Orthopedics/Rheumatology (Alice) (5%) Flashcards by Seth Northway

insidious onset of a dull ache or throbbing localized to the groin, lateral hip, or buttocks

avascular necrosis of proximal femur

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3 rf for avascular necrosis of the femur

trauma
steroids
SSA

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in peds, AVN is called

legg-calve perthes dz

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what is this showing

AVN of femur

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gs dx for AVN

MRI

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2 XR findings of AVN

effusion
joint space widening

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tx for AVN

conservative vs joint replacement

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4 mo F w. asymmetric thigh creases - LUE is shorter than the right and legs externally rotated

congenital hip dysplasia

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what is this showing

hip dysplasia

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2 XR findings of hip dysplasia

superiorly displaced femur
hypolastic acetabulum

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congenital hip dysplasia is malignment of the

acetabulum and femoral head

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3 PE findings of hip dypslasia

legs of unequal lengths
asymmetric skin folds
limping/waddling gait

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screening for hip dysplasia

hip exam at every WCC until 2 yo

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PE tests for hip dysplasia

barlow
ortolani

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adduction of the hip while holding the knee straight to assess for popping of the femoral head out of the socket

barlow maneuver -> hip dysplasia

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flexion of the hip at 90 degrees with gentle abduction -> relocation of hip
performed after barlow maneuver

ortolani maneuver

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what imaging is useful to assess the position of the femoral head and structure of acetabulum

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_ is contraindicated for hip dysplasia until 4 months old

due to radiolucency of femoral head

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tx of hip dysplasia based on age

< 6 mos: pavlik harness (abduction bracing)
6-15 mos: hip spica cast
15-24 mos: ORIF followed by hip spica cast

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what type of harness is this

pavlik -> abduction bracing

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what type of harness is this

hip spica cast

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group of rheumatic dz’s that begin at or before 16 yo

juvenile rheumatoid arthritis (JIA)

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3 types of JIA

oligoarticular -> mc
polyarticular
systemic (still dz)

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oligoarticular JIA mc affects _ and involves </= _ joints during the first 6 mos of the dz

girls
4

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polyarticular JIA affects >/= _ joints at onset, and is divided into (2)

>/= 5 joints RF (-) vs RF (+)

_ are typically RF negative w. polyarticular JIA, and have a better prognosis

girls

describe pattern of arthritis w. polyarticular JIA (2)

symmetric small joints

what symptoms are associated w. systemic JIA (5)

prolonged fever iridocyclitis generalized LAD splenomegaly unexplained rash

what is iridocyclitis

inflammation of the iris and ciliary body

dx for systemic JIA is clinical - what should the work up include (3)

RF ANA HLA-B27

tx for systemic JIA (3)

NSAIDs steroid injxns MTX

3 pediatric osteo cancers to know

osteosarcoma ewing's sarcoma osteochondroma

what age group do you think of w. osteosarcoma

10-14 yo

describe pain w. osteosarcoma

progressively worsening night time bone/joint pain with swelling

what is this showing

sun ray/burst hair on end appearance **osteosarcoma**

mc site of metastasis for osteosarcoma

lung

PE findings of ewing's sarcoma (4)

fever palpable mass swelling ttp

what is this showing

lytic lesion onion peel appearance of periosteum **ewing's sarcoma**

tx for ewing's sarcoma

chemo surgery xrt

osteosarcoma mimics _ ewing's sarcoma mimics _

osteosarcoma: growing pains ewing's sarcoma: infxn

age group mc affected by osteochondroma

10-20 yo males

benign chondrogenic lesion derived from cartilage

osteochondroma

mc benign bone tumor

osteochondroma

what is this showing

pedunculated stalk -> osteochondroma

what is this showing

lesion on the bone -> osteochondroma

tx for osteochondroma

resection vs obs

presentation of nursemaid elbow (4)

holding elbow flexed and pronated ttp of lateral elbow loss of pronation/supination limited flexion/extension

moi for nursemaid elbow

sudden pull on extended, pronated forearm -> dislocation of elbow joint ex swinging kid by the arm or pulling, tugging on uncooperative child

nursemaid elbow is _ subluxation

radial head

what is this showing

radial head subluxation (nursemaid elbow)

tx for nursemaid elbow

supination-flexion make sure kid uses arm before d/c'ing

inflammation of patellar ligament where it inserts on the tibial tuberosity -> painful swelling below knee

osgood schlatter dz

typical presentation of osgood schlatter (3)

9-14 yo - growth spurt tenderness over tibial tubercle involved w. sports that require running

2 PE findings of osgood schlater

pain w. resisted knee extension prominent tibial tuberosity

XR is not necessary for osgood schlater dx, but what would you see if severe

fragmentation of tibial tuberosity

tx for osgood schlater

reduce PA ice PT NSAIDs last line: surgery

indication for surgery for osgood schlater

closed growth plates

what test is this

Adams forward bend

what is this showing

scoliosis

clinical definition of scoliosis

lateral spine curvature w. cobb angle >/= 10

PE finding of scoliosis

asymmetry in scapular height w. adams forward bend

scoliosis is more likely to progress and require tx in girls or boys

girls

3 indications for MRI w. scoliosis

atypical curve pattern rapid progression neuro sx (ex reflex abnl)

complication of scoliosis

decreased pulmonary fxn spirometry shows restrictive pattern

tx for scoliosis based on degree of curvature

10-15: monitor q 6-12 mo, +/- XR 15-20: serial AP XR q 3-4 mo 20-40 degrees: conservative (PT/bracing) > 40: surgery

obese male, limp, knee pain w. external rotation

slipped capital femoral epiphysis

head of femur slips off neck of femur inferiorly and posteriorly

slipped capital femoral epiphysis (SCFE)

4 PE findings of SCFE

-pain in hip/groin/thigh/ipsilateral knee w.o trauma -antalgic waddling -externally rotated leg -drehmann sign

what is drehmann sign

while in supine position, hip externally rotates and abducts w. passive hip flexion -> **SCFE**

what PA is associated w. SCFE

jumping

dx for SCFE

XR for all: AP PLUS frog leg lateral

3 XR findings of SCFE

widening of joint space decrease in epiphyseal height steel sign

what is this showing

steel sign: double density from superimposition of epiphysis and metaphysis -> **SCFE**

tx for SCFE (2)

surgical fix w. screw for all +/- contralatearl prophylactic screw fix