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Pediatric MSK Flashcards

1
Q

How does growth and development influence pediatric musculoskeletal assessment and disease?

A
  • Change from cartilage to bone
  • More vascular and porous
  • Ability to remodel faster
  • Vulnerable to infection
  • Possible infarct
  • Laxity of ligaments
  • Always refer to age-related normal x-rays
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2
Q

What is the pathophysiology of Congenital torticollis?

A
  • SCM is very tight
  • Usually congenital and due to sternocleidomastoid fibrosis
  • Rarely vertebral anomaly
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3
Q

What is the diagnostic evaluation for Congenital torticollis?

A

Inspect-palpate-ROM

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4
Q

What is the management for Congenital torticollis?

A
  • Stretching, referral to PT

- If persistent can lead to plagiocephaly and potential helmet use

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5
Q

What is the pathophysiology of Developmental dysplasia?

A
  • Breech delivery - increased risk of developmental dysplasia of the hips
  • Spontaneous dislocation due to lax hip ligaments
  • Improper development of femoral head and acetabulum
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6
Q

What are the diagnostic evaluations of Developmental dysplasia?

A
  • Ultrasound recommended
  • Typically > 1 month old
  • Femoral head ossification starts at 4-6 months so early radiographs may not be helpful
  • X-ray can be an alternative if infant is >5-6 months of age
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7
Q

What are the clinical findings of Developmental dysplasia?

A
  • Barlo and Ortolani testing
  • Palpate and range of motion
  • Older infants: Galeazzi sign and decreased range of motion
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8
Q

What is the management of Developmental dysplasia?

A
  • Keep the formal head in the acetabulum
  • Pavlik harness ( in 1st 4 months)
  • Casting (+/- traction)
    Surgery (open reduction)
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9
Q

What is the pathophysiology of Legg-Calvé-Perthes disease?

A

Avascular necrosis of the femoral head

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10
Q

What is the epidemiology of Legg-Calvé-Perthes disease?

A
  • Boys > girls

- Peak ages 4-8 years

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11
Q

What are the clinical findings of Legg-Calvé-Perthes disease?

A

2-3 weeks history of limp, +/- aching

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12
Q

What are the diagnostic evaluations of Legg-Calvé-Perthes disease?

A
  • PE: limited abduction

- Hip films: AP and frog

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13
Q

What is the management of Legg-Calvé-Perthes disease?

A
  • Containment and limit weight bearing
  • Non-surgical: Muscle strengthening/ROM, casting, can take 2 to 5 years for resolution
  • Surgical: Femoral osteotomy, pelvic osteotomy
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14
Q

What is the epidemiology of Slipped capital femoral epiphysis?

A
  • Boys 12 - 15 years (MC)
  • Girls 10 - 13 years
  • Increased in obesity
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15
Q

What is the pathophysiology of Slipped capital femoral epiphysis?

A

Femoral head (epiphysis) slips posterior and inferior at the growth plate

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16
Q

What are the clinical findings of Slipped capital femoral epiphysis?

A
  • Limp, pain (acute of chronic limiting)
  • Pain can be located in groin, thigh, or knee region
  • PE: decreased internal rotation, abduction, flexion
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17
Q

What is the diagnostic evaluation of Slipped capital femoral epiphysis?

A

X-Ray: ice cream slipped off cone

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18
Q

What is the management of Slipped capital femoral epiphysis?

A
  • Immediate management: stop weight-bearing and refer immediately
  • Surgical pinning
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19
Q

What is the pathophysiology/3 levels of Torsional and angular deformities

A
  • Femoral anteversion
  • Tibial torsion
  • Metatarsus adductus
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20
Q

What are the clinical findings of Torsional and angular deformities

A
  • Physiologic causes of intoeing vary with age

- Decreased external and internal ROM

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21
Q

What is the diagnostic evaluation of Torsional and angular deformities

A

Refer to age-appropriate norms

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22
Q

S/sx of Femoral anteversion?

A
  • “W” sitting
  • girls > boys
  • intoeing ages 3-10
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23
Q

S/sx of internal tibial torsion?

A
  • MC intoeing in toddlers

- patellae straight w/ feet turned inwards

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24
Q

S/sx of Metatarsus adductus?

A
  • MC foot deformity of infants
  • usually flexible
    convex lateral surface of foot
  • poss. d/t intrauterine postion
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25
Q

What is the epidemiology of Blount disease?

