Paediatrics - MSK + rheum Flashcards
What are some causes of hip (or other joint) pain in 0-4 year olds (3)?
- Septic arthritis
- Developmental dysplasia of the hip * Transient sinovitis
What are some causes of hip (or other joint) pain in 5-10 year olds (3)?
- Septic arthritis
- Transient sinovitis
- Perthes disease
What are some causes of hip (or other joint) pain in 10-16 year olds (3)?
- Septic arthritis
- Slipped upper femoral epiphysis
- Juvenile idiopathic arthritis
How can hip pain present (3)?
- Pain
- Refusal to walk/ weight bear
- Swollen/ tender joint
What are some red flag features for hip pain (6)?
- Child under 3
- Fever/ weight loss
- Night waking/ pain
- Swollen/ red joint
- Persistent pain
- Other injuries (NAI)
What are some general investigations for joint pain (5)?
- Bloods
- Xray
- USS
- Joint aspiration
- MRI
What is the most common cause of hip pain in children 3-10?
Transient synovitis
What is transient synovitis also known as?
Irritable hip
What causes transient synovitis?
Inflammation of the synovial membrane typically following a viral URTI
What are the signs/ symptoms of transient synovitis (4)?
- Inability to weight bear
- Groin/ hip pain
- Limp
- Mild low grade fever
children should otherwise be well
How should children with transient synovitis be managed?
Refer if symptoms not improving after 72 hours
What is an important differential for transient synovitis and how can it be differentiated?
Septic arthritis - usually present with a high fever
What age is septic arthritis most common in children?
Under 4 years old
What is a risk factor for septic arthritis?
Joint replacement
What is the most common bacteria and what other bacteria cause septic arthritis (5)?
- Staph aureus = mc
- Neiserria gonorrhoea
- GAS (strep pyogenes)
- H. influenza
- E. coli
What are the signs/ symptoms of septic arthritis (5)?
- Red, hot, swollen joint
- Fever
- Reduced range of motion
- Stiffness
- Non weight bearing
How is septic arthritis investigated (2)?
- Joint aspiration (high WBC, MC+S)
- Bloods
What criteria can be used to differentiate between transient synovitis and septic arthritis?
Kocher criteria
What are the kosher criteria (3)?
- Non weight bearing
- Temp > 38.5
- High WCC/ ESR
How is septic arthritis managed (2)?
- IV Abx (3-6 weeks)
- Surgical debridement (if severe)
What is developmental dysplasia of the hip?
Structural abnormality caused by abnormal development of the foetal bones during pregnancy
What are the risk factors for DDH (4)?
- Family history
- Breech position
- Fibroids
- Multiple pregnancy
What are the signs/ symptoms of DDH (3)?
- Leg length discrepancy
- Skin folds on one side
- Restricted hip abduction
- Clunking noise when leg examined
What are two special tests that can be used to check for DDH?
- Ortolani (hip dislocate anteriorly)
- Barlow (hip dislocate posteriorly)
When is DDH often picked up/ diagnosed?
When examining the baby in the NIPE and again at 6-8 weeks
How is DDH diagnosed (2)?
- USS
- Xray in older infants
How is DDH managed?
Pavlik harness is worn permanently for 6-8 weeks
if child diagnosed before 6 months old
How is DDH managed if the child is diagnosed after 6 months?
Surgery
What is Perthes disease?
Disruption of blood flow to the femoral head causing avascular necrosis
What are some risk factors for Perths disease (3)?
- Male
- Family history
- Downs
How quickly do symptoms of Perthes disease come on?
Slow onset
What are the signs/ symptoms of Perthes disease (4)?
- Slow onset pain in the hip
- Limp
- Restricted range of movement (abduction + internal rotation)
- Trendelenburg +ve (muscle waisting - from lack of use)
What age is Perthes disease most common?
Mostly 5-8 years (can be 4-12 years)
How is Perthes disease investigated (3)?
- Xray
- Bloods
- MRI
What are the signs of Perthes on x-ray (2)?
- Wide joint space
- Caffey sign (decreased BMD, thin fracture)
How can Perthes disease be monitored?
Using the catterall classification (from xray appearance)
How is Perthes disease managed (2)?
- Bed rest
- Crutches
- Osteotomy (reshape joint)
How long can Perthes disease last?
5 years
What is a common-ish complication of Perths disease?
OA of the hip
What is a slipped upper femoral epiphysis?
When the head of the femur is displaced along the growth plate
What type of fracture occurs in SUFE?
Salter Harris 1 fracture
What are some risk factors for SUFE (3)?
- Obese
- Male
- Trauma
What age is usually affected by slipped upper femoral epiphysis?
10 -15 year olds (during growth spurt)
What are the signs/ symptoms of SUFE (3)?
- Hip/ groin/ thigh/ knee pain
- Restricted range of movement
- Painful limp
What position do children with slipped upper femoral epiphysis like to rest their leg in?
Externally rotated (drehmann sign)
What usually precedes children with SUFE in the history?
Minor trauma
How is SUFE investigated (3)?
- Xray (frog leg)
- Blood (rule out other stuff)
- Other imaging (CT, MRI)
How is SUFE managed?
Surgical internal fixation
What is a complication of SUFE?
Avascular necrosis of the femoral head as blood supply cut off by fracture
What condition not mentioned yet may cause hip and other larger joint pain?
Rheumatic fever associated arthritis
