Rheum week 1 - hip pain in a child

Question 1

what might joint pain that wakes a child at night indicate ?

Answer 1

malignancy

Question 2

What might the following symptoms indicate in a child with a limp ?
- weight loss
- fever
- night sweats
- anorexia
- fatigue

Answer 2

malignancy, infection or inflammation

Question 3

What might the following symptoms indicate in a child with a limp ?
- redness
- swelling
- stiffness of joint

Answer 3

infections or inflammatory joint disease

Question 4

What might morning stiffness indicate in a child with a limp ?

Answer 4

inflammatory joint disease (JIA)

Question 5

What might the following symptoms indicate in a child with a limp ?
- severe pain
- anxiety
- agitation after traumatic injury

Answer 5

neurovascular compromise or impending compartment syndrome

Question 6

What might be wrong in a child with a limp that has a high fever and holds their leg abducted, not allowing any internal rotation ?

Answer 6

septic arthritis

Question 7

What might a changeable or unusual history indicate in a child with a limp ?

Answer 7

non accidental injury

(child maltreatment)

Question 8

A painful hip may be referred pain, where else would you examine ?

Answer 8

abdomen including hernia orifices and testes - enlarged liver or spleen or mass = malignancy

the knee

Question 9

What is Perthes disease ?

Answer 9

a condition caused by avascular necrosis due to interruption of blood supply to femoral epiphysis

remodelling occurs which can cause deformity and early onset osteoarthritis

Question 10

Who is usually affected by Perthes disease?

Answer 10

boys between 4-8 years old

Question 11

How does Perthes disease present ?

Answer 11

gradual onset limp, can be painless

Question 12

What conditions can cause referred pain to the hip ?

Answer 12

• testicular torsion
• inguinal hernia
• appendicitis

Question 13

What are the signs of transient synovitis of the hip ?

Answer 13

• acute onset limp
• with or without pain
• reduced hip movements
• systematically well child
• often preceded by viral illness (URTI or gastroenteritis)

Question 14

Who is most commonly affected by transient synovitis of the hip ?

Answer 14

boy between 4-8yrs old

Question 15

What age range is most commonly affected by haematological malignancy ?

Answer 15

0-3 yrs

Question 16

What age range is most commonly affected by perthes disease ?

Answer 16

4-10

Question 17

What age range is most commonly affected by bone tumours ?

Answer 17

11-16

Question 18

What age range is most commonly affected by non accidental injury?

Answer 18

any age

Question 19

What age range is most commonly affected by sepsis/osteomyelitis ?

Answer 19

any age

Question 20

What age range is most commonly affected by transient synovitis ?

Answer 20

4-10

Question 21

What age range is most commonly affected by slipped upper femoral epiphysis (SUFE) ?

Answer 21

11-16

Question 22

What age range is most commonly affected by juvenile idiopathic arthritis (JIA) ?

Answer 22

any age (16 or below, over that it is no longer ‘juvenile’)

Question 23

What age range is most commonly affected by fracture ?

Answer 23

0-3 yrs

Question 24

What age range is most commonly affected by testicular torsion/inguinal hernia/appendicitis ?

Answer 24

any age

Question 25

What age range is most commonly affected by developmental dysplasia of the hip (DDH) ?

Answer 25

0-3 yrs

Question 26

what does perthes disease look like on an XR ?

Answer 26

the femoral head is likely missing due to the avascular necrosis and there may be craggy surface to top of that femur

Question 27

What is juvenile idiopathic arthritis (JIA) ?

Answer 27

an autoimmune inflammation of the joints causing arthritic symptoms

Question 28

How common is juvenile idiopathic arthritis (JIA) ?

Answer 28

affects 1 in 1000 children

Question 29

What are the 7 types of arthritis that fall under the term JIA ?

Answer 29

- **oligioarthritis** *<5 joints affected in first 6mths* - **positive polyarthritis** *5+ joints affected in first 6mths and positive RhF test* - **negative polyarthritis** *5+ joints affected in first 6mths and negative RhF test* - **enthesitis related arthritis (ERA)** *inflammation in tendon attachment sites* - **psoriatic arthritis** - **systemic onset JIA** *diagnosed if fever or rash at beginning of illness* - **undifferentiated arthritis** *if none of the other types fit*

Question 30

What is the treatment for transient synovitis of the hip ?

Answer 30

it is self limiting prescribe analgesia and review in a few days *(should have gone by then)*

Question 31

Where is the epiphyseal plate (growth plate) ?

Answer 31

between the epiphysis (bone end) and diaphysis (bone shaft)

Question 32

what is the shaft of a long bone called ?

Answer 32

diaphysis

Question 33

What is the most likely diagnosis in a 7yr old boy presenting with unilateral hip pain of gradual onset and no diurnal deviation ?

Answer 33

perthes disease

Question 34

What is the most likely diagnosis of hip pain which developed gradually over weeks in a 13yr old boy ?

Answer 34

Slipped upper femoral epiphysis (SUFE)