Musculoskeletal Disorders Flashcards
What can cause bow legs? What does it present like?
Can be caused by Rickets, Blount disease
Wide based gait + proximal myopathy eg. Gower’s sign
What is genu varum? Pes planus?
Genu Varum: bow legs
Pes planus: flat feet
What are some causes of tip-toe walking?
Can be common in young children, will be able to walk normally if asked.
Also ASD, cerebral palsy, tight Achilles, inflammatory arthritis, Duchenne’s
What is talipes? How does it develop? What is the management?
Talipes equinovarus- clubfoot
Commonly results from in utero compression (positional)
Mx: plaster casting, physio, braces (Ponseti method) usually successful, may need surgery
How is DDH diagnosed? What is the management?
-Dx after birth on NIPE, 6 wk USS in at risk groups, or later with abnormal gait, limp
Mx:
-If dysplasia: observe and followup every months, consider harness if persisting (Xray at 6 months)
-If subluxation: 3 week followup, harness + Xray at 6 months
-If harness not successful or >6 months: surgery
A newborn baby has a positive finding of clunk sound on Barlow’s test on the first NIPE. What should be done next?
Refer for USS within 4 weeks, ortho review before 6 weeks
What are some causes of scoliosis? What is the management?
-Postural
-CP
-Connective tissue diseases
Assess for severity (Xray, symptoms). Mild: watch and wait. Mod-severe: physio, surgery
Growing pains are common in children. How can you distinguish growing pains from pathological causes of leg/joint pain?
Growing pains usually:
- Symmetrical
- Do not affect the joint solely
- Not present first thing in the morning on waking
- Do not affect physical activity/cause limp
- Have a normal physical examination
Name some causes of acute onset limb pain?
- Trauma: fractures, bruising, etc.
- Septic arthritis
- Osteomyelitis
- Tumours
What is osteomyelitis? Which areas does it affect? What are the common organisms involved? How does it present?
- Infection of the metaphysis of long bones
- Most commonly affects lower limbs (distal femur/prox tibia)
- Usually S aureus, Strep pyogenes, Salmonella, TB
- Presents with acute limb pain, fever, swollen, hot and erythematous limb, loss of function/limp
A 5 year old child presents to A&E with an acutely painful knee. On examination, there is swelling and erythema proximal to the knee joint, which is very tender on palpation. The child has a fever of 38.7. What is your management?
- DDx: osteomyelitis, septic arthritis
- Give pain relief: paracetamol, ibuprofen
- Bloods (FBC, CRP, ESR, VBG, cultures), Xray 1st , then consider MRI (best) or USS
- Consider joint aspiration if effusion present
- Start IV antibiotics after samples taken
Describe the management of osteomyelitis
- Admission
- Analgesia
- Monitor for sepsis/Sepsis guidelines eg. fluids
- IV empirical antibiotics in line with trust guidelines for 2-4 weeks until infection markers down, switch as informed by MC&S eg. Ceftriaxone +/- clindamycin if high MRSA prevalence
- Switch to oral antibiotics when better
What is Osgood-Schlater disease? How does it present? What is the management?
Osteochondritis of the patellar tendon insertion at the knee. Common in active young M
-Painful knee/hip esp after exercise, lump below the patella, tenderness
Mx: reassure. Conservative: ice packs for 10-15 mins 3x/day, reduce/stop exercising- try cycling/swimming.
-Paracetamol/NSAIDs as needed
Name some causes of back pain in children/teens
- Mechanical: posture, spasms/tightness
- Inflammatory: ankylosing spondylitis
- Infection: osteomyelitis, discitis
- Malignancy: osteoid osteoma, mets
A 13 year old boy presents to the GP with back pain. What are some important questions to ask in the HPC?
- Onset and progression. Any specific triggers eg trauma
- Timing/exacerbating: night-time waking, first thing morning, on movement/exercise
- Alleviating factors: pain relief, etc
- Symptoms: fever, weight loss, tingling/shooting pains, bladder and bowel control
What is transient synovitis? How does it present? What is the management?
Acute and self-limiting inflammation of the site of tendon insertion. Common in the hips.
Presents suddenly after viral infection. Painful hip on movement, limp, reduced ROM, can have mild fever.
**If worried about possible septic arthritis: aspiration and antibiotics
Otherwise: reassure. Advise rest and pain relief. Safety net: TCI if high fever, joint red, swollen, hot
What is Perthes disease? How does it present and what is the diagnosis? What is the management?
Avascular necrosis of the femoral head (capital femoral epiphysis).
Presents with limp, +/- painful hip/knee. 7 y/o active males. Positive Trendelenburg. Limited ROM.
Dx: clinical + imaging. Xray of both hips in AP and frog (shows increased density of femoral head)
Mx: advise self-limiting. Encourage mobilisation, pain relief, ice packs, physio. Monitor. Consider splinting, surgery if older + failure to respond.
What is SUFE? How does it present and what is the management?
Slipped upper femoral epiphysis.
Presents as sudden onset painful hip, limp. Usually in overweight young teens.
Xray: Trethowan’s sign- line of Klein does not intersect superior femoral epiphysis
Mx: pain relief, urgent ortho referral for surgery
How does reactive arthritis present? What is it caused by? What is the management?
Transient monoarthritis, usually ankle/knee, 1-2 weeks after infection (urethritis or GI eg. gonorrhoea, campylobacter) +/- mild fever
Supportive Mx- rest, pain relief, ice packs. Safety net.
How does septic arthritis present? What is it caused by?
Acute monoarthritis- pain, swelling, redness, hot, tender joint with high fever +/- sepsis. Often hip joint in infants. May have preceding cut/injury.
Commonly caused by S aureus.
How is septic arthritis diagnosed and managed?
Dx: examination, obs, bloods (FBC, CRP, ESr, U+Es, VBG, cultures), USS/Xray, joint aspiration (immediately)
Mx: admission, supportive (IV fluids), analgesia, IV empirical antibiotics eg. vancomycin (gram +ve or cef gram -ve), for 2 weeks -> oral 4 weeks.
May need further aspirations/arthroscopy and washout
How does JIA present?
- *Persistent joint swelling (>6 weeks), <16 years with no signs of infection/other cause
- Oligo/polyarthritis, worse in am, stiffness + pain
- Extra-articular: rashes, fever, nodules, uveitis
- Can be ANA +, RF+, HLA-B27 +
Describe the management of JIA
- MDT approach with paediatric rheumatology, physio, OT, psych, ophthal, dietician etc
- Supportive: pain relief
- Medical: steroids, immunomodulators (DMARDs)- methotrexate.
