5th metatarsal
What are the two sites where the ITB can get impinged?
lateral femoral epicondyle, greater trochanter
What presents with gradual onset of pain over the forefoot that worsens with activity?
metatarsal stress fracture
What is internal snapping hip?
iliopsosas tendon sliding over the pectineal eminence
What is external snapping hip?
ITB or gluteus medius sliding over the greater trochanter
What is dancer’s fracture?
avulsion fracture of the base of the 5th metatarsal
What is a Jones fracture?
Fracture of the 5th metatarsal at the metaphyseal-diaphyseal junction
What should a Jones fracture not be missed?
they are at risk for poor healing due to tenuous blood supply
What provocative test is positive in femoracetabular impingement?
FADIR
What is a Stener lesion?
entrapment of the 1st digit UCL at the adductor policies aponeurosis
What is the most common fracture of childhood?
clavical
What should not be missed in the skeletally immature athlete with lateral ankle pain?
Salter-Harris I fracture of the distal fibula
Indication for surgery in brachial plexus palsy?
lack of antigravity biceps function at 6 to 9 months
3 risk factors for brachial plexus palsy?
breach, shoulder dystocia, large birth weight
2 protective factors for brachial plexus palsy?
C-section, multiple gestation
About what percentage of brachial plexus palsy occurs with Horner’s syndrome?
15%
Femoral anteversion angle at birth?
40 degrees
When is cervical fusion recommend in Downs syndrome?
Alantodens interval (ADI) above 7mm
What are 4 pediatric conditions in which a cavus foot can be seen?
MMC, CMT, Friedreich’s ataxia, or spinal tumor
What pediatric orthopedic condition presents with a rocker bottom and laterally deviated forefoot?
congenital vertical talus
