Paeds: MSK Flashcards
< 16 years Fever joint pain (<4 joints) salmon-pink rash limp
Juvenile idiopathic arthritis
2-10 years old
Acute hip pain
Hx of recent viral infection
Transient synovitis
Tx: Self-limiting
Osteochondrosis due to inflammation at Tibial tuberosity
- repeated avulsion of apophysis where patellar tendon is inserted
Osgood-schlatter Disease
- found in kids who play a lot of sport
Pain not present at beginning of day
No limitation of activity
Worse after exercise
Growing pains
Absent medial arch on standing
Pes Planus (flat feet)
- Self resolves (4-8 years)
Bowed legs
Increased intercondylar distance
Genu varum
- self resolves (4-5 years)
Knock knees
Increases intermalleolar distance
Genu algum
- Self resolves
Inverted + plantar flexed feet
Not passively correctable
Talipes Equinovarus
“Clubfoot”
50% bilateral
Risk factors for Talipes equinovarus
Spina bifida
cerebral palsy
Edwards syndrome
Management for Talipes equinovarus
Ponseti methods
- progressive braces
Widening of the joints due to excess of non-mineralised osteoid at the growth plate
- bowed legs
- costochondral swelling
Ricket’s
- Caused by Vit D deficiency
External tibial torsion
Patellofemoral pain
Out toeing
- Resolves by 2 years
Metatarsus adductus: Abnormal heel bisector line
Internal tibial torsion
Femoral anteversion (W sign)
In toeing
Self resolve mostly
If not casts/ surgery
Age 5 Increased CK Rapid progression Calf pseudohypertrophy Uses arms to stand up from squat (Gower's sign)
Duchenne’s Muscular dystrophy
- 30% have intellectual impairment
- Dilated cardiomyopathy is common
Live into 20-30s
Uses arms to stand up from squat position
- Seen in Duchenne’s + Becker’s muscular dystrophy
Gower’s sign
Age 10
Slow progression
Calf pseudohypertrophy
Uses arms to stand up from squat (Gower’s sign)
Becker’s muscular dystrophy
- colour blindness is common
Live into 40s-50s
Genetics for Duchenne’s Muscular dystrophy
Frameshift utation in dystrophin
X-linked recessive (gene Xp21)
Genetics for Becker’s Muscular dystrophy
Non-frameshift utation in dystrophin
X-linked recessive (gene Xp21)
Unequal leg lengths
Limp
Discrepancy between skin creases of hip
Developmental dysplasia of the hip (DDH)
Risk factors for DDH
Female ( x 6 risk) Breech FHx First born Oligohydramnios Birth weight >5kg Congenital calcaneovalgus foot deformity
Investigations for DDH
<3 months: US (6 weeks post birth to all breech >36w gestation)
>3 months: X-RAY (shenton’s line should be smooth arc)
To diagnose:
Barlow test: attempt to dislocate articulated femoral head
Ortolani test: attempt to relocate a dislocated femoral head
attempt to relocate a dislocated femoral head
Ortolani test
attempt to dislocate articulated femoral head
Barlow test
Management for DDH
Spontaneously stabilise by 3-6 weeks
Palik harness (dynamic flexion-abduction orthosis) - used <4-5 months
Surgery
Age 4-12 years (Primary school)
Hip pain
limp
Stiffness and decreased movement
Perthe’s disease (in Primary school)
- avascular necrosis of the femoral head (epiphysis)
- 5M:1F
- 20% bilateral
Staging of Perthe’s disease
Caterall Staging
- Histological features only
- Sclerosis + preservation of articular surface
- Loss of structural integrity of femoral head
- Loss of acetabular integrity
Investigations for Perthe’s disease
XR: Widening of joint space
Flattening of femoral head
Technetium bone scan
MRI: Gold standard for diagnosis
Management of Perthe’s Disease
< 6 years: observe
> 6 years: surgery
Keep femoral head in acetabulum (cast + braces)
Age 10-15 years (Secondary School)
Obese male
Knee pain (referred from ipsilateral hip, 2 months)
Limits to internal rotation
Slipped Upper Femoral Epiphysis (SUFE)
- displacement of femoral head epiphysis posterior-inferiorly
- bilateral 20%
- most common adolescent hip disorder
Investigations in SUFE
XR: Displacement of femoral epiphysis
Falls inferolaterally (like melting ice cream)
Calculated degree of displacement with Southwick angle
Management of SUFE
Bed rest + non-weight bearing
Severe: Percutaneous pinning of the hip (internal fixation)
