ortho/rheum (5%) Flashcards
what is the anatomic term for nursemaids elbow
radial head subluxation w annular ligament stretching
what age is nursemaids elbow MC
2-5yo
what is the MOI of nursemaids elbow
pulling of arm while it is pronated + extended
presentation of nursemaids elbow
slightly flexed, usu no swelling
TTP of radial head
tx of nursemaids elbow
reduce
what happens in SCFE
femoral head slips posterior + inferior at growth plate
what populations are most likely to have SCFE
obese
AA
puberty-age
growth-spurt
what way is leg usu rotated in SCFE
external
tx of SCFE
non-wt bearing crutches –> ORIF
if pt gets SCFE before puberty, what should you check for
hormonal/systemic disorders
e.g. hypothyroidism
what is osgood-schlatter disease
osteochondritis of patellar tendon @ tibial tuberosity
what causes osgood-schlatter
overuse or small avulsions
who MC gets osgood-schlatter
males
10-15yo
athletes w growth spurt
presentation of osgood-schlatter
activity-related knee pain/swelling
painful lump below knee
tx of osgood schlatter
RICE, NSAIDs, stretch quads
surgery if refractory
in what population is scoliosis MC
8-10yo girls
what is the definition of scoliosis
lateral curvature >10 degrees
most sensitive test for scoliosis
adams forward bending test
what is cobb’s angle
measured on AP/lateral films to dx scoliosis
when should you brace scoliosis? surgery?
> 20, >40
what is legg-calve-perthes dz
AVN of the proximal femur
in what population is legg-calve-perthes MC
kids 4-10yo
boys
presentation of legg-calve-perthes
painless limping for weeks that is worse w continued activity (end of day)
loss of abduction + internal rotation
what do you see on XR in pt w legg-calve-perthes
early- inc density of femoral head, widening of cartilage space
advanced- deformity, crescent sign (microfxs w collapse of bone)
tx of legg-calves-perthes
observe- self-limiting w revascularization w.i 2yrs
restrict activity- NWB w ortho follow up
what is the MC bone malignancy
osteosarcoma
what is the MC benign bone tumor
osteochondroma
what populations are most affected by osteosarcoma
adolescents
what are the most common met sites of osteosarcoma
lungs
sx of osteosarcoma
bone pain, joint swelling, palpable soft tissue mass
what do you see on XR of osteosarcoma
hair on end or sun ray/burst appearance on soft tissue mass
mixed sclerotic lesions
periosteal bone runs
codmans triangle
what is codmans triangle
ossification of raised periosteum
what is tx for osteosarcoma
resect, radial amputation if neovascular, chemo PRN
what type of tumor is ewing sarcoma
giant cell tumor
who MC gets ewing sarcoma
males 5-25yo
what are the MC sites of ewing sarcoma
femur + pelvis
what is the MC site of mets of ewing sarcoma
bone
presentation of ewing sarcoma
bone pain
+/- palpable mass
joint swelling
fever
what does ewing sarcoma look like on XR
lytic lesion, layered periosteal rxn (onion skin)
+/- codmans triangle
tx of ewing sarcoma
chemo, surg, radiation
what population MC gets osteochondroma
10-20yo males
progression of osteochondroma
begins in childhood + grows to skeletal maturity
what do you see on XR of osteochondroma
pedunculated, grows away from growth plate + involves medullary tissue
tx of osteochondroma
observe, resect if painful or pelvis
tx of juvenile rheumatoid arthritis
NSAIDs, corticosteroids
methotrexate or leflunomide
freq eye exams
usu resolves by puberty
how many joints are involved in pauci-articular JRA
<5 joints (MC large)
what are the 2 types of pauci-articular JRA
type I: iridocyclitis (Anterior uveitis)- often asx but may cause blindness if not tx
type II: inc incidence of ankylosing spondylitis
how does systemic/acute febrile JRA present and what is the other name for it
stills disease
arthritis (small + large), diurnal high fever
salmon/pink migratory rash
hepatosplenomegaly, hepatitis
LAD, serositis (pleural + pericardial effusions)
how does polyarticular JRA present
5+ small joints, iridocyclitis +/- low grade fever
which type of JRA is most like adult RA
polyarticular
