Muskuloskeletal Flashcards
Are there any risk factors for developing developmental dysplasia of the hip?
- Family history
- Breech position
How is DDH usually detected?
Newborn screening examination (Barlow + Ortolani)
In a case of suspected DDH, how is the diagnosis confirmed?
USS
Describe the management of developmental dysplasia of the hip
- Conservative = Pavlik harness
- If this fails/presentation is late, surgery may be required
Describe the pathophysiology of osteomyelitis
Inflammation of the metaphysis of long bones, caused by infection
Which sites are most commonly affected in osteomyelitis?
- Distal femur
- Proximal tibia
What is the most common causative organism for osteomyelitis?
Staphylococcus aureus
Describe the clinical features of osteomyelitis
Fever, plus cardinal signs of inflammation:
- Pain
- Redness
- Warmth
- Swelling
- Loss of function
Describe the investigation of suspected osteomyelitis
- Blood cultures
- MRI
Describe the management of osteomyelitis
- IV antibiotics
- Surgery if unresponsive to antibiotics
Are there any risk factors for developing osteomyelitis?
- Immunodeficiency
- Sickle cell disease
Describe the pathophysiology of septic arthritis
Inflammation of a joint, caused by infection
What is the most common causative organism for septic arthritis?
Staphylococcus aureus
Are there any risk factors for developing septic arthritis?
- Immunodeficiency
- Sickle cell disease
What are the clinical features of septic arthritis?
Fever, plus cardinal signs of inflammation:
- Pain
- Redness
- Warmth
- Swelling
- Loss of function
Describe the investigation of suspected septic arthritis
- Blood cultures
- Joint aspirate
Describe the management of septic arthritis
- IV antibiotics
- Surgery if unresponsive to antibiotics
Describe the epidemiology of transient synovitis
Most common cause of acute hip pain in children
Describe the pathophysiology of transient synovitis
- Transient inflammation of the hip joint
- Often triggered by a preceding viral infection, e.g. URTI
Describe the clinical features of transient synovitis
- Hip pain
- Reduced ROM at hip
- Limp
Describe the investigation of transient synovitis
It can be difficult to differentiate between transient synovitis and early septic arthritis. If there is any suspicion it may be septic arthritis, perform:
- Blood cultures
- Joint aspiration
Describe the management and natural course of transient synovitis
Self-limiting:
- Rest
- Analgesia
Perthes disease is more common in…
More common in boys
Describe the pathophysiology of Perthes disease
- Avascular necrosis of the femoral head
- Followed by revascularisation and reossification (gradual healing)
What are the clinical features of Perthes disease?
- Hip pain
- Reduced ROM at hip
- Limp
Describe the investigation of Perthes disease
XR
Describe the management of Perthes disease
Usually condition is self-resolving, therefore treatment is mainly supportive:
- Rest
- Analgesia
- Physiotherapy
In severe cases, surgery may be required
Describe the prognosis of Perthes disease
- Good prognosis for recovery
- Higher risk of developing degenerative arthritis in later life
Describe the pathophysiology of Osgood-Schlatter disease
Inflammation of the patellar tendon at its insertion site (tibial tuberosity)
Describe the clinical features of Osgood-Schlatter disease
- Knee pain after physical activity
- Palpable lump over tibial tuberosity
Describe the management of Osgood-Schlatter disease
- Reduce physical activity
- Physiotherapy
What is osteogenesis imperfecta? Describe its pathophysiology
- Group of genetic disorders of collagen metabolism
- This results in bones which are more fragile and become deformed/fracture easily
Which is the most common type of osteogenesis imperfecta
Type I
Describe the clinical features of type I osteogenesis imperfecta (MSK and other)
MSK:
- Frequent fractures
- Bone deformity
Other:
- Blue appearance to the sclerae
- Some children develop hearing loss
Describe the management of type I osteogenesis imperfecta
Bisphosphonates to reduce frequency of fractures
Describe the pathophysiology of slipped femoral epiphysis
- Displacement of the femoral epiphysis postero-inferiorly
- Onset may be acute, e.g. following minor trauma, or insidious
Slipped femoral epiphysis is more common in…
More common in obese boys
Describe the clinical features of slipped femoral epiphysis
- Hip pain
- Reduced ROM at the hip
- Limp
Describe the investigation of slipped femoral epiphysis
XR
Describe the management of slipped femoral epiphysis
Surgery
Describe the epidemiology of juvenile idiopathic arthritis
Most common type of chronic arthritis in children
What are the clinical features of juvenile idiopathic arthritis? (MSK and other)
MSK:
- Pain
- Swelling
- Stiffness
Other:
- Fever
- Salmon-coloured rash
- Lymphadenopathy
Describe the classification of juvenile idiopathic arthritis
- Polyarthritis (more than four joints affected)
- Oligoarthritis (up to and including four joints affected)
- Systemic (with fever, rash, lymphadenopathy)
Describe the management of juvenile idiopathic arthritis (conservative and medical)
Conservative:
- Physiotherapy
Medical:
- Analgesia, e.g. NSAIDs
- Intra articular corticosteroid injections
- Methotrexate
- Biologics
Hip pain in a child < 3 years old - how is this managed?
Urgent further investigation
Which criteria are used to assess the probability of septic arthritis in children?
Describe the interpretation
Kocher’s criteria:
- Non weight bearing = 1 point
- Fever > 38.5 = 1 point
- WCC > 12 x 10^9/L = 1 point
- ESR > 40 = 1 point
1 point = highly unlikely
2 points = 50/50
3-4 points = highly likely
