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YEAR 1 MED > Paediatric joint disease > Flashcards

Paediatric joint disease Flashcards

1
Q

What are some examples of normal paediatric conditions usually referred?

A
  • Flat feet: usually self-limiting
  • Toe walkers: children often take first steps on their tip toes, but examination required to exclude tight Achilles tendon and cerebral palsy
  • In-toeing gait: can be due to femoral torsion, tibial torsion, or metatarsus (inwardly pointing forefoot), all usually self-limiting
  • Bow legs (genu varum): usually self-limiting, sometimes caused by Rickets
  • Knock knees (genu valgum): usually self-limiting
  • (in general, if symmetrical issue then usually normal, but if asymmetrical then pathology should be suspected)
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2
Q

Child sitting in the W position in excessive femoral anteversion…

A
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3
Q

What are the 3 paediatric hip disorders?

A
  • Developmental dysplasia of the hip (DDH)
  • Perthes disease
  • Slipped upper femoral epiphysis (SUFE)
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4
Q

What is the pathology of DDH (developmental dysplasia of the hip)?

A
  • DDH is due to failure of the normal development of the acetabulum and the femoral head and acetabulum do not articulate properly
  • joint can dislocate easily
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5
Q

What is the aetiology of DDH? (what is DDH associated with)

A

DDH is associated with:
- breech presentation (baby born feet first rather than head first)
- family history
- other congenital deformities / twins

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6
Q

Normal hip anatomy VS DDH hip anatomy…

A
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7
Q

What are the clinical features of DDH?

A

(majority are picked up on routine baby checks)
Late presenting DDH can present with:
- loss of abduction
- leg length discrepancy
- child will have a limp

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8
Q

What are the 2 special tests for dysplastic hips?

A
  • Barlow test (attempt to dislocate a reduced hip): with child’s hip flexed to 90 degrees, try to dislocate hip by gently adducting, a clunk is felt if +ve
  • Otrolani test (attempt to reduce a dislocated hip): with hips at 90 degrees, gently abduct hip, +ve test if hip reduces with a clunk
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9
Q

Barlow test diagram…

A
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10
Q

What is the management for DDH?

A
  • most are self-limiting
  • conservative: abduction splint holds hips in abduction (Pavlik harness)
  • surgical: reduction, osteotomies to pelvis/hip to restore normal anatomy
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11
Q

Pavlik harness (holds hips in abduction)…

A
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12
Q

What is Perthes disease?

A
  • blood supply to the femoral head is interrupted, causing avascular necrosis and collapse of the femoral head
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13
Q

What are the clinical features of Perthes disease?

A
  • child with knee or hip pain and a limp
  • aged 4 to 8yrs
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14
Q

What investigations should be done for suspected Perthes?

A
  • Plain x-ray: sclerosis and fragmentation of epiphysis
  • (MRI also very sensitive for diagnosis and staging)
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15
Q

What does involvement of femoral head mean about prognosis of Perthes disease?

A
  • if less than 50% of femoral head involved: good prognosis and usually self-limiting
  • if more than 50% of femoral head involved: poor prognosis, high risk for OA in later life
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16
Q

What is the single biggest risk factor for a SUFE and what are the 2 main groups affected by SUFE?

A
  • obesity
  • (2 groups affected: athletic children, overweight boys with delayed puberty)
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17
Q

What are the clinical features of a SUFE?

A
  • typically adolescents
  • hip pain and limp (history can be acute or gradual), pain may be referred to knee
  • examination: reduced hip flexion, +ve Trendelenburg gait
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18
Q

What investigation should be done for suspected SUFE?

A
  • X-ray: AP, frog-lateral view
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19
Q

X-ray of SUFE (frog-lateral view)…

A
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20
Q

What is the treatment for a SUFE?

A
  • Surgical: epiphysis should be pinned in situ to prevent further displacement
  • note: treatment should be prompt to prevent avascular necrosis of the femoral head
21
Q

What is congenital talipes equinovarus (clubfoot)?

A
  • a deformity of the lower limb with calf-wasting and the classic inward-pointing foot (equinus deformity due to tight Achilles tendon and associated contraction of soft tissues on medial side of ankle)
22
Q

Untreated talipes equinovarus showing inversion contracture…

A
23
Q

Intraoperative view of talipes equinovarus surgery showing release of soft tissues…

A
24
Q

Post-operative image from talipes equinovarus surgery showing corrected deformity and soft tissue coverage…

A
25
Q

What is the management for talipes equinovarus?

