Pediatric MSK

Question 1

Toxic synovitis

Answer 1

• inflammation of the hip with insidious painful limp
• internal rotation of hip causes spasm, no redness/warmth/fever
• Tx: typically self-limiting, bedrest PRN and analgesics, hospitalize for suspected septic arthritis

Question 2

Legg-Calve-Perthes disease (LCPD)

Answer 2

• necrosis of the femoral head
• insidious limp with knee pain that migrates up to groin/hip
• limited range of motion
• Tx: refer if older than 6yo or more than half of the femoral head is affected (seen on x-ray)- may require hip replacement; goal of treatment is to restore range of motion

Question 3

Slipped Capital Femoral Epiphysis (SCFE)

Answer 3

• spontaneous dislocation of femoral head, generally without
• obese, sedentary, African American
• acute limited range of motion, pain from groin that migrates to knee, limb shortening
• x-ray, immediate referral to ortho, BED REST, often need ORIF

Question 4

Genu Varum (Bowleg)

Answer 4

• normal variant until age 2

- refer to ortho if older than 2, unilateral, or progressive worsening

Question 5

Genu valgum (knock knee)

Answer 5

• normal variant up to age 7

- x-ray and refer to ortho if over age 7 or if unilateral involvement

Question 6

Scoliosis

Answer 6

• rarely painful
• positive Adam’s Forward Bend Test (shows asymmetry)
• x-ray to check degree of curve
• refer if painful or curve is greater than 25 degrees
• may refer to PT for strengthening

Question 7

Developmental dysplasia of the hip (DDH)

Answer 7

• Galeazzi’s or Allis’ sign
• Barlow until 6mo, Ortolani until 1yo
• may present as a limp when the child starts to walk
• decreased hip range of motion
• x-ray, refer to ortho (may need to splint with Pavlick harness)

Question 8

Muscular dystrophy

Answer 8

• progressive neuromuscular disease
• average age of diagnosis is 3-5 years; rare in girls
• Gower’s maneuver, firm woody calves
• wheelchair by 12yo, eventual cardiopulmonary failure/death
• diagnosis: elevated CK, EMG, abnormal EKG, muscle

Question 9

Ankle sprain

Answer 9

• stretching/tearing of the ligaments, typically lateral ligament
• usually related to a forced inversion or eversion
• x-ray according to Ottowa ankle rule
• RICE, NSAIDs

Question 10

Gower’s maneuver

Answer 10

Child “walks” hands up legs to attain standing position when getting up; highly suggestive of muscular dystrophy; suggests pelvic girdle weakness

Question 11

Ottowa Ankle Rule

Answer 11

x-ray indicated if pain near the malleoli AND bone tenderness is present at either malleolus or 6cm distal to it, OR if patient is unable to bear weight for at least 4 steps

Question 12

Grade I ankle sprain

Answer 12

• stretching but no tearing of the ligament

- local tenderness, minimal swelling, full ROM remains (although may be uncomfortable), able to bear weight

Question 13

Grade II ankle sprain

Answer 13

• partial tearing of the ligament

- localized edema and bruising, significant pain with weight bearing, ROM limited

Question 14

Grade III ankle sprain

Answer 14

• complete ligament tearing; joint unstable

- severe pain, significant edema, profound bruising (worsens over several days), cannot bear weight, no ROM to ankle

Question 15

Elbow fracture

Answer 15

• often assoc with FOOSH injury
• S/sx: “fat pad sign” or “sail sign” on x-ray suggests occult fracture- follow up with oblique views
• refer to ortho

Question 16

Nursemaid elbow

Answer 16

• radial head subluxation (swinging child)
• holds arm across body with thumb up
• significant bruising and swelling justifies x-ray
• supportive care at home with NSAIDs (ER can put it back into joint)

Question 17

Osgood-Schlatter Disease

Answer 17

• tibial tubercle inflammation with point tenderness, enlargement
• young athletes, rapid growth spurts
• self-limiting disease, limit activity to control pain, knee immobilizer