A

More common in early walkers, obese, African Americans

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26
Q

What is the pathophysiology of Blount disease?

A
  • Inhibited growth of medical aspect of proximal tibial growth plate
  • 2 types = infantile and adolescent
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27
Q

What are the clinical findings of Blount disease?

A
  • Asymmetric and extreme
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28
Q

What is the management of Blount disease?

A
  • Surgery if bracing fails or if onset > age 4: guided growth or tibial osteotomy
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29
Q

What is the epidemiology of Flatfoot (pew planus)?

A

> 6 years

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30
Q

What is the pathophysiology and tx of flexible Flatfoot (pew planus)?

A
  • Normal variant

- If painful, consider heel cord stretches

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31
Q

What is the pathophysiology and tx of rigid Flatfoot (pew planus)?

A
  • May be tarsal coalition

- Treatment: casting and resection (painful)

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32
Q

What is the epidemiology of Clubfoot?

A

75% isolated, sporadic but look for other abnormalities

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33
Q

What is the pathophysiology of Clubfoot?

A

Tendons develop abnormally

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34
Q

What are the clinical findings of Clubfoot?

A
  • Rigid inverted foot
  • Equinus (plantar flexion at ankle)
  • Varus of heel (inversion)
  • Adduction of forefoot
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35
Q

What is the management of Clubfoot?

A
  • Serial casting (Ponseti) followed by bracing to prevent relapse
  • May require achilles tenotomy
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36
Q

What is the epidemiology of Scoliosis?

A
  • Adolescence

- Girls > boys

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37
Q

What is the pathophysiology of idiopathic Scoliosis?

A
  • MC

- Usually no pain

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38
Q

What are some causes of Scoliosis?

A
  • Vertebral malformation (hemivertebrae) or disease (tumor)
  • Neuromuscular disease
  • Spinal cord disease (tethered)
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39
Q

What are some clinical findings of Scoliosis?

A
  • Unequal shoulder and pelvic height

- Rib prominence on forward bending

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40
Q

What is the diagnostic evaluation of Scoliosis?

A

10 degree Cobb angle

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41
Q

What is the management of Scoliosis?

A
  • Observation in most cases
  • Bracing (20-50 degrees)
  • Surgery (greater than 50 degrees)
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42
Q

What is the epidemiology of Kyphosis?

A

Similar frequency boys and girls

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43
Q

What is the pathophysiology of Kyphosis?

A

Congenital - progressive

44
Q

What are the clinical findings of Kyphosis?

A

Postural - flexible

45
Q

What are the diagnostic evaluations of Kyphosis?

A
  • Scheuermann disease
  • Early teens during rapid growth
  • Often in pain
  • > 3 adjacent wedge-shaped vertebrae
  • Usually thoracic
  • Refer
46
Q

What is the management of Kyphosis?

A
  • Brace

- Surgery >80 degrees

47
Q

What is needed during the evaluation of a fracture?

A
  • History
  • Physical
  • Imaging
  • Stability of fracture
  • Alignment
  • Biomechanics of injury
48
Q

What is the usual management of a fracture?

A

Casting and/or referral

49
Q

What is the evaluation of a Radial head subluxation?

A
  • Sudden jerk to forearm <3 years old

- Radiographs not needed

50
Q

What is the management of a Radial head subluxation?

A
  • Manipulation

- Normal use in 5-10 minutes

51
Q

What is the evaluation of a brachial plexopathy (stinger or burner) sports injury?

A

Neck-shoulder traction, direct blow, and compression

52
Q

What is the management of a brachial plexopathy (stinger or burner) sports injury?

A
  • Work up if bilateral or persistent
  • Return to play once asymptomatic with full range of motion
  • Tend to reoccur
53
Q

What are S/Sx of Little Leaguer’s shoulder?

A

Excessive overhead throwing can cause proximal humeral epiphysitis

54
Q

What are S/Sx of Little Leaguer’s elbow?

A
  • Overuse injuries can occur in any of the elbow’s 6 ossification centers
  • Traction apophysitis - widening - avulsion
55
Q

What is the evaluation of Little Leaguer’s shoulder and elbow?

A
  • History
  • Physical exam: palpate and check range of motion, neurovascular integrity
  • Radiographs if bony lesions suspected
56
Q

What is the management of Little Leaguer’s shoulder and elbow?

