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MSK-Derm by Minnie AH Version > SM 251a, 252a - Peds MSK, Peds/Adult Sports Med > Flashcards

SM 251a, 252a - Peds MSK, Peds/Adult Sports Med Flashcards

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Dermatology Board Prep flashcards
1
Q

What is Sever disease?

Describe the presentation

A

Inflammation of the calcaneal aphophysis

The “childhood version of achilles tendinopaty/plantar fasciitis”

Children are more likely to have bone issues than tendon issues

  • Insidious onset
  • Worse with activity
  • No mechanical symptoms
    • May have mild weakenss with ankle dorsiflexion
  • Tendernes with medial/lateral heel compresion
  • Most common in children 8-11
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2
Q

Describe the structure of a tendon

A

Water

Collagen Type I

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3
Q

Which Salter-Harris fractures are most likely to affect bone growth?

A

III, IV, V

Anything that involves teh epiphysial side of the growth plate (III, IV), or crushes the growth plate (V)

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4
Q

What is the Salter-Harris classification of this fracture?

A

Salter-Harris 1

Growth plate is a bit wider than it should be

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5
Q

Why do tendons heal poorly comparted to muscle?

A

Less oxygen consumption (=> less metabolic activity/ cell turnover)

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6
Q

What is Sinding-Larsen-Johansson Syndrome?

What is the management?

A

Irritation fo the accessory growth area (apophysis) of the inferior patella

  • Rest if it hurts
  • Play if it feels okay
  • Stretching and strengthening can help
  • Patellar strap
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7
Q

What causes Achilles Tendinopathy?

A

Non-inflammatory intra-tendinous collagen type I degradation

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8
Q

What causes Osgood-Schlatter?

Describe the presentation and treatment

A

Tibial tubercle (apophysis) separates from the rest of the tibia

  • Months of anterior knee pain
    • Especially after activity
  • Bump on tibial tubercle
  • Treatment
    • Activity modification, ice, NSAIDs
    • Patellar strap
    • Physical therapy for stretching/strengthening
    • Consider immobilization

(via damage/tear in hyaline cartilage)

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9
Q

What is an apophysis?

A

Accessory growth plate

  • Makes the bone wider, not longer
  • Attachment points of muscles
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10
Q

Describe these fractures

A

Incomplete fracture of the radius (Greenstick fracture)

Complete fracture of the ulna

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11
Q

Rehabilitation after an ankle sprain is important because

  1. Most people do not exercise so at least they should have strengthening exercises for the ankle
  2. Exercise will maximize healing of the sprained ligament
  3. It will decrease chance of experiencing another sprain at the same ankle
  4. Tendons are usually injured with an ankle sprain and need to be strengthened before returning to fitness and sport activities
A

c. It will decrease chance of experiencing another sprain at the same ankle

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12
Q

Where in the tendon is achilles tendinopathy most common?

A

Mid-portion

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13
Q

What are the pathologic features of Achilles tendinopathy?

A

Fiber disorientation and thinning

Scattered vascular ingrowth (neovascularization)

Gray-brown, amorphous

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14
Q

Describe the stages of muscle strain healing

A
  • Stage 1 - Inflammatory phase
    • Neutrophils
    • Proinflammatory cytokines
    • Removal of necrotic material, initiation of angiogenesis
  • Stage 2 - Proliferative phase
    • Infiltration of myocytes
    • Fibroblasts produce collagen (TIII), GAGs, elastin
  • Stage 3 - Remodeling phase
    • Collagen remodeling
    • Consolidation, maturation
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15
Q

Why should Slipped Capital Femoral Epiphysis (SCFE) be treated immediately?

A

Treatment = immediate surgical fixation

Goal is to avoid complications

  • Avascular necrosis of the hip
    • SCFE of the other hip (always check for both at presentation)
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16
Q

In a long bone, where will you find the primary ossification center?

Where will you find the secondary ossifcation center?

A
  • Primary ossificaiton center
    • Starts in the shaft of the long bone
  • Secondary ossification center
    • In the epiphysis of long bones
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17
Q

What is the treatment for a muscle strain?

A
  • Rest (4-7 days)
  • Ice
  • Compression
  • Elevation

Most recover after significant sequelae

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18
Q

What is a muscle strain? What causes it?

A

Intrinsic injury to the muscle

Due to excessive intrinsic tensile force, usually occurs at myotendinous junction

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19
Q

How would you describe this fracture?

A

Salter Harris II fracture of the distal radius

Transverse fracture of the ulna

20
Q

What is the Salter-Harris classification of this fracture?

A

Salter-Harris IV

Fracture through the metaphysis, physis, and epiphysis. Extends into the joint

21
Q

What are the risk factors of slipped capital femoral epiphysis?

A
  • M > F
  • Obesity
  • Endocrine dysfunction
22
Q

What is the role of rehabilitation in treating an ankle sprain?

A

Redues risk of future sprain after first sprain

(But does not prevent 1st sprain)

23
Q

Which muscles are most likely to be strained?

A

Muscles that span two joints

  • Hamstrings (Knee and hip)
  • Rectus femoris (Knee and hip)
  • Gastrocnemius (Knee and ankle)
24
Q

Patients with Achilles tendinopathy often have pain that is worst with

a. Sitting
b. Running
c. Walking
d. Lying down

A

b. Running

25
Q

What is the treatment for little league elbow (Medial epicondyle apophysitis)?

