Paeds MSK Flashcards
What is Osgood-Schlatter disease
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
What is Osteochondritis dissecans
Pain after exercise
Intermittent swelling and locking
What is Patellar tendonitis
More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination
Growth plate fractures
Type 1: Straight across
Type 2: Above
Type 3: BeLow
Type 4: Through
Type 5: CRush
Undisplaced spiral fracture of the tibia
toddlers fracture
Presentation transient synovitis
limp/refusal to weight bear
groin or hip pain
a low-grade fever is present in a minority of patients
after respiratory illness
Management transient synovitis
Transient synovitis is self-limiting, requiring only rest and analgesia.
Investigations ?septic arthritis
USS, if shows effusion and with corroborating history, treat as septic arthritis
joint aspiration: for culture. Will show a raised WBC
raised inflammatory markers
blood cultures
Most common causative organism septic arthritis
Staphylococcus aureus is the most common causative organism
If you were going to get septic arthritis from an STI, what would it be?
neisseria gonorrhoea
what is the kocher criteria
fever >38.5 degrees C
non-weight bearing
raised ESR > 40
raised WCC >12
Best imaging for osteomyelitis
MRI
Most common organism osteomyelitis
staph aureus
Management osteomyelitis
sepsis 6 and local protocol
adult and over 5 1. fluclox 2. vancomycin if pen allergic
<5 1. ceftriaxone
How does perthes present
Pain in the hip or groin
Limp
Restricted hip movements
There may be referred pain to the knee
no trauma!!
investigations perthes
plain x-ray
technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist
Management perthes
rest
cruches
analgesia
physio
Age typical SUFE
typically presents aged 8 – 15 years, with the average age of 12 in boys
Presentation SUFE
Hip, groin, thigh or knee pain
Restricted range of hip movement
Painful limp
Restricted movement in the hip
Minor trauma history
Investigations SUFE
- X-ray
Blood tests are normal, particularly inflammatory markers used to exclude other causes of joint pain
Technetium bone scan
CT scan
MRI scan
Management SUFE
surgery
Inheritance osteogenesis imperfecta
autosomal dominant
abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides
Features of osteogenesis imperfecta
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common
Blood tests osteogenesis imperfecta
adjusted calcium, phosphate, parathyroid hormone and ALP results are usually normal in osteogenesis imperfecta
manaagement osteogenesis imperfecta
Bisphosphates to increase bone density
Vitamin D supplementation to prevent deficiency
Investigatons rickets
Serum 25-hydroxyvitamin D is the laboratory investigation for vitamin D. A result of less than 25 nmol/L establishes a diagnosis vitamin D deficiency, which can lead to rickets.
Xray is required to diagnose rickets.
Dosage vitamin D for kids whoa re deficient
6 months and 12 years is 6,000 IU per day for 8 – 12 weeks.
Whos at more risk of vitamin D deficiency - breast fed babies or bottle fed
breast fed
Management kawasaki disease
High dose aspirin to reduce the risk of thrombosis
IV immunoglobulins to reduce the risk of coronary artery aneurysms
Features of kawasaki/ criteria
Conjunctivitis (non-exudative, bilateral)
Rash (nonvesicular)
Adenopathy
Strawberry tounge
Hands (peeling, redness)
and burn (5 days of fever)
4 of 5 symptoms WITH fever > 5 days fever (above 39 degrees)
What is rheumatic fever?
Acute rheumatic fever is an autoimmune condition triggered by streptococcus bacteria.
It is caused by antibodies created against the streptococcus bacteria that also target tissues in the body.
Criteria for rheumatic fever
A diagnosis of rheumatic fever can be made when there is evidence of recent streptococcal infection, plus:
Two major criteria OR
One major criteria plus two minor criteria
The mnemonic for the Jones criteria is JONES – FEAR.
Major Criteria:
J – Joint arthritis
O – Organ inflammation, such as carditis
N – Nodules
E – Erythema marginatum rash
S – Sydenham chorea
Minor Criteria:
Fever
ECG Changes (prolonged PR interval) without carditis
Arthralgia without arthritis
Raised inflammatory markers (CRP and ESR)
Investigations for rheumatic fever
Throat swab for bacterial culture
ASO antibody titres
Echocardiogram, ECG and chest xray can assess the heart involvement
What causes rheumatic fever
Group A strep - strep pyogenes
How does stills disease present?
salmon pink rash, high swinging fevers, arthritis
How does polyarticular arthritis present?
5 or more joints, symmetrical
How does oligoarticular/pauciarticular arthritis
4 joints or less
Larger joints
60% of JIA
Girls under 6 years
Anterior uveitis
How does enthesitis present?
Boys over 6 years
Tender entheses
How do psoriatic arthritis present?
symmetrical polyarthritis affecting the small joints similar to rheumatoid, or an asymmetrical arthritis affecting the large joints in the lower limb.
Pitting
Dactylitis
Psoriatic plaques
enthesitis
Most common juvenile arthritis
Oligoarticular/pauarticular
Which JIA do you get raised inflammatory markers
systemic/stills
Which JIA is associated with HLA-B27
enthesitis
What arthtitis is ANA positve
oligoarticular/pauarticualr
What JIA may be RF positive
polyarticualr
in older children
Acute inflammation JIA
NSAIDs
Steroid injections or oral
Long term management JIA
- DMARDs methotrexate or IM sulfasalazine
- Biologics: adalimubab
Kids and methotrexate
upset stomach
Symptoms of reactive arthritis
‘Can’t see, pee or climb a tree’
What pathogens causes reactive arthritis
Chlamydia
Shigella
Salmonella
Yersinia
Campylobacter
Management reactive arthritis
symptomatic: analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months
Associations reactive arthritis
Bilateral conjunctivitis (non-infective)
Anterior uveitis
Circinate balanitis is dermatitis of the head of the penis
What rheumatological condition is POTS associated with
ehlers danlos
features of growing pains
never present at the start of the day after the child has woken
no limp
no limitation of physical activity
systemically well
normal physical examination
motor milestones normal
symptoms are often intermittent and worse after a day of vigorous activity
features of rickets
Rickety rosary
I pigeon chest (pectus carinatum)
Craniotabes (soft skull bones)
Knock knees (older), bowed legs (toddler)
End of long bones –> wide
Teeth hypoplasia
Skull frontal bossing and delayed closure of fontanelles
aching bones and joints
Genu varum (bow legs)
Genu valgum (knock knees) - stuck together with gum
‘rickety rosary’ - swelling at the costochondral junction
kyphoscoliosis
craniotabes - soft skull bones in early life
Harrison’s sulcus
widening of joints on imaging
What collagen is implicated in osteogenesis imperfecta?
type 1
genetics achondroplasia
The achondroplasia gene, fibroblast growth factor receptor 3 (FGFR3), is on chromosome 4. Achondroplasia results from either a sporadic mutation or inheritance of an abnormal copy of this gene. The condition is inherited in an autosomal dominant pattern. Homozygous gene mutations, meaning two abnormal gene copies with one from each parent, is fatal in the neonatal period. Therefore, patients with achondroplasia have one normal gene and one abnormal gene.
Mutations in the FGFR3 gene causes abnormal function of the epiphyseal plates (growth plates). This restricts the bone growth in length, leading to short bones and short stature.