A
  • Complete rest 4-6 weeks, ice, NSAIDs
  • PT, splinting
  • Refer if not improving
57
Q

What are S/Sx of Spondylosis?

A
  • Back stress + hypertension
  • Separation in vertebral pars interarticularis (90% L5)
  • Pain w/ lumbar extension
58
Q

What are S/Sx of Spondylolisthesis?

A
  • Instability due to spondylolysis can lead to anterior slippage of vertebral body
  • Limited forward bend and straight leg lifting
  • May feel a “step-off” at slippage
59
Q

What is the management of Spondylosis and Spondylolisthesis?

A
  • Pain relief, restrict activity, physical therapy
  • Follow until growth complete
  • Remove from aggravating sport
  • Surgical fusion if: slippage >25%, progressive, and has neurologic symptoms
60
Q

What is the pathophysiology of Osgood-Schlatter disease?

A
  • Tibial traction apophysitis
  • Adolescent with knee pain during and after activity
  • Boys > girls
61
Q

What is the evaluation of Osgood-Schlatter disease?

A

Point tenderness of tibial tubercle, knee joint stable

62
Q

What is the management of Osgood-Schlatter disease?

A
  • Ice, prn analgesia
  • Rest/decreased activity
  • Bracing during activity
  • Resolves once physically mature
63
Q

What is the pathophysiology of Sever Disease?

A
  • Calcaneal apophysitis
  • Heal pain
  • Limp in pre-pubertal children
64
Q

What is the evaluation of Sever Disease?

A
  • Painful posterior calcaneus

- +/- tight heel cord

65
Q

What is the management of Sever Disease?

A
  • Ice, change activity, heel cord stretching, shoe modification
  • Outgrown as growth plate closes
66
Q

What is the etiology of Osteomyelitis?

A
  • Source of most bone infections in the blood

- MC sites: femur and tibia

67
Q

What are the clinical findings of Osteomyelitis?

A
  • Pain and reduced function
  • Redness and swelling
  • Fever
68
Q

What are the diagnostic evaluations of Osteomyelitis?

A
  • Increased ESR
  • Increased CRP
  • CBC: sometimes WBC > 12,000 cells/uL
  • Blood culture
  • Plain films
  • Bone scan, MRI if needed
69
Q

What is the management of Osteomyelitis?

A
  • IV antibiotics until CRP decreased by 50%, then oral for 4-6 weeks
  • Staph aureus, consider MRSA
  • May need surgical debridement
70
Q

What is the etiology of Septic arthritis?

A

Bacterial source:

  • Blood stream
  • Cellulitis
  • Puncture wound
71
Q

What are the clinical findings of Septic arthritis?

A
  • Painful single join
  • Swelling
  • Erythema
  • Warmth
  • Fever (+/-)
72
Q

What are the diagnostic evaluations of Septic arthritis?

A
  • Aspirate joint ASAP
  • Blood tests:
    □ ESR and CRP elevated
    □ CBC may be abnormal
    □ Blood culture
73
Q

What is the management of Septic arthritis?

A
  • IV antibiotics, then po (follow CRP)
  • Staph and Strep coverage
  • May need repeated drainage
  • Course typically 3 weeks
74
Q

What is the etiology of Transient synovitis?

A
  • Joint inflammation in response to preceding viral or bacterial infection elsewhere
75
Q

What are the clinical findings of Transient synovitis?

A
  • Afebrile with limp after URI

- Peak age 3-8 years

76
Q

What are the diagnostic evaluations of Transient synovitis?

A
  • Normal labs and imaging

- Send out viral cultures and viral panel

77
Q

What is the management of Transient synovitis?

A
  • Rest
  • Pain management
  • Close follow up
78
Q

What is the etiology of Juvenile idiopathic arthritis (or RA)?

A
  • Arthritis in >1 joint for >6 weeks in a child

- Autoimmune inflammation that targets the synovium

79
Q

What are the clinical findings of Juvenile idiopathic arthritis (or RA)?

A
  • Joint pain
  • Stiffness
  • Erythema
  • Swelling
80
Q

What are the three types of Juvenile idiopathic arthritis (or RA)?

A
  • Oligoarticular < 5 joints (MC)
  • Polyarticular > 5 joints
  • Systemic
81
Q

What are the diagnostic evaluation for the Oligoarticular type of Juvenile idiopathic arthritis (or RA)?

