Paediatric MSK conditions Flashcards
what is developmental dysplasia of the hip?
dislocation/subluxation of the femoral head during the perinatal period which affects the development of the hip joint
if DDH is left untreated what can occur?
shallow acetabulum, leading to shortened limb and limp
severe arthritis
give 4 risk factors for DDH?
Girls > boys
Breech presentation
1st born
Multiple pregnancy
which hip is more likely to be affected in DDH?
Left hip
A baby presents with shortening of their left leg, and asymmetrical groin creases, what investigations would you do and what differential diagnosis would you be considering?
Ultrasound of hip
Ortolani/Barlows tests
DDH
what are Ortolani and Barlows tests?
diagnostic for DDH if a clunk is heard
Ortolani = reducing a dislocated hip with abduction and anterior displacement
Barlows = dislocating hip with adduction and posterior displacement
How is DDH managed?
Pavlik’s harness for 6 weeks - holds hips flexed and abducted
What is Perthes disease?
idiopathic Osteochondritis of the femoral head - inflammation of the bone/cartilage which leads to the femoral head losing its blood supply, AVN and collapse/fracture as a result
Who is most likely to be affected by Perthes disease?
Short boys who are active
How does Perthes disease present?
Hip pain
Limp
Loss of internal rotation of the hip
Management of Perthes disease?
regular X-rays and no exercise to monitor improvement
what is transient synovitis of hip?
self limiting of the synovium of the hip joint, usually following an URTI
How does transient synovitis of the hip present?
limp with knee/groin pain
history of URTI
reluctance to weight bear
management of transient synovitis of hip?
once more serious causes have been excluded NSAIDs and rest
what does SUFE stand for?
Slipped Upper Femoral Epiphysis
What is SUFE?
when the femoral head slips inferiorly in relation to the femoral neck
Who is most likely to get SUFE?
Overweight pre-pubertal boys
What can develop as a result of SUFE?
avascular necrosis of the femoral head
How would SUFE present?
pain - can sometimes only be in the knee
loss of internal rotation of the hip
limp
Management of SUFE?
Pinning of the femoral head to prevent it slipping further
What is osteogenesis imperfecta and what is it caused by?
Brittle bone disease - autosomal dominant defect in maturation and organisation of type I collagen
What are blue sclera, loss of hearing and multiple fragility fractures signs of?
Osteogenesis imperfecta
What will bones look like on X-Ray in osteogenesis imperfecta?
Bones will have thin cortices and be osteopenic
What is the difference between proportionate and disproportionate skeletal dysplasias?
proportionate = limbs and spine are proportionately short disproportionate = limbs are disproportionately short/long compared to the spine
What is the most common type of skeletal dysplasia and what are its typical features?
Achondroplasia
Disproportionately short limbs, lax joints & prominent forehead
What is Ehlers-Danlos syndrome?
autosomal dominant condition where there is abnormal collagen and elastin formation - get joint hypermobility and instability
What is Marfans syndrome?
autosomal dominant/sporadic condition affecting the fibrillin gene - tall with disproportionately long limbs
What is duchenne’s muscular dystrophy?
progressive muscular weakness due to a defect in the dystrophin gene
what is a sign of duchenne’s muscular dystrophy?
Gowers sign - walking hands up legs due to pelvic weakness
Who is most likely to be affected by duchenne’s?
Boys
What is cerebral palsy?
neuromuscular condition due to insult to the developing brain before age 3
Give 5 causes of cerebral palsy?
Brain malformation Intrauterine infection Premature birth Hypoxia during birth Menengitis
What is ataxic cerebral palsy?
When the cerebellum is affected so there is reduced coordination and balance
What is athetoid cerebral palsy?
when there is uncontrolled writhing motion, sudden changes in tone and difficulty controlling speech
Give 3 MSK related complications of cerebral palsy?
Joint contractures
Scoliosis
Hip dislocation
What is Spina Bifida?
a congenital disorder where 2 halves of the posterior vertebral arch fail to fuse in the first 6 weeks of gestation
What is poliomyelitis?
viral infection affecting the anterior motor horn cells in the spinal cord/brain stem - this results in lower motor neurone deficit (paralysis)
What is the most common type of obstetric brachial plexus palsy and which nerve roots are affected in it?
Erb’s palsy - injury to C5 & C6 nerve roots
loss of innervation to trapezius, deltoid and some of the rotator cuffs resulting in “waiter tips” pose
What is the more rare type of obstetric brachial plexus palsy where C8 and T1 roots are affected?
Klumpkes palsy
What is talipes equinovarus?
clubfoot - congenital deformity where the calcaneus, talus and navicular are misaligned and there are contractors in the surrounding soft tissues
Are boys or girls more likely to have clubfoot?
boys
Give 2 risk factors for the development of clubfoot?
Breech presentation
Low amniotic fluid content
Management of clubfoot?
Ponseti technique
What is myositis ossificans?
post traumatic calcification of soft tissues - history of trauma with soft tissue swelling, hardness then develops over a couple of weeks
What is the best imaging for suspected DDH?
Ultrasound
