Paeds Musculoskeletal Flashcards
Young teenage male with knee pain. Athlete
Osgood-Schlatter Disease
Osteochondritis of patellar tendon insertion
Adolescent female
Pain on sitting down or climbing in knees
Chondrocalcinosis patellae
inflammation of underside of patella
Blue Sclerae
Osteogeneis Imperfecta Type 1
5-10 year old with insidious onset limb pain
+ Progressively worsening
+ Abducted externally rotated limb
(painless limp?)
Flattened femoral head on Xray
Idiopathic Avascular Necrosis of femoral head
Perthes Disease
Perthes Primary, so think younger
10-15 year old overweight boy with painful limp
+ shortened externally rotated limb
+ Ice Cream Sign
Frog lateral position on X ray
Fracture through growth plate resulting in slipped head of femur
Slipped upper(capital) femoral epiphysis - SUFE
SUFE Secondary, so think older
Gowers sign + dilated cardiomyopathy
Duchenne’s Muscular Dystrophy
Tongue Fasciculations + absent deep tendon reflexes
Spinal Muscular Atrophy Type 1
Pain on waking at night in 3-12 year old
Growth pain/ nocturnal idiopathic pain
Differential dx of pads limp
STARTSS HOTT
Septic joint Tumour Avascular Necrosis (Perthes)- painLESS Rheumatoid arthritis/ JIA Tuberculosis Sickle cell disease SCFE/ SUFE - painFUL Hence Schonlein Purpura Osteomyelitis Trauma Toxic/transient synovitis
What is Sever’s Condition
Apophysitis of Achilles tendon insertion at heel bone
Four differentials for arthralgia/arthritis and rash
Kawasaki Disease
Heuloch Schonlein Purpurs
Acute Rheumatic Fever
Still’s disease - severe juvenile idiopathic arthritis
Kawasaki Disease Presentation
Toddler COLOR features + 5 days of fever Polymorphous rash arthralgia not a big feature Watch out for: coronary disease - Echo at presentation and 6 weeks after
Henloch Schonlein Purpurs Presentation
Young child
Purpuric rash on butt/legs
Abdominal pain –> risk of intussusception
Arthralgia
Haematuria
Hypertension
Watch out: renal failure, multi organ failure
Acute Rheumatic Fever Presentation ***
Young child Indigenous or immigrant background STREP features in Jones major criteria - Syndham's chorea/ transient migratory arthralgia/ rheumatic subcutaneous nodules / erythema marginatum / pancarditis Arthralgia migrates Erythema marginatum rash Watch out for RHD
Still’s Disease or JIA
Toddler Fever spikes Salmon pink rash arthralgia not a big issue Potential multi organ Watch out for: growth failure
Differentials for arthralgia with NO rash - 4
And what must you rule out?
Perthes
SUFE
OSD - osgood Schalter Disease
OCD - osteochondrosis dissecans
must rule out SARCOMAS
Perthes presentation
Younger child, not obese with/out prior transient synovitis insidious presentation XR: flattened femoral head
Slipped upper femoral epiphysis presentation
Older child
obese
Presents acutely, but also with chronic features
XR: ice-cream slipping off cone
Osgood Schalter Disease
older child
not obese, very active
acutely presents with tibial tuberosity Sx
XR: fragmentation of tibial tuberosity
Osteochondrosis dissecans
Older child,
not obese, very active
vague knee pain with activity
XR: fragmentation
Four syndromic neuro mimickers
Spinal muscular atrophy
Duchenne Muscular Dystrophy
Ataxia telangiectasia
Friederich’s ataxia
Spinal muscular atrophy
different types - but infantile Autosomal recessive Floppy baby Respiratory issues Paradoxical chest breathing
Duchenne muscular dystrophy
Young child X-linked recessive (more boys) Walking issues Gower's sign - tripod backward hand walking Calf pseudo-hypertrophy Dilated cardiomyopathy with/out ID
Ataxia telangiectasia
young child Autosomal recessive cerebellar signs telangiectasia recurrent infections Associated with leukaemia lymphoma