A
  • Conservative: manipulation and casting for 3 months
  • Surgical: severe cases only, soft tissue release
  • (prognosis: foot and limb will never be normal in terms of appearance but patient will live a normal life)
26
Q

What is osteogenesis imperfecta and what is the pathology?

A
  • aka. brittle bone disease
  • OI is a type 1 collagen disorder predisposed to multiple fractures
    Pathology:
  • 4 different types of OI
  • OI is usually inherited as an autosomal dominant condition (types 1 and 4)
  • types 2 and 3 are sporadic and recessive but rare (type 2 is lethal)
27
Q

What are the clinical features of osteogenesis imperfecta?

A
  • fragile bones and low-energy fractures
  • (blue sclerae occur in types 1 and 2 OI)
  • associated features: deafness, joint laxity, brownish teeth, face dysmorphia, valvular defects
28
Q

Blue sclera (occurs in types 1 and 2 osteogenesis imperfecta)…

A
29
Q

What is the treatment for osteogenesis imperfecta?

A
  • Conservative: gentle handling, IV bisphosphonates to improve bone strength
  • Surgical: intramedullary telescoping rods for prevention of deformity and further fracture (established deformity is treated with osteotomy)
30
Q

What is cerebral palsy?

A
  • a non-progressive upper motor neurone, neuromuscular disorder that results from injury to an immature brain
  • (can be caused by perinatal infection such as meningitis)
31
Q

What are the clinical features of cerebral palsy?

A
  • muscle weakness and spasticity
  • ataxic gait, cognitive impairment and emotional disturbance
32
Q

What is the management for cerebral palsy?

A
  • (diagnosis is a clinical one)
  • Conservative: physio, OT, SALT
33
Q

What are some clinical features of a non-accidental injury (NAI)?

A
  • vague and inconsistent history
  • children <2 yrs: fractures are rare
  • delayed presentation
  • may be other bruises (may be old bruises)
  • child may be withdrawn, particularly when parents are present
  • (note: OI can sometimes be mistaken for NAI)
34
Q

What is the management for NAI?

A
  • social workers should be involved
  • fractures/bruises should be treated as normal
35
Q

What are the 2 paediatric knee conditions?

A
  • Osgood-Schlatter disease
  • Osteochondritis dissecans
36
Q

What is the pathology of Osgood-Schlatter disease?

A
  • inflammation of the insertion point of the patella tendon at the tibial tuberosity
37
Q

Osgood-Schlatter disease diagram…

A
38
Q

What are the clinical features of Osgood-Schlatter disease?

A
  • localised pain over the tibial tuberosity (tender/swollen)
  • pain worse with activity, relieved by rest
39
Q

What is the management for Osgood-Schlatter disease?

A
  • Conservative: rest, analgesia, activity modification (activity will not make it worse)
40
Q

What is Osteochondritis dissecans?

A
  • a small area of avascular bone on an articular surface (usually in the knee, medial femoral condyle)
  • caused due to repeated trauma in a susceptible patient
41
Q

What are the clinical features of osteochondritis dissecans?

A
  • adolescents and young adults
  • intermittent ache, swelling, joint locking
42
Q

What investigations should be done for suspected osteochondritis dissecans?

A
  • X-ray: shows variably sized lesion on medial femoral condyle (fragmented in children), lesion may be attached or loose
  • MRI: can also be used to help define lesion
43
Q

What is the management for osteochondritis dissecans?

A
  • Conservative: activity modification to allow to heal (usually self-limiting)
  • Surgical: surgical stabilisation for loose lesions, or removal of loose body
44
Q

What is juvenile idiopathic arthritis (JIA)?

A
  • JIA is a persistent autoimmune inflammatory arthritis lasting > 6 weeks in patients younger than 16 yrs (it is a diagnosis of exclusion)
45
Q

What are the clinical features of JIA?

A
  • systemic: fevers, malaise, salmon pink rash
    Joint disease: pain, stiffness, swelling ( > 6 weeks ), can cause stunted growth
46
Q

What investigations should be done for suspected JIA?

A
  • diagnosis is clinical and that of exclusion
  • X-ray: can help
  • Blood tests: can help (FBC, ESR/CRP, RhF, ANA)
47
Q

What is the management for JIA?

A
  • MDT approach
  • pharmacological: NSAIDs, corticosteroids, biologics
48
Q

What is transient synovitis (aka. irritable hip)?

A
  • cause of limp in children from inflammation of the synovial lining of the hip joint
  • symptoms: usually preceded by a viral infection (URTI common), acute onset limp, fever
  • management: bloods, joint aspirate and culture to rule out septic arthritis

YEAR 1 MED (49 decks)

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