Musculoskeletal Flashcards
What diagnoses SCFE?
Radiographs
What salter has fractures require open reduction with internal fixation?
Salter 3 and 4
What is gower’s maneuver? Why does it occur?
Due to the loss of tone in the core muscles the child walks hands up legs to attain a standing position one getting up. Also suggest pelvic girdle weakness
What is the term for bowleg?
Genu Varum
Describe a grade one ankle sprain.
Local tenderness, minimal edema, full range of motion present but maybe uncomfortable, patient can wear weight
What arm injury is often associated with a straight, outstretched arm fall?
Elbow fracture
When does genu valgum typically resolve?
7 years of age
Describe a typical person who has suffered from slipped capital femoral epiphysis?
Obese, sedentary, adolescent
What is a lateral curvature of the spine?
Scoliosis
How are salter Harrison fractures classified?
There are five classifications. They go slipped, above, lower, through, crushed
When is referral needed for Genu Varum?
Continues after age 2, unilateral, becomes worse after walking
Until what age is tibial torsion normal?
Self resolves by age 4
You see a child with an insidious onset of a limp with knee pain that has migrated to the groin or lateral hip. They are afebrile. What is this disease?
A vascular necrosis of the femoral head
What is the classic sign or symptom of Osgood-Schlatter disease?
Pain and tenderness at the tibial tubercle
What is the hallmark laboratory change in muscular dystrophy?
Markedly elevated creatinine kinase levels
What type of injury occurs in the growth plate of long bones during development as a traumatic injury?
Salter Harris fractures
When does a child with Legg-Calve-Perthes Disease need to be referred to orthopedics?
When more than one half of the femoral head is involved and in children older than 6 years of age
What is the management of Osgood-Schlatter disease?
Limit the activity to control pain and use knee immobilizers if helpful
What is the most common inherited neuromuscular disease in children?
Duchesne’s muscular dystrophy
What sign or symptom distinguishes slipped capital femoral epiphysis from avascular necrosis of the hip?
There is an acute onset in severe pain causing the inability to emulate or move the hip
When is it appropriate to observe Legg-Calve-Perthes Disease?
If the child has full range of motion, is less than 6 years of age and involvement is less than 1/2 of the femoral head
By what age is a child with muscular dystrophy wheelchair dependent?
12 years of age
What physical exam finding is found with a vascular necrosis of the femoral head?
Limited passive internal rotation and abduction of the hip joint
On assessment a painful limp is seen that is unilateral it was insidious in onset. Also internal rotation of the hip caused a spasm and there were no obvious signs infection on inspection or palpitation. What is this?
Toxic synovitis
what is an inflammation of the tibial tubercle as a result of repetitive stressors in patients with immature skeletal development?
Osgood-Schlatter disease
what is the spontaneous dislocation of the femoral head both downward and backward relative to the femoral head and secondary to disruption of the epithelial plate?
Slipped capital femoral epiphysis
How are salter Harris fractures diagnosed?
X-ray
What salter hairs fractures can be casted or splinted with closed reduction?
Salter one and two
Describe a grade three ankle sprain.
Complete ligament tearing causing severe pain significant edema and bruising, in the patient is unable to bare weight or rotate the ankle
What is Legg- Calve- Perthes disease?
A vascular necrosis of the femoral head
Until what age is femoral anterversion normal?
Normal until adolescence (in-toeing)
How is a vascular necrosis of the formal head diagnosed?
Radiograph studies
What is the most common musculoskeletal injury?
Ankle sprain
What is the most common age and race of a vascular necrosis femoral head?
Caucasian, 4-9 years old
In the following years what will need to be watched after the repair of an SCFE?
Recurrence in the opposite hip
What injury of the arm results in a young child being swung or pulled causing radial subluxation?
Nursemaids elbow
What is the most common age range for toxic synovitis?
2 to 6 years old
Describe a grade two ankle sprain.
Partial tearing of the ligament causing pain some edema and bruising and pain with weight bearing, decreased range of motion
When are radiographs of genu valgum necessary?
Over the age of seven or if unilateral involvement
What is seen on the radiograph of toxic synovitis?
They are normal
What is an abnormal distance between the medial malleolus in genu valgum?
More than 3 inches
What is the fat pad sign?
when no fracture is visible on x-ray the lateral view demonstrates elevation of the anterior and posterior fat pads suggesting presence of a fracture
What is a self-limiting inflammation of the hip, most likely due to a viral or immune cause?
Toxic synovitis
what is a progressive genetic disorder beginning the lower extremities and progressing to the upper extremities and torso?
Duchesne’s muscular dystrophy
Is scolio more common in males or females?
Fem
When does scoliosis need to be referred to an orthopedist?
If the curvature causes pain, or if the curvature is greater than 25°
What physical findings are seen with slipped capital femoral epiphysis?
Limb may be shorter from proximal displacement of metaphysis and the child will likely be unable to properly flex the hip as the femur abducts externally
What is the correct term for knock knee?
Genu Valgum
What is the Ottawa ankle rule?
Recommendations for x-rays in ankle injuries. there is pain near the malleoli and bone test tenderness is present at the posterior edge, distal 6 cm from the tip of either malleolus or the patient is unable to bear weight for at least 4 steps at the time of injury and evaluation
What are the peak ages of Osgood-Schlatter disease?
11 to 14 years associated with their rapid growth spurt
What is a normal variant up until the age of two?
Genu Varum
What is the most common soldier Harris fracture?
Salter 2 above
What will a muscle biopsy show in muscular dystrophy?
Necrotic degenerating fibers
What are radiographs used for in scoliosis?
Quantification of the degree of scoliosis
What is the classic sign of a nursemaid elbow?
Holding arm across the bunny with the thumb up
What is the management of SCFE?
Surgery with an orthopedist
What is the management for an ankle sprain?
RICE and NSAIDS
What is the general classification for JIA?
Arthritis for more than 6 weeks and yard and 16 years old
Is systemic JIA autoimmune or uncontrolled activity of phagocytes?
Phagocytes
What are the exam findings of JIA?
Fever, salmon colored rashes, leukocytosis, lymphadenopathy, joint swelling, joint pain, heat and inflammation, loss of range of motion
What signifies risk for uvitis in JIA?
Positive ANA
Foit promocologic management options for JlA?
NSAIDS, steroids, MTX and biologics
What is the age and gender range for SLE?
11 to 12 years and female
What are some classic symptoms of SLE?
Joint pain, butterfly rash, mouth ulcers
What is the positive lab finding in 97% of children with SLE?
A n a
When are steroids most often used in SLE management?
If Reno, cardiac, or CNS involvement
