Musculoskeletal Flashcards
What is the treatment for hip congenital hip dysplasia and what is the risk?
Pavlik harness - keeps hip flexed and abducted
Risk = avascular necrosis to head of femur
What is Perthes Disease?
Avascular necrosis of the femoral head –> revascularisation over 18-36m
More common boys 4-8y
What is Osgood-Schlatter?
Avascular necrosis of the tibial tuberosity
What is slipped upper epiphysis?
Displacement of the epiphysis of femoral head postero-inferiorly
More in obese teenage boys
Features of transient synovitis
2-12y
Often associated with recent / intercurrent viral illness
Sudden onset hip / knee (referred) pain
Otherwise well
Genetics and presentation of osteogenesis imperfecta
- Dominant / recessive
- Mutation COL1A1 or 2 –> abnormalities in production in alpha chain of Type 1 collagen –> bone fragility and low bone mass
- Presentation: bowing frequent fractures, hypermobility
Causes of Rickets
Vitamin D Deficiency (1,25-dihydrocholecalciferol deficiency)
Phosphate deficiency (low calcium)
Presentation of Rickets
Bowed limbs
Metaphyseal swelling
Bone pain / miserable
Gross motor delay, delayed growth
Hypotonia, weakness
Bossed forehead
Delayed dentition
X-ray: cupping, splaying, fraying. General osteopenia
Rickets Biochemistry
- Low Vit D
- High PTH
- High Alk Phos
- Calcium / Phosphate normal or low
What is osteopetrosis and how does it present?
Failure of bone resorption –> brittle
Faltering growth
Recurrent infection
Hypocalcaemia
Anaemia, thrombocytopenia
Common organisms for septic arthritis
- Staph. aureus
- Group A strep
- Gram negative bacilli
Common infections preceding reactive arthritis
Salmonella
Shigella
Campylobacter
STIs
Strep
Mycoplasma
Lyme’s
Extra-articular features of JIA
Anterior uveitis
Leg length discrepency
Rheumatoid nodues in RF +ve
Low grade fever - polyarthritis
Define oligoarticular JIA
4 or fewer joints in the 1st 6 months of disease. Commonly larger joints eg knees, ankles, elbows. Usually presents 2-4y.
Difference between extended oligoarthritis and polyarthritis
Extended oligoarthritis = Asymmetrical large and small
Polyarthritis = Symmetrical large and small (often fingers)
Features of systemic arthritis (Still’s disease)
Oligo / poly
Acute illness
Malaise, anorexia, weight loss
Daily fever >2w
Salmon pink rash (worse with fevers)
Hepatosplenomegaly
Serositis
Raised inflammatory markers, low Hb
More in young girls