Paeds: Musculoskeletal

Question 1

12 year old girl presents to GP complaining of pain in the legs. Never present at the start of the day after the child has woke. 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. Most likely diagnosis?

Answer 1

Growing pains

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NB: JIA, osteosarcoma and others

Question 2

A 14-year-old boy who plays basketball begins to experience pain whilst playing. He attends his GP and is diagnosed with Osgood-Schlatter disease.

This condition occurs as a result of inflammation at which bony prominence?

Answer 2

Tibial tuberosity

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Osgood-Schlatter disease is a type of osteochondrosis caused by inflammation (apophysitis) at the tibial tuberosity.

Palpating the tibial tuberosity often reveals the diagnosis. This condition is very common in young, active children.

Trochanteric tenderness may occur in trochanteric bursitis.

Tenderness below the patella on examination suggests patellar tendonitis.

The medial femoral condyle may be affected in sporting injuries.

Fibular head pain is uncommon.

Question 3

Slipped Capital Femoral Epiphysis (SCFE) management?

Answer 3

Surgery, internal fixation (If severe)

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A slipped upper femoral epiphysis is an emergency, as there is a risk of avascular necrosis of the femoral head. It therefore mandates immediate referral to paediatric orthopaedics.

Question 4

Treatment of club foot?

Answer 4

Ponseti method

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The Ponseti method is a process of serial manipulation and casting over a few weeks used to treat clubfoot.

Question 5

What is the treatment for Developmental dysplasia of the hip?

Answer 5

Use of a Pavlik harness