Paediatric MSK Flashcards
What is transient synovitis f the hip?
A self-limiting inflammatory disorder of the hip that commonly affects young children (2-12)
“Irritable hip”
What are the clinical features of transient synovitis of the hip?
Unilateral and transient hip or groin pain Limp, reduced range of motion (pain) Recent URTI Positive log roll Normal CRP, ESR, FBE and x-ray
What is the most important differential for transient synovitis of the hip?
Septic arthritis
What is the management for transient synovitis of the hip?
Rest with simple analgesia (NSAIDs and paracetamol)
Gets better within 2 weeks
What is Perthe’s disease (LCPD)?
An idiopathic, avascular necrosis of the femoral head
What are the clinical features of Perthe’s disease?
Antalgic gait (on weight-bearing leg) Pain in hip or upper leg, may refer to the knee Insidious onset Exacerbated by internal rotation Faber test elicits pain Groin tenderness on palpation Restricted range of movement
What is the management for Perthe’s disease?
Conservative
Surgery
Who gets conservative management for Perthe’s disease?
Young children (<6 years of age) Lateral pillar A classification Femoral head mostly undamaged
What are the indications for surgery for Perthe’s disease?
> 8 years of age
Lateral pillar B or C classification
Extensive damage to the femoral head
What is slipped femoral epiphysis (SCFE)?
Posterior and inferior femoral head displacement in relation to the femoral neck at the proximal femoral growth plate
What are the clinical features of SCFE?
Pain in the medial thigh, groin or hip
Sudden onset limp
Reduced range of motion
Shortened, externally rotated hip
What are the risk factors for SCFE?
Male sex
Obesity
Growth spurt/puberty
Endocrine disorders
What are the investigations for SCFE?
Hip x-ray
TFTs - hypothyroidism
Serum growth hormone - deficiency
UEC - renal osteodystrophy
What is the management for SCFE?
Avoid weight bearing
Urgent surgical internal fixation
Prophylactic fixation of the contralateral hip
What are the complications of SCFE?
Avascular necrosis of the femoral head
Early onset osteoarthritis of the hip
Chondrolysis - rapid degeneration of the articular cartilage
What is Osgood-Schlatter’s disease?
An overuse syndrome of the paediatric population that typically affects young athletes during their adolescent growth spurt.
What are the risk factors for Osgood-Schlatter’s disease (OSD)?
Athlete
Adolescent
PHx OSD
Male sex
What are the clinical features of OSD?
Knee pain and tenderness to palpation
Exacerbated by resisted knee extension
Prominence or swelling over the tibial tuberosity (at the attachment of the patellar tendon)
What are the investigations for OSD?
Diagnosis is usually clinical. If unsure:
Kneee x-ray and ultrasound
What is the management for OSD?
Conservative - activity modification, ice, stretching and strengthening.
Analgesia
Surgical excision on bone in severe cases.
What is the prognosis of OSD?
Ultimate resolution occurring when patients reach skeletal maturity
What is juvenile idiopathic arthritis (JIA)?
Umbrella term for chronic paediatric arthropathies characterised by onset before 16 years and the presence of objective arthritis (in one or more joints) for at least 6 weeks
What are the risk factors for JIA?
Age <16
Female sex
FHx autoimmune disease
What are the classifications of JIA?
Oligoarticular Polyarticular Systemic Enthesitis-related Psoriatic Unclassified
What is oligoarticular JIA?
Most common subtype of JIA Affects up to 4 joints in the first 6 months Usually large joints In 3-year-olds Associated with chronic anterior uveitis
What is polyarticular JIA?
Affects 5 or more joins in the first 6 months
Affects children between ages 1-12 years
What is persistent oligoarticular JIA?
≤4 joints affected
Likely remission before adulthood
How is oligoarticular JIA subclassified?
At 6 months as either persistent (75%) or extended (25%)
What is extended oligoarticular JIA?
> 4 joints affected
Less likely to remit before adulthood
How is polyarticular JIA subclassified?
RF+ or RF-
Describe RF+ polyarticular JIA?
Likely to start hands/feet and then spreads to other joints
May have nodules over joints and tendons
More likely to persist into adulthood
Describe RF- polyarticular JIA?
More common than RF+
Affects a wide range of joints and varies in severity
Can go into remission in later childhood
May remit in adulthood
What is systemic JIA?
‘Still’s disease’
Least common
Fever and rash, affected heart, lungs
50% remit after 2-3 years without lasting damage
What is enthesitis-related JIA?
Inflammation of an enthesis (where a tendon joins a bone)
Large joints affected
HLA-B27 associated
Associated with acute anterior uveitis
What is psoriatic JIA?
Associated with psoriasis
Affected 7 year olds
Other psoriatic features
