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
