Musculoskeletal Disorders Flashcards
What is the Ortolani manoeuvre and why is it done?
Test for developmental dysplasia of the hip, and aims to relocate a subluxed / dislocated hip. With baby’s legs flexed and abducted, put fingers on greater trochanter and lift the femoral heads to try and insert them back into acetabulum. A ‘clunk’ indicates a positive test. NB - this test will be negative for an irreducible dislocated hip.
What is the Barlow manoeuvre and why is it done?
Test for developmental dysplasia of the hip, and aims to dislocate an unstable hip. With baby’s legs flexed and partially adducted, apply axial force to the femur and try to dislocate the femoral head. A positive test is when dislocation results.
What is the Galeazzi test and why is it done?
Observes apparently different leg lengths in a child with developmental dysplasia of the hip. With the child lying supine and with knees flexed (feet touching buttocks), look from the end of the bed at the level of the knees. If the knees are at different heights, the test is positive. NB - this test will be negative in bilateral DDH.
What is transient synovitis?
AKA ‘irritable hip’, this is the most common cause of acute hip pain in children, affecting those aged 2-12
How does a child with transient synovitis present?
Sudden onset pain in the hip on movement, limp, decreased range of movement (especially internal rotation)
Pain may be referred to the knee.
List some risk factors for developmental dysplasia of the hip
Breech presentation Oligohydramnios First born Female sex Congenital abnormalities e.g. foot abnormalities Large birth weight Family history
What is SUFE?
Slipped upper femoral epiphyses
What is the classical presentation of a child with SUFE?
Limp in older, usually obese boys…No fever
Which pathology classically gives an ‘slipped ice cream’ appearance on x-ray?
SUFE - Slipped upper femoral epiphyses
What is the treatment for developmental dysplasia of the hip?
Age 6/52 to 6/12: Pavlik harness fixes the hip in abduction
6/12 to 18/12 old: Examination under anaesthetic, orthography, closed reduction, followed by period of immobilisation
Above 18 months of age: Open reduction
Which sex is at higher risk of developmental dysplasia of the hip: Male or female?
Female
What is the most common cause of hip pain in children?
Transient synovitis (irritable hip)
Give some differential diagnoses for a limp in children
Septic arthritis Transient synovitis (irritable hip) Juvenile idiopathic arthritis Perthes disease Developmental dysplasia of the hip SUFE - Slipped upper femoral epiphysis Trauma i.e. direct injury Osteomyelitis Neoplasia Neurological causes
3 year old girl with sudden onset pain in right hip with refusal to weight bear. She is otherwise well and does not have a fever, although a few days ago she had a mild coryzal illness from which she is fully recovered. What is the most likely diagnosis?
Transient synovitis i.e. irritable hip
What is the treatment for transient synovitis?
Bed rest and analgesia - It will recover over a few days
