Other MSK

Question 1

MSK presentations

Answer 1

Limp
Sore joint
Swollen joint
Limited movement
Painful muscles
Morning stiffness
Muscle weakness

Question 2

Non MSK presentations

Answer 2

Fever without focus
Abdominal pain
School refusal
Change in behavior/activities (play, mood, motor skills, 'clumsy')
Deteriorating school work
Rash, 'unwell child'

Question 3

Red flags

Answer 3

Systemic features (weight loss, fever, anorexia, night pain)
Inconsistent/incongruous story
Developmental regression
Associated symptoms
Inflammatory symptoms
Acute hot swollen joint

Question 4

High Fever

Answer 4

FBC, CRP, ESR
Blood cultures
Septic arthritis/osteomyelitis if CRP/ESR high
Irritable hip if not

Question 5

Weight loss, pallor, malaise

Answer 5

FBC and film
Malignancy (ALL):
Commonest childhood malignancy
Peak age 2-5 years
Survival 80%
Bone pain common, often present at night, secondary to marrow infiltration or occaisionally fractures/mets
Weight loss, lethargy, pallor, brushing, lymphadenopathy
Blasts on film diagnostic
High risk: male, WCC load at diagnosis, cytogenic markers, age (very young or adolescent)
Consider also chronic infection (TB)

Question 6

Reduced internal rotation of the hip

Often overweight adolescent

Answer 6

Hip xray including frog view
Slipped capital femoral epiphysis:
Risk factors = overweight, down’s, hypothyroid
Aged 10-16
Limp, hip or knee pain
Bilateral in 20%
Risk avascular necrosis if not treated properly

Question 7

Limp/hip pain in well child (m>f) aged 5 - 10 years

Answer 7

Hip Xray
Legg-Calve-Perthe disease:
Avascular necrosis of the femoral head
Limp, hip or knee pain
Bilateral in 20%
Poorer outcome if >6y or >50% femoral head affected

Question 8

Bony tenderness, history of fall

Answer 8

Trauma

Consinder NAI

Question 9

Chronic intermittent limp (>6 weeks)

Answer 9

pGALS

Juvenile Idiopathic Arthritis

Question 10

pGALS: screening

Answer 10

Do you have any pain in your joints, muscles or back?
Do you have any difficulty getting yourself dressed without help?
Do you have any difficulty going up and down stairs?

Question 11

pGALS: gait

Answer 11

Walk
Tip-toes
Heels

Question 12

pGALS: arms

Answer 12

Put arms out
Turn hands over and make a fist
Pinch index finger and thumb together
Touch the tips of fingers with thumb
Squeeze MCP joints
Put hands in prayer sign and back to back
Arms straight up above head
Look at ceiling
Put hands behind neck

Question 13

pGALS: legs

Answer 13

Patellar tap
Active movement of knee
Passive movement of knee and hip

Question 14

pGALS: spine

Answer 14

Open mouth and put three fingers in
Lateral flexion of cervical spine
Observe spine from behind
Bend and touch