A

REST

  • Return to sport includes starting with a shorter distance, fewer throws
26
Q

What is the Salter-Harris classification of this fracture?

A

Salter-Harris V

Crush injury to the physis

Most likely to result in premature closure of the growth plate and growth arrest

27
Q

Describe the grading system for muscle strains

A
  • Grade 1 = microscopic tear
  • Grade 2 = partial tear
  • Grade 3 = full tear
28
Q

What is a greenstick fracture?

What causes it?

A

An incomplete fracture; one side appears normal, and the other is fractured

Caused by compression or bending forces

This x-ray shows a greenstick fracture of the radius, and a complete fracture of the ulna

29
Q

What is the treatment for Achilles tendinopathy?

A
  • No running - cross-training is ok
  • Heel lift if significant pain with walking
  • Physical therapy
    • Eccentric exercise program
    • Heavy slow resistance training
  • Limited role of injections and surgery

Rest alone will not cure the tendinopathy

Most patients make a full recovery

30
Q

In pediatric bones, where is the germial layer?

A

Epiphysial side of the long bone

New chondrocytes migrate to the metaphysial side, where they are calcified

31
Q

Describe the management of a buckle (torus) fracture

A

Simple immobilization (pre-made splint)

Heals well

32
Q

A hip x-ray of a 12 year old male child shows “ice ream falling off of the cone.”

He walks with a slight limp, and the affected leg is externally rotated

What is the most likely diagnosis?

What is the treatment?

A

Slipped Capital Femoral Epiphysis (SCFE)

M>F, obesity, endocrine disorder = risk factors

Immediate surgical fixation to prevent further slippage

33
Q

What are the structural differences in pediatric vs. adult bone?

A

Compared to adult bones, pediatric bones have different:

  • Periosteum
    • Thick, strong, metabolically active
    • Holds fracture fragments in alignment
    • Aids in reduction, healing, remodeling
  • Extensive remodeling
    • Can self-correct large degrees of angulation and displacement
34
Q

What is a toddler’s fracture?

What causes it?

A
  • Oblique, non-displaced fracture of distal tibia
  • Child must be walking and <5 years old
  • Usually a twist while running or falling, or while trying to free the leg
    • ex: Lands funny at the end of the slide

Treatment = full immobilization! Important not to bear weight

35
Q

Describe the history and physical exam consistent with Slipped Capital Femoral Epiphysis (SCFE)

A
  • Sub-acute or chronic pain with acute worsening
  • Vague pain to groin, thigh, knee
  • Limp w/leg externally rotated at the hip
  • Pain an limitation with flexion and internal rotation
36
Q

Why are sprains uncommon in young children?

A

Pediatric ligaments are strong compared with pediatric bone; the bone is the weak point, and is more likely to fracture than the ligament is to sprain (tear)

37
Q

A 3 year old girl has leg pain and a limp after falling and twisting her leg. Is she more likely to have a fracture or a sprain?

A

Fracture

Childrens bones are weak compared with tendons

38
Q

2 year-old girl with left arm pain and refusing to move her left arm

Her teenaged cousin was swinging her around by the arms when she began to cry and have pain in her left elbow

Physical exam:

  • Holding left arm at side, won’t move it
  • No swelling or deformity
  • No tenderness to palpation (check bony landmarks)
  • Cries with movement of elbow

What is the most likely diagnosis?

A

Dislocated elbow (radial head subluxation)

  • History of tracion to the arm
    • Pulls radial head distally, annular ligament gets trapped in the joint space
  • Comfortable at rest, pain with movement
  • No swelling, deformity, or bony tenderness
  • Treatment
    • Hyperpronation or supination + flexion

X-ray for fracture if H&P does not fit

39
Q

Are children more likely to sustain fractures or sprains?

A

Fractures, often incomplete

Ligaments are strong compared to the bone; the bone is more likely to sustain injury than the ligament

40
Q

How are ankle sprains treated?

A
  • Rest
  • Ice
  • Compression
  • Elevation
  • Rehab
    • Prevents recurrence (but does not prevent 1st sprain)
41
Q

Which structure is affected in Sinding-Larsen-Johansson Syndrome?

Which structure is affected in Osgood-Schlatter Syndrome?

A
  • Sinding-Larsen-Johansson: inferior patella
  • Osgood-Schlatter: tibial tuberosity
42
Q

What causes a sprain?

A

Injury to a ligament

43
Q

What is the difference in appearance between a Bowing fracture and a Greenstick fracture?

A

Bowing = cannot see clear fracture line anywhere

Greenstick = Can only see clear fracture line on one side of the bone

Both are much more likely to occur in pediatric vs. adult bone

44
Q

Where in the muscle do most muscle strains occur?

Why?

A

Myotendinous junction

Weakest point of the muscle beacause the tendon is not a fully formed muscle

45
Q

Name the kind of fracture in each picture

A

From left to right

  • Transverse
  • Oblique
    • More likely to slip out of place than transverse, may require fixation
  • Spiral
  • Comminuted
46
Q

What is the Salter-Harris classification of this fracture?

A

Salter-Harris II

Fracture through a portion of the physis, extends through the metaphysis

47
Q

What is the Salter-Harris classification of this fracture?

A

Salter-Harris III

Fracture through a portion of the physis that extends through the epiphysis and into the joint

MSK-Derm by Minnie AH Version (47 decks)

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