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**Y4 CBLs edited > Paeds: The Limping Child (3) > Flashcards

Paeds: The Limping Child (3) Flashcards

1
Q

What’s Enthesitis related arthritis?

A
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2
Q

What’s Psoriatic Arthritis?

  • features/criteria
A

Psoriatic Arthritis

  • Arthritis and psoriasis

or

  • Arthritis and at least 2 of:
  • dactylitis
  • nail abnormalities, e.g. pitting
  • family history of psoriasis
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3
Q

Ix in suspected psoriatic arthritis

A

Non-diagnostic → exclude definable causes of arthritis, e.g. septic

  • Anaemia of chronic disease
  • sJIA - Leucocytosis / thrombocytosis
  • ESR
  • ANA →risk for uveitis, especially in oligo sub-type
  • Radiology
  • plain films / MRI with contrast /US / nuclear scans
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4
Q

Aims of management of psoriatic arthritis

A
  • Disease remission
  • Symptomatic improvement
  • Stiffness
  • Pain
  • Joint range of movement
  • Prevent joint damage
  • Normal growth and development
  • Education and normal adolescence
  • Prevent eye damage from uveitis
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5
Q

Management of psoriatic arthritis

A
  • MDT: paediatric rheumatologist, nurse specialist, OT/physio, ophthalmologist etc.
  • Anti inflammatory drugs:
  • NSAIDs
  • Glucocorticoids - intra-articular
  • Disease modifying drugs
  • Methotrexate
  • Biologics
  • Anti TNF, e.g. etanercept / adalimumab
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6
Q

Poor and good indicators for prognosis in psoriatic arthritis

A

Poor indicators

  • Polyarticular onset and course
  • Rheumatoid factor positive girls
  • Systemic disease with persistent features
  • Delay in starting effective treatment

Good indicators

•Oligoarticular disease

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7
Q

What’s Perthes’ disease?

(epidemiology, pathophysiology)

A

Perthes’ disease

  • a degenerative condition affecting the hip joints of children
  • typically between the ages of 4-8 years

Pathophysiology: to avascular necrosis of the femoral head, specifically the femoral epiphysis → impaired blood supply to the femoral head → bone infarction

Perthes’ disease is 5 times more common in boys. Around 10% of cases are bilateral

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8
Q

Features of Perthes’ disease

A
  • hip pain: develops progressively over a few weeks (in 10-20% cases it’s bilateral)
  • limp
  • stiffness and reduced range of hip movement
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9
Q

X-ray changes in Perthes’ disease

A
  • normal initially
  • early changes → widening of joint space
  • later changes → decreased femoral head size/, ↑ density of femoral head, fragmented and irregular, flattening and sclerosis

Bone scan is useful

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10
Q

Diagnosis of Perthes’ disease

A
  • plain x-ray
  • technetium bone scan or magnetic resonance imaging if normal x-ray and symptoms persist
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11
Q

Complications of Perthes’ disease

A
  • osteoarthritis
  • premature fusion of the growth plates
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12
Q

Staging of Perthes’ disease

A
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13
Q

Management of Perthes’ disease

A
  • To keep the femoral head within the acetabulum: cast, braces
  • If less than 6 years: observation
  • Older: surgical management with moderate results
  • Operate on severe deformities

Another source:

  • If detected early and < half femoral head affected
  • Bed rest and traction
  • More severe
  • Maintain hip in abduction with plaster
  • Femoral or pelvic osteotomy
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14
Q

Prognosis with Perthes’ disease

A
  • Most cases will resolve with conservative management
  • Early diagnosis improves outcomes
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15
Q

The other name for Slipped upper femoral epiphysis

A

aka Slipped CAPITAL femoral epiphysis

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16
Q

Epidemiology of slipped upper femoral epiphysis

A
  • typically age group is 10-15 years
  • more common in obese children and boys
  • Two main groups
  • Fat and sexually underdeveloped
  • Tall and thin
17
Q

