Orthopedics/Rheumatology (Alice) (5%) Flashcards
insidious onset of a dull ache or throbbing localized to the groin, lateral hip, or buttocks
avascular necrosis of proximal femur
3 rf for avascular necrosis of the femur
trauma
steroids
SSA
in peds, AVN is called
legg-calve perthes dz
what is this showing
AVN of femur
gs dx for AVN
MRI
2 XR findings of AVN
effusion
joint space widening
tx for AVN
conservative vs joint replacement
4 mo F w. asymmetric thigh creases - LUE is shorter than the right and legs externally rotated
congenital hip dysplasia
what is this showing
hip dysplasia
2 XR findings of hip dysplasia
superiorly displaced femur
hypolastic acetabulum
congenital hip dysplasia is malignment of the
acetabulum and femoral head
3 PE findings of hip dypslasia
legs of unequal lengths
asymmetric skin folds
limping/waddling gait
screening for hip dysplasia
hip exam at every WCC until 2 yo
PE tests for hip dysplasia
barlow
ortolani
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
flexion of the hip at 90 degrees with gentle abduction -> relocation of hip
performed after barlow maneuver
ortolani maneuver
what imaging is useful to assess the position of the femoral head and structure of acetabulum
US
_ is contraindicated for hip dysplasia until 4 months old
XR
due to radiolucency of femoral head
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
what type of harness is this
pavlik -> abduction bracing
what type of harness is this
hip spica cast
group of rheumatic dz’s that begin at or before 16 yo
juvenile rheumatoid arthritis (JIA)
3 types of JIA
oligoarticular -> mc
polyarticular
systemic (still dz)
oligoarticular JIA mc affects _ and involves </= _ joints during the first 6 mos of the dz
girls
4
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
