Paediatrics MSK Flashcards
Causes of a limp.
a) 0 - 3 years
b) 3 - 10 years
c) 10 - 15 years
a) - Infection (septic arthritis, OM)
- Trauma (e.g. toddler fracture, NAI)
- Developmental (e.g. DDH)
- Malignancy (leukaemia), haem (e.g. SCD)
b) - Transient synovitis
- Trauma
- Infection
- Perthes’
- JIA
- Malignancy (leukaemia)
- Haem (e.g. SCD)
c) - Trauma
- SCFE
- Perthes’
- Osgood-Schlatter
- Infection
- JIA
- Chrondromalacia
- Haem (e.g. SCD)
- Rare - malignancy (osteosarcoma, Ewing’s, leukaemia)
Most common site of pathology in limp
Hip, then thigh, then leg, then knee, then foot/ankle
Note: hip pathology may present as knee pain and vice-versa
16 month old begins limping, no witnessed trauma. Otherwise happy and aseptic.
- O/E: point tenderness in left leg.
a) Likely diagnosis
b) Management
a) Toddler’s # (usually undisplaced spiral # of tibia after unwitnessed fall)
b) - XR leg (caveat: may not be present)
- If clinical suspicion of fracture: immobilise, back slab or supportive cast
6 year old girl presents with acute onset of limp. Has some coryzal symptoms, apyrexial. Mild effusion of right hip and mildly raised WCC and CRP.
a) Likely diagnosis
b) Management
a) Transient synovitis
b) - Aspirate joint to rule out septic arthritis
- XR hip
- Rest, physio, NSAIDs, review inb
18 month old presents unwell and crying. Previously walking but now refusing to walk. Resistance to movement of left hip. Temp 38.3 C
a) Likely diagnosis
b) What rule may be applied to assess the likelihood of this diagnosis in an inflamed hip? (probability for each score)
c) What appearance may the affected hip have?
d) Management
a) Septic arthritis
b) Kocher criteria:
- Non-weight bearing (1 point)
- Temp > 38.5 C (1 point)
- ESR > 40 (1 point)
- WCC > 12,000 (1 point)
Probability of septic arthritis: 0 = <1%, 1 = 3%, 2 = 40%, 3 = 93%, 4 = 99%
c) Flexed, abducted and externally rotated
d) - FBC and CRP
- Aspirate joint
- XR hip
- IV Abx 4 - 6 weeks: flucloxacillin
6 year old boy presents with a progressive painful left leg and limp. The child was a baby of low weight and both parents smoke. Vitals are normal. No hx of trauma.
O/E: reduction in all movements in the left hip
a) Likely diagnosis
b) Pathogenesis
c) What simple test on examination would support the diagnosis?
d) Management
a) Perthes’
b) Avascular necrosis of the femoral head, causing abnormal growth and eventual remodelling
c) Roll test (internal and external rotation) - causes pain
d) - Bloods: FBC and CRP
- Aspirate if effusion
- XR: Widening of joint space
- If < 6 years and minimal necrosis: conservative (physio)
- If > 6 years or severe necrosis: surgical
13 year old boy presents with increasing left knee pain over a few weeks, leading to a limp and pain on any physical activity. You note that he is overweight. There are no signs of trauma or infection. When you flex the hip, it begins to externally rotate and abduct.
a) What is the likely diagnosis?
b) What sign is present on examination?
c) What is the pathogenesis of this condition?
d) Management
a) SCFE
b) Drehmann’s sign
c) The epiphysis and diaphysis slip out of line with each other at the growth plate; may be due to minor trauma but often non-traumatic
d) - AP and frog-leg XR of femurs: shows displacement of femoral head
- Immobilise - no weight bearing
- Need surgery - usually screw fixation across growth plate
A 6 week old girl presents for newborn screening test. No abnormalities were found on postnatal examination. The mother tells you her daughter was a breech birth, but no other complications were found. You observe clunking of the hips during examination manoeuvres.
a) What is the likely diagnosis?
b) What 2 tests are performed to assess this? (explain each)
c) What other signs o/e would support this?
d) How should this diagnosis be confirmed?
e) Management
f) Other complications of breech birth
g) Management of breech presentation
a) DDH
b) - BarLow’s: try to disLowcate the hips
- Ortolani’s: try to relocate the hips
c) Asymmetrical skin folds in the thigh/gluteals; limb length discrepancy (Galeazzi sign)
d) USS
e) - Bracing of the hip
- Surgery if required
f) - PROM/ premature labour
- Cord prolapse
- Trauma: fractures, intracranial haemorrhage, nerve injury (e.g. Erb’s)
g) - ECV between 32- 35 weeks
- If this fails: planned CS
