Musculoskeletal Flashcards
Genu Varum (Bow Legs) Causes
Normal variant
Rickets
Osteogenesis
Blount Disease- severe progressive and unilateral
Genu Valgum (Knock-knees)
Internalleolar distance >8cm
Usually resolves spontaneously
Pes Planus (Flat feet) in Toddlers
Flatness of medial longitudinal arch
Presence of fat pad which disappears with age
Arch demonstrated standing on tip-toe or passive extension of big toe
Feature of hypermobility
Causes In-toeing
Metatarsus Varus
Medial tibial torsion
Persistent anteversion of femoral neck
Features Metatarsus Varus
Occurs in infants
Passively correctable
Heel held in normal position
Treatment if persists beyond 5 years
Features Medial tibial torsion
Occurs in toddlers
Associated with bowing o tibiae
Self-corrects by 5y
Tibia is laterally rotated less than normal in relation ot the femur
Features Femoral Neck anteversion
Presents in childhood
Corrects by age 8
Associated with hypermobility
W sitting (sit between feet with hips internally rotated)
Femoral neck is twisted more forward than normal
Osteotomy for persistent anteversion
MSK variations and normal ages
Bow Legs 1-3y Knock-knees 2-7y Flat feet 1-2y In-Toeing 1-2y Toe Walking 1-3y
Toe Walking
Common in young children
Walks normally on request
dDx: cerebral palsy, Duchenne, tightness of Achilles or inflammatory arthritis of the foot
Positional Talipes Features
Due to intrauterine compression
Mild deformity
Correctable to neutral position
Passive exercises in marked deformity
Talipes Equinovarus CAVE
Cavus Midfoot
Adductus Forefoot
Varus Hindfoot
Equinous Hiindfoot
Mx Talipes equinovarus
Plaster casting (Ponsetti method) Corrective surgery
Vertical Talus Features
Foot stiff
Rockerbottom shape
Confirmation by Xray
Surgery required
Talipes Calcaneovalgus
Foot dorsiflexed and everted
Due to intrauterine moulding
Usually self corrects
Associated with DDH
Tarsal Coalition
Lack of segmentation between one or more bones of foot
Coalitions become symptomatic as they ossify
Foot is progressively rigid with limited foot motion
More symptomatic during preadolescence
Radiograph normal until ossified
Corrective surgery
Pes Cavus
High arched foot
Associated with neuromuscular disorders in older children
Treatment required if symptomatic
Late Presentation DDH
Hip dysplasia- requires complex Mx including surgery Limp or abnormal gait Asymmetry of skinfolds around hip Limited abduction of the hip Shortening of affected leg
Ix DDH
Neonatal screening: Barlows (dislocates) Ortolani (relocates)
Repeated at 8 w
US in high risk infants
Mx DDH
Most spontaneously stabilise by 3-6w
Pavlick Harness- hip flexed and abducted (babies <4-5m)
Cx splinting: necrosis of femoral head
Surgery if fails
Risk factors DDH
female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity
Definition of scoliosis
Lateral curvature of front plane of the spine
Structural scoliosis: rotation of vertebral bodies
Causes of scoliosis
Idiopathic (early <5y or late 10-14y onset)
Congenital
Secondary
Mx Scoliosis
Mild resolves spontaneously
Severity and progression determined by Xray
Bracing
Surgery if co-existing pathology
Torticollis (Wry neck) Causes
Most commonly sternomastoid tumour Muscular spasm ENT infection Spinal tumour Cervical spine arthritis Malformation Posterior fossa tumour
Features Sternomastoid tumour
Occur in first few weeks of life Mobile, non tender nodule Felt within body of sternocleidomastiod Restriction of head turning and tilting of head Resolves by 2-6m
Features Growing Pains
Generalised pains in lower limbs Typically 3-12y Pain in night, waking from sleep Resolves with massage/comforting Symmetrical in lower limbs No limitation of physical activity
Features hypermobility
MSK pain confined to lower limbs Pain worse on exercise Symmetrical hyperextension -thumbs and fingers to forearm -elbows and knees >10' -flat feet with normal arch on tiptoe -hyperextensibility of knee Recurrent mechanical joint and muscle pain Associated with: Down's syndrome, Ehler-Danlos, Marfans
Complex Region Pain Syndrome Features
Most dramatic musculoskeletal pain
Usually adolescent females
Typically with distraction movement is normal
Localised forms typically foot and ankle
Triggered by minor trauma
Hyperasthesia, allodynia, cool, sweollen, mottled, flexed
Diffuse forms are widespread pain with disturbed sleep
Extreme exhaustion
Acute Onset Limb Pain dDx
NAI Trauma Osteomyelitis Bone Tumours Septic Arthritis
Osteomyelitis Pathology
Infection of metaphysis
Most common sites distal femur and proximal tibia
Haematogenous spread/direct spread from wound
Usually staph aureus
In sickle cells likely staph or salmonella
Non-immunised possibly strep or H.influenzae
Osteomyeltitis Presentation
Markedly painful immobile limb Acute febrile illness Swelling and tenderness over site Movement causes severe pain Sterile effusion of adjacent joint More insidious presentation in infants Pelvic infection- limp or groin pain Vertebral infection- back pain Multiple foci in disseminated infection