A
  • Medium to large joints (knee, ankle, wrist)

- Early childhood and pre-adolescent

82
Q

What are the diagnostic evaluation for the Polyarticular type of Juvenile idiopathic arthritis (or RA)?

A
  • Small to medium joints (hands, feet, ankles, wrists)
  • Usually symmetrical
  • Early childhood and adolescence
83
Q

What are the diagnostic evaluation for the Systemic type of Juvenile idiopathic arthritis (or RA)?

A
  • Starts with recurring fever and rash, malaise
  • Organ involvement
  • Polyarticular arthritis weeks-months
  • Across childhood
84
Q

What is the management of Juvenile idiopathic arthritis (or RA)?

A
  • Primary care
  • Rheumatology
  • Meds: NSAIDs and limited corticosteroids
  • Ophthalmology
  • Physical therapy: range of motion and splinting
85
Q

What are some distinguishable characteristics of a benign Osteochondroma?

A
  • MC benign bone tumor (10-20 years)
  • MC in males
  • Begins in childhood and grows until skeletal maturity
86
Q

What are the diagnostic findings of a benign Osteochondroma?

A

Often pedunculated, grows away from growth plate.

- Often involves medullary tissue

87
Q

What is the management of a benign Osteochondroma?

A

Observation

88
Q

What is the pathophysiology of a malignant Osteosarcoma?

A
  • Bone pain
  • Swelling
  • Pathologic fracture
89
Q

What are some distinguishable characteristics of a malignant Osteosarcoma?

A
  • MC bone malignancy
  • MC in adolescents (80% occur <20 years)
  • Produces osteoid (immature bone)
  • 90% occur in the metaphysis of long bones (MC in femur –> tibia, humerus
  • MC mets to the lungs (usually the cause of death
90
Q

What are the clinical manifestations of a malignant Osteosarcoma?

A
  • Bone pain/joint swelling

- Palpable soft tissue mass

91
Q

What are the diagnostic findings of a malignant Osteosarcoma?

A
  • Radiographs: “hair on end” or “sunray/burst” appearance of the soft tissue mass
92
Q

What is the management of a malignant Osteosarcoma?

A
  • Limb-sparing resection (if not neovascular)
  • Radical amputation (if neovascular)
  • Chemotherapy as adjuvant treatment
93
Q

What are some distinguishable characteristics of a malignant Ewing Sarcoma?

A
  • Giant cell tumor
  • MC in children
  • MC in males 5-25 yrs
  • Sites: Femur (MC) and pelvis
94
Q

What are the clinical manifestations of a malignant Ewing Sarcoma?

A
  • Bone pain
  • +/- palpable mass
  • +/- joint swelling
  • +/- fever
  • Bone MC site of metastasis
95
Q

What are the diagnostic findings of a malignant Ewing Sarcoma?

A
  • Lytic lesion

- Layered periosteal reaction “onion skin” appearance on radiographs

96
Q

What is the management of a malignant Ewing Sarcoma?

A

Options include chemotherapy, surgery and radiation therapy

97
Q

What are some characteristics of benign and pathologic musculoskeletal pain?

A
  • Difficult for children to localize so may present in non-specific manner
  • Prevalence of pain increases with age
98
Q

When does the likelihood of pathology increases with benign and pathologic musculoskeletal pain?

A
  • The younger the child
  • The more activity is limited by pain
  • If the pain awakens child from sleep
99
Q

What are some S/Sxs of benign musculoskeletal pain?

A
  • At rest pain decreases
  • Simple analgesia and massage for nighttime pain relief
  • Absent joint swelling
  • Hypermobile joints
  • Absent bony tenderness
100
Q

What are some S/Sxs of pathologic musculoskeletal pain?

A
  • At rest pain present
  • Simple analgesia and massage for nighttime pain gives no change
  • Present joint swelling
  • Stiff joints
  • Present bony tenderness
101
Q

What are S/Sxs of Osteogenesis Imperfect?

A
  • Tibial fracture
  • Long-standing complaints of back pain
  • Bruises easily
  • Blue sclera
  • Angular Cheilitis
102
Q

When does the anterior fontanelle line close?

A

1-3 yrs

103
Q

When does the posterior fontanelle line close?

A

2-3 mos after birth

104
Q

When does the sphenoidal fontanelle line close?

A

6 months after birth

105
Q

When does the mastoid fontanelle line close?

A

6-18 months after birth

MSK (11 decks)

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