The child with an abnormal gait Flashcards
1
Q
Musckuloskeletal examination
A
1. Observation Growth Inflammation Limp/function CP, spina bifida NFM, marfan;s HSP Dermatomyosistis Spinal scoliosis Ligamentous hyperlaxity 2. Joints Compare Palpate ROM->passive and active Hip stability Lengths Pain 3. Gait analysis 4. Organomegaly
2
Q
Key MSK history
A
1. Newborn- risks for breech Female Breech First born 2. Inflammation->pain, redness, swelling 3. Limitation in activities 4. Gait problems->limping, plegias, waddling, dislocation of the hip Tip toe walking 5. Fever or skin rash
3
Q
Etiology of leg pain and limp in children
A
Benign causes 1. Growing pains 2. Transient synovitis More serious 1. Septic arthritis 2. Trauma 3. Osteomyelitis 4. Legg-Perthes 5. Slipped capital femoral epiphyses 6. Neoplastic disease Other 1. Reactive 2. IBD 3. Juvenile rheumatoid arthitis 4. HSP 5. Rheumatic fever
4
Q
Key features in growing pains, counselling to parents
A
- Most commonly in pre-school aged children
- Pain most common at night, no limp by day
- Often bilateral in shins or thighs
- Pain mostly in muscles, not bone
- In a healthy child with no physical signs
- No interference with daily activities
5
Q
Key features in transient synovitis
A
- Common and benign in boys 2-8
- Sudden onset limp
- No systemic features
- Commonly following URTI
- Normal investigations and radiographs
6
Q
Key features in septic arthritis
A
- Appear septic
- Infants and toddlers
- Painful, swollen, tender joint
- Serious
- Pain of movement
7
Q
Key features in osteomyelitis
A
- Fever
- Swollen, erythema, tenderness
- Decreased movement of limb, refusal to weight bear
- High CRP and high WCC
- Diagnosed by radiograph, bone scan or MRI.
8
Q
Key features in Legg-Perthes
A
- Osteochondritis->avascular necrosis
- May follow transient synovitis
- 4 X more common in boys, peaks 4-7
- Initially painless->pain when fracture
- Diagnose by radiograph or MRI
9
Q
Key features in SCFE
A
- Obesity
- Males
- Gradual onset
- Diagnosis by radiograph
10
Q
History in limp/swollen joint
A
1. Organic-> Persistent Day and night School Unilateral Located in joint 2. Limp, refusal to walk is significant 3. Weight loss, fever, night sweats, rash, diarrhea, psoriasis 4. Duration 5. Trauma 6. Morning stiffness 7. New medications 8. Family history->arthritis, IBD, autoimmune conditions, blood dyscriasis, psoriasis
11
Q
Investigations in limp/swollen
A
If thought to be organic 1. FBC Collagen Infection Leukemia 2. ESR/CRP Infection Collagen IBD Tumor 3. Radiograph Tumor Infection Trauma AVN Leukemia Slipped epiphyses 4. MRI/bone scan Osteomyelitis 5. Blood culture 6. RF/ antiCCP 7. ASOT
12
Q
Most common bacteria in septic arthritis and osteomyelitis
A
- Staph Aureus
- GAS
- H influenzae
13
Q
Investigations in septic/osteomyelitis
A
- FBC
- ESR/CRP
- Blood culture
- Xray (usually normal)
- Bone scan
14
Q
Management of septic/osteomyelitis
A
- Refer to orthopaedics
- Urgent aspiration in septic +/- arthotomy and washout w/ Flucloxacillin
- Elevate and immobilise limb
- Analgesia
- Manage fluid input/output
- Admission
- Patient handout
- F/U with GP
15
Q
Risk factors for osteomyelitis (in adults)
A
- Pentrating injuries
- Surgical contamination
- IVDU
- HIV
- DM
- Periodinitis
16
Q
Management in transient synovitis
A
- Rest
- Regular analgesia
Paracetamol
Ibuprofen - Gentle skin traction
- R/V w. GP 3 days
- Return if febrile, unwell or getting worse
- If ongoing >4 weeks->OPD to rheumatology
17
Q
Advice to parents about prognosis of transient synovitis
A
- Typically a benign course
- Recurrence is uncommon
- Close f/u recommended
- If pain worsens at any time or persists beyond 7-10 days, further F/U is warranted.
- May be the presenting feature sin a chronic inflammatory disease in 10% of cases