musculosketal Flashcards
causes of genu varum
rickets
blounts disease
causes of pes planus
normal in toddlers
tendo-achilles contracture
INF
What causes of toe-walking should be excluded
mild cerebral palsy
achilles tendinitis
inflammatory arthritis
in older people - duchenne’s
what is pes cavus and what’s it associated with
high arched foot neuromuscular disorder (ie friederich's ataxia
How does missed DDH present
Asymmetrical skin folds, abduction of hip, abnormal gait
what are the indications for DDH investigation
breech presentation at 36/40
breech delivery
FHx of DDH
Mx DDH
1st lie - if <6 months old monitor progress with US/X Ray
2nd line - put in pavlik harness if <6 months and follow up with x ray at 6 months
3rd line - surgery if nothing works
causes of scoliosis
idiopathic (10-14 weeks) congenital secondary - neuromusclar problems (CP) bone disorders (neurofibromatosis) connective tissue disorders (marfan's) leg length discrepancy (arthritis of knee)
where does osteomyelitis occur
metaphysis of bone
features of osteomyelitis
painful immobile limb
illness
can see sterile effusion of adjacent limb
What does X-ray of osteomyelitis show
after 7-10 days you see new subperiosteal bone formation and localised bone rarefaction
mx of osteomyelitis
ACUTE
- immobilse
- blood cultures
- High dose empirical IV Abx (switch to oral when pt improved)
- surgical debridement
CHRONIC
- disease staging
- surgical debridement
- IV Abx
why do you assess hip when pt presents with knee pain
hip pain often referred to knee
what is osgood-schlatter disease
osteochondritis of patellar tendon insertin at knee
how does osgood schlatter present
knee pain
tibial swelling
hamstring tightness
mx osgood schlatter
pain relief
ice packs
reassure it will resolve over time
change sporting activity to less running and jumping (but don’t have to stop sport)
what is osteochondritis dissecans
segmented avascular necrosis of subchondral bone
presents as persistent knee pain in active kids
Why is transient synovitis significant clinically
most common cause of hip pain between 2-12 year olds
follows/accompanied by viral infection
hard to distinguish it from septic arthritis
what is Perthes disease
avascular necrosis of femoral head due to interrupted blood supply
revascularises and reossifies after 18-36 months
how does perthes’ present
insidious limp + hip pain
mx Perthes’ disease
conservative:
supportive care for acute pain
activity continuation
physio - stretch hamstring and quads
surgical treatment if >6 and not responding
What is a slipped capital femoral epiphysis and what is mx
femoral head slips postero-inferiorly
need to operate quickly to prevent avascular necrosis of femoral head
mx - immobilise, immediate ortho referral, screw fixation of growth plate
what infections cause reactive arthritis
enteric bacteria - shigella, campylobacter, salmonella
STI - chlamydia, gonococcus
rheumatic fever + post streptococcal arthritis more common in low income countries
what usually causes septic arthritis
s. aureus
if immunodeficient or with sickle cell can be others
Ix for septic arthritis
US - shows joint effusion
X-Ray - exclude trauma (will normally be normal)
aspirate for diagnosis
mx septic arthritis
2 weeks IV Abx followed by 4 weeks of oral
gram +ve - vancomycin
gram -ve - cefotaxime
joint aspiration whenever needed
surgical washing + drainage may also be needed
what is the definition of juvenile idiopathic arthritis
persistent joint swelling (>6 weeks) in children <16 with no signs of infection
how does JIA present
gelling
morning stiffness
joint pain
young children can have limp
complications of JIA
bone deformities and subsequent asymmetry
chronic anterior uveitis (can lead to visual impairment)
flexure contraction of joint
growth failure
osteoporosis
amyloidosis
mx JIA
mobility encouraged
NSAIDs for pain relief
can give adjunctive intra-articular steroids
DMARDs if nothing works
How does osteochondritis dissecans present
persistent knee pain
localised tenderness over femoral condyles
complete separation of fragments can cause feeling of knee locking or giving way
when do you US vs X ray for DDH
US before 6 months
X ray after 6 months
