Musculoskeletal Flashcards
What is the most common sarcoma causing acute limp in paediatrics and over what age does it occur?
Osteosarcoma - 10 plus
3 infections that can cause acute paediatric limp?
Septic arthritis
Osteoarthritis
Discitis
3 ways in which sickle cell disease can contribute to acute limp?
Avascular necrosis
Stroke
Increased infection risk
What is the most common cause of paediatric acute limp?
Trauma
At what age do growth plates tend to fuse in girls vs boys? Why?
12-14 girls, 14-16 boys
Due to oestrogen
What should be considered as an alternative injury a suspected sprain in a child?
Growth plate injury as these are more susceptible to injury than ligaments
What is a Toddler’s Fracture?
A subtle undisplaced spiral fracture of tibia, often seen in preschool children due to twist or unwitnessed fall
6 risk factors for developmental dysplasia of hip DDH?
Family history Being a girl Oligohydramnios High birth weight over 4kg First born baby Breech presentation
What are the 2 manoeuvres used to screen for DDH at birth?
Barlow - posterior force on adducted legs to try to posteriorly dislocate hips
Ortolani - anterior force on bent and abducted legs to relocate and confirm posterior dislocation
Why do many kids ‘grow out of’ DDH?
Ligaments and soft tissue strengthen over time
If DDH is found or suspected at birth, what should you do? What if it persists?
Recheck at 6-8 weeks
If still there can do hip USS if less than 4-6 months
Or hip XR if older
What screening takes place for breech babies for DDH?
Hip USS at 2 weeks
What is first line management of DDH in a child under 6m old?
Pavlik harness
How long should you try a Pavlik harness for?
At least 6 weeks full time
What is there a risk of with use of Pavlek harness?
Avascular necrosis
What is first line management of DDH for child over 6m or after tried Pavlik harness?
Closed reduction and hip spica (cast)
Manipulation under anaesthesia then cast stays on for at least 12 weeks
What is a further option if closed reduction for DDH fails?
Open reduction
What age and sex of child is commonly affected by transient synovitis?
Boys aged 4-10
How long does transient synovitis normally last?
3-10 days
What does transient synovitis follow in 50% of cases?
Viral URTI
What findings on exam, bloods and US would be reassuring for transient synovitis?
Limited range of movement
Mild inflammatory blood picture, low grade CRP
Effusion on USS
Management of transient synovitis?
NSAIDs and non-weight-bearing rest
What is Perthes disease/Legg-Calve-Perthes disease?
Idiopathic AVN of femoral head
In what age and sex of child does Perthes disease typically affect?
Boys aged 4-10 plus
Over how long does Perthes disease tend to resolve?
Months - couple of years, physio may hope and surgery may be needed
2 long term consequences of healed Perthes disease?
Stiffness of joint
Osteoarthritis
What is SUFE?
Slipped Upper Femoral Epiphysis - capital femoral epiphysis displaces relative to metaphysis leading to hip, knee or thigh pain
What is a common RF for SUFE? 3 other associations?
Being overweight
Also hypothyroidism or previous radiotherapy/growth hormone therapy
Over what age does SUFE tend to occur?
Over 10
Movement restricted classically early in SUFE?
Internal rotation
2 management options for SUFE?
External in situ pinning
Open reduction and pinning
What needs to be done quickly for SUFE and why?
Orthopaedic assessment - risk of AVN
What is Osgood-Schlatter disease?
Multiple small avulsion fractures of anterior tibial tuberosity apophysis leading to anterior knee pain in sporty adolescents
When does pain associated with Osgood-Schlatter disease tend to resolve?
Either after reducing activity or end of growth spurt
What is the definition of JIA?
Autoimmune inflammatory joint disease lasting for over 6 weeks in under 16s (commonly 7-12)
What growth anomalies can occur related to JIA?
Overall growth rate may fall but affected joints may be large due to inflammation
What are the 4 major subtypes of JIA?
Oligo/pauciarticular
Systemic (Still’s disease)
Polyarticular (juvenile RA)
Seronegative spondylarthritis/juvenile AS
What is oligo/pauciarticular JIA and what blood finding is usually positive?
Less than 4 affected joints in first 6m
ANA positive
What joints are typically affected in oligo/pauciarticular JIA?
Larger joints but not hips, asymmetrical pattern
What rash is classical of systemic JIA/Stills disease?
Salmon pink macular rash that migrates around trunk, associated with systemic malaise
What is the most common subtype of JIA?
Oligo/pauciarticular
What is polyarticular JIA?
Juvenile RA - 5 or more joints affected in first 6 months, often very symmetrical with worse prognosis
What is Farber disease?
Lysosomal storage disorder caused by ceraminidase deficiency
Looks like JIA plus subcut nodules plus hoarse/weak voice (vocal cord nodules)
What is Severs disease?
Apophysitis of the calcaneus leading to heel pain
What is thought to be the cause of Severs disease?
Pull of Achilles’ tendon on unossified apophysis causing repeated microtrauma
3 diseases causing limp more associated with active adolescent males?
Osgood-Schlatter disease
Severs disease
Osteochondritis dissecans
What is osteochondritis dissecans? Where is it most common?
Most common cause of loose body in joint space - typically in knee joint medial femoral condyle
How does osteochondritis dissecans present?
OA-like symptoms, mild pain and effusion that can present in adolescence or adulthood
What is chondromalacia patellae?
Anterior knee pain typically felt ascending or descending stairs, more common in females than males aged 10-19
Cause of anterior knee pain in adolescent girl worse on ascending or descending stairs?
Chondromalacia patellae
What is apophysitis of the calcaneus and resultant heel pain called?
Severs disease
What is bony fragment within joint space, often near medial femoral condyle, called?
Osteochondritis dissecans
What might acute limp following trauma plus extreme pain, anxiety and agitation suggest?
Compartment syndrome
What swift assessment should be done if querying compartment syndrome?
Neurovascular assessment
7 red flags for acute paediatric limp?
Pain waking from sleep
Bone pain
Red swollen joints
Bruises or rashes
Constitutional Sx incl fever, weight loss, anorexia etc.
Early morning worsening
Sx suggestive of evolving compartment syndrome
What should a child over 9 presenting with acute limp with limited or painful hip movement be rapidly assessed for?
SUFE
3 cancers that may present with acute limp?
Leukaemia
Lymphoma
Sarcoma