Presentation of the slipped upper femoral epiphysis

A

May present acutely following trauma or more commonly with chronic, persistent symptoms

  • Shortened, externally rotated leg
  • All movements painful
  • hip, groin, medial thigh or knee pain
  • loss of internal rotation of the leg in flexio
  • bilateral slip in 20% of cases
18
Q

What happens in Slipped upper femoral epiphysis? (pathophysiology)

A

Displacement of the femoral head epiphysis postero-inferiorly

19
Q

Investigations in Slipped upper femoral epiphysis

A
  • AP and lateral (typically frog-leg) views are diagnostic
  • CT/MRI if there is diagnostic difficulty
20
Q

Management of Slipped Upper Femoral Epiphysis

A

internal fixation: typically a single cannulated screw placed in the center of the epiphysis

21
Q

Transient Synovitis

  • another name
  • presentation
  • investigations
  • management
A

Transient Synovitis aka Irritable Hip

• commonest cause of acute hip pain in children

Presentation

  • 2-12yrs
  • Sudden onset hip pain / limp
  • Often following or with viral infection
  • Not systemically unwell (fever should raise a suspicion of septic arthritis)

Investigations

  • Polymorphonucleral lymphocyte (PMN) and ESR/CRP are normal
  • -ve blood cultures
  • May need joint aspiration and culture

Management

  • Rest and analgesia
  • Settles over 2-3d
22
Q

What should raise a suspicion of non-accidental injury?

A
  • Inappropriate history
  • Physical signs don’t match the story
  • Other concerning features
  • Concerns raised by others
  • Physical and emotional abuse
23
Q

Chondromalacia patellae

  • pathophysiology
  • epidemiology
  • presentation
  • management
A
  • *Pathophysiology:** Softening of the cartilage of the patella
  • *Epidemiology:** Common in teenage girls

Presentation: Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting

Management: self limiting but may require physio for quads strengthening

24
Q

Pathophysiology of Osgood-Schlatter disease

A

Osgood-Schlatter disease (tibial apophysitis)

Pathophysiology:

  • type of osteochondrosis characterised by inflammation at the tibial tuberosity
  • It is a traction apophysitis thought to be caused by repeated avulsion of the apophysis into which the patellar tendon is inserted

Tibial tuberosity apophysitis + patellar tendonitis

25
Q

Presentation of Osgood-Schlatter disease

A
  • Children 10-14yrs,
  • commonly boys
  • Associated with physical activity

Symptoms:

  • pain below knee, especially with quads contraction
  • pain and swelling at tibial tuberosity
  • increased by exercise
  • Tenderness +/- swelling of tibial tuberosity
  • Pain on resisted extension of knee
26
Q

Investigations and diagnosis of Osgood Schlatter disease

A
  • usually clinical diagnosis
  • X-ray: tuberosity enlargement ± fragmentation
27
Q

Management of Osgood- Schlatter disease

A
  • supportive - analgesics if needed
  • rest
  • consider plaster of paris (POP)
  • physiotherapy
  • physical activity may be carried out within the limits of symptoms appearing - may need braces, tapes etc

Prognosis: excellent - symptoms usually disappear within 2 years

28
Q

Can flat feet cause lower limb pain?

A
  • Common cause of lower limb pain
  • If symptomatic - correct with good footwear and insoles
29
Q

The naming of ‘growing pains’

A

This is a misnomer as the pains are often not related to growth - the current term used in rheumatology is ‘benign idiopathic nocturnal limb pains of childhood’

30
Q

Features of growing pains

A
  • 25 - 40% of children!
  • 3 - 5 years and 8 - 12 years

Typical history

  • Wake during night with pain
  • Eased with massage
  • May be worse after active day
  • No daytime symptoms
  • No abnormal physical signs (no limp, no limitation of activity)
  • never present at the start of the day after the child has woken
  • systemically well
  • normal physical examination
  • motor milestones normal
  • symptoms are often intermittent and worse after a day of vigorous activity

**Y4 CBLs edited (32 decks)

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