Paeds MSK Flashcards
Rickets
inadequately mineralised bone in developing and growing bones.
- Soft and easily deformed bones
- Often due to VitD deficiency in adults: Osteomalacia
- Dietary deficiency, Prolonged breast feeding, Unsupplemented milk formula, lack of sun light are major causes
- Miserable child
- Aching bones and joints
- Bow legs - toddlers
- Genu Valgum - Knock Knees
- Rickety Rosary - swelling at wrist joint
- Soft skull in early life - craniotabes
- Kyphoscoliosis
Bloods Low VitD, Serum Calcium. Raised Alk phosphatase
Management: Oral Vit D
Brittle Bone Disease | Autosomal Dominant
Osteogenesis Imperfecta
disorder of collagen metabolism resulting in bone fragility & fractures
- Fractures from minor trauama
- Blue Sclera
- Deafness 2ndry to Otosclerosis
- Dental Imperfections
Management
- Underlying condition cannot be cured.
Medical treatment includes:
- Bisphosphonates to increase bone density
- Vitamin D supplementation to prevent deficiency
all relevant bloods for bones are normal.
Irritable Hip
Transient Synovitis
Acute pain following viral infection
Most common hip pain in children b/ween 3-8Y
- Limp/ Refusal to weight bear
- Pain in hips and/or groin
- Low grade fever
Management
- Self limiting
High grade fever should point towards a septic arthritis cause.
children may be monitored in primary care (with a presumptive diagnosis of transient synovitis)
M:F ratio = 2:1
Septic Arthritis
Infection of joint space by bacteria or fungi. Beyond neonatal period
Most common: Staph Aureus so important to perform joint aspiration to see.
- Joint pain often unilateral
- Limp
- High grade fever with lethargy
- Swollen Red Joint with minimal movement
Management
- Antibiotics started promptly and adjusted according to culture results.
The most commonly affected joints are the hip, knee and ankle.
The Kocher criteria for the diagnosis of septic arthritis:
fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC
Infection of the metaphysis of long bones. often femur or tibia
Osteomyelitis
Infection of the bone.
- Staph Aureus most common
- Salmonella species dominate in sickle cell.
- low-grade pyrexia or malaise; may possibly be afebrile.
Once infection becomes established in a bone, it presents with a markedly painful, immobile limb in a child with acute febrile illness. - Haematogenous spread common in children results from bacteraemia
MRI investigation of choice
Management
- Flucloxacillin 6wks
- Clinamycin if penicillin allergy
M 5:1 F
Perthe’s Disease
Degenerative hip joints in children due to avascular necrosis of femur
- Specifically the femoral epiphysis. Impaired blood supply to the femoral head causes bone infarction.
- often unilateral
- Hip pain, stiffness and limp
- XRay: widening of joint space, decreased femoral head size
- Technetium bone scan if XRay clear.
can lead to osteoarthritis
Treatment involves physiotherapy initially to optimise range of movement. Sometimes surgery is required in severe disease.
obese boys - 10-15y
Slipped capital femoral epiphysis
Hip condition, displacement of femoral head epiphysis postero-inferiorly
May present acutely following trauma or more commonly with chronic, persistent symptoms
- hip, groin, medial thigh or knee pain
- Sometimes following trauma
- loss of internal rotation of the leg in flexion
- bilateral slip in 20% of cases
AP + lateral Xray = Diagnostic
- Management is primarily surgical stabilisation, usually with pin fixation in situ - single cannulated screw in middle of epiphysis.
- Physiotherapy following surgery is essential to optimise the range of movement and return to normal activities.
Osgood Schlatter
type of osteochondrosis
Repetitive strain from overuse of the knee can increase risk.
- inflammation at tibial tuberosity
- Pain in the anterior aspect of the knee
- Pain exacerbated by physical activity, kneeling and extension of the knee
- commonly unilateral
inflammation @ growth plate site.
- Reduction of physical activity
- Ice
- NSAIDs
- Physio
Congeital dislocation of Hip
Developmental dysplasia of the hip
sublaxation through to frank dislocation of the hip.
RF: Female, Breech Presentation, Oligohydraminos
More common at Left hip
Symptoms: - Different leg lengths, Restricted hip abduction on one side.
Examination: Barlows test(dislocate femoral head) Ortolani(Relocate dislocated head)
USS 1st line. if older than 4.5m then Xray
Management
* most unstable hips will spontaneously stabilise by 3-6 weeks of age
* Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
* older children may require surgery
Juvenile idiopathic arthritis
Arthritis in U16 for more than 6wk
- pyrexia
- salmon-pink rash
- lymphadenopathy
- arthritis
- uveitis
- anorexia and weight loss
ANA +ve. RF -ve
Cannot be cured, but early aggressive control of inflammation improves long-term outcomes.
Medical management includes:
- NSAIDs and analgesia
- Methotrexate – less effective in Still’s disease.
- Corticosteroids – either oral, intramuscular or intra-articular in oligoarthritis
- Biologic therapies.
Scoliosis
Risk factors : +VE fam history, connective tissue disorders(Marfans)
Causes of scoliosis are:
- Idiopathic: most common cause, either early onset (less than 5) or late onset, mainly girls aged 10-14 years
- Congenital: congenital structural defect of the spine
- Secondary: related to other disorders such as neuromuscular problems, bone or connective tissue disorders, arthritis etc.
Lateral curvature of the spine in the frontal (CORONAL) plane. In most cases the changes are mild, pain free and mainly a cosmetic problem; however severe can lead to further complications.
- Mild disease will resolve spontaneously, or progresses minimally.
- Severe cases are managed in specialist spine centres where non-medical treatment such as bracing is considered.
- Surgery indicated only if severe, or there is coexisting pathology such as neuromuscular or respiratory disease.
Torticolis
Common cause is sternocleidomastoid tumour
Torticollis – wry neck. Tends to be a problem with the muscles of the neck that cause the head to tilt down.
- Congenital condition tends to present with a mobile, non-tender nodule which can be felt within the body of the sternocleidomastoid muscle. May be restriction or head turning and tilting of the head.
- Resolves it self 2-6mths
