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4C > Paediatric MSK > Flashcards

Paediatric MSK Flashcards

1
Q

What is transient synovitis f the hip?

A

A self-limiting inflammatory disorder of the hip that commonly affects young children (2-12)
“Irritable hip”

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2
Q

What are the clinical features of transient synovitis of the hip?

A 
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
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3
Q

What is the most important differential for transient synovitis of the hip?

A

Septic arthritis

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4
Q

What is the management for transient synovitis of the hip?

A

Rest with simple analgesia (NSAIDs and paracetamol)

Gets better within 2 weeks

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5
Q

What is Perthe’s disease (LCPD)?

A

An idiopathic, avascular necrosis of the femoral head

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6
Q

What are the clinical features of Perthe’s disease?

A 
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
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7
Q

What is the management for Perthe’s disease?

A

Conservative

Surgery

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8
Q

Who gets conservative management for Perthe’s disease?

A 
Young children (<6 years of age)
Lateral pillar A classification
Femoral head mostly undamaged
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9
Q

What are the indications for surgery for Perthe’s disease?

A

> 8 years of age
Lateral pillar B or C classification
Extensive damage to the femoral head

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10
Q

What is slipped femoral epiphysis (SCFE)?

A

Posterior and inferior femoral head displacement in relation to the femoral neck at the proximal femoral growth plate

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11
Q

What are the clinical features of SCFE?

A

Pain in the medial thigh, groin or hip
Sudden onset limp
Reduced range of motion
Shortened, externally rotated hip

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12
Q

What are the risk factors for SCFE?

A

Male sex
Obesity
Growth spurt/puberty
Endocrine disorders

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13
Q

What are the investigations for SCFE?

A

Hip x-ray
TFTs - hypothyroidism
Serum growth hormone - deficiency
UEC - renal osteodystrophy

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14
Q

What is the management for SCFE?

A

Avoid weight bearing
Urgent surgical internal fixation
Prophylactic fixation of the contralateral hip

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15
Q

What are the complications of SCFE?

A

Avascular necrosis of the femoral head
Early onset osteoarthritis of the hip
Chondrolysis - rapid degeneration of the articular cartilage

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16
Q

What is Osgood-Schlatter’s disease?

A

An overuse syndrome of the paediatric population that typically affects young athletes during their adolescent growth spurt.

17
Q

What are the risk factors for Osgood-Schlatter’s disease (OSD)?

A

Athlete
Adolescent
PHx OSD
Male sex

18
Q

What are the clinical features of OSD?

A

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)

19
Q

What are the investigations for OSD?

A

Diagnosis is usually clinical. If unsure:

Kneee x-ray and ultrasound

20
Q

What is the management for OSD?

A

Conservative - activity modification, ice, stretching and strengthening.
Analgesia
Surgical excision on bone in severe cases.

21
Q

What is the prognosis of OSD?

A

Ultimate resolution occurring when patients reach skeletal maturity

22
Q

What is juvenile idiopathic arthritis (JIA)?

A

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

23
Q

What are the risk factors for JIA?

A

Age <16
Female sex
FHx autoimmune disease

24
Q

What are the classifications of JIA?

A 
Oligoarticular
Polyarticular
Systemic
Enthesitis-related
Psoriatic
Unclassified
25
Q

What is oligoarticular JIA?

A 
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
26
Q

What is polyarticular JIA?

A

Affects 5 or more joins in the first 6 months

Affects children between ages 1-12 years

27
Q

What is persistent oligoarticular JIA?

A

≤4 joints affected

Likely remission before adulthood

28
Q

How is oligoarticular JIA subclassified?

A

At 6 months as either persistent (75%) or extended (25%)

29
Q

What is extended oligoarticular JIA?

A

> 4 joints affected

Less likely to remit before adulthood

30
Q

How is polyarticular JIA subclassified?

A

RF+ or RF-

31
Q

Describe RF+ polyarticular JIA?

A

Likely to start hands/feet and then spreads to other joints
May have nodules over joints and tendons
More likely to persist into adulthood

32
Q

Describe RF- polyarticular JIA?

A

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

33
Q

What is systemic JIA?

A

‘Still’s disease’
Least common
Fever and rash, affected heart, lungs
50% remit after 2-3 years without lasting damage

34
Q

What is enthesitis-related JIA?

A

Inflammation of an enthesis (where a tendon joins a bone)
Large joints affected
HLA-B27 associated
Associated with acute anterior uveitis

35
Q

What is psoriatic JIA?

A

Associated with psoriasis
Affected 7 year olds
Other psoriatic features

4C (15 decks)

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