The limping child Flashcards
Sorter stance phase aka
A limp (is on that leg for less time)
anatalgic gait meaning
Your typical limp, is off the leg asap becuase of pain. Think trauma, infection or tumour
Trendelenberg gait
Swaying of upper body. Often due to weakness of the abductors
metabolic issue eg
Vit D deficiency (Rickets)
trimodal ages and respective causes?
Pre-primary school (0-5)
-normal varients
-Trauma
-Transient synovitis (remember following that urt infection)
-DDH, JIA
Primary school (5-10)
-Trauma,
-Transient synovitis (really picking up all the bugs from school!)
-Perthes
Secondary (10+)
-Trauma
-SUFE
-Chrondeomalacia
Neoplasm
Ostomyelitis and Septic arthrisis continue to get increasingly common as the child gets older.
Ages for DDH, JIA, Perthes ad SUFE
DDH = new born, may present late a year or so old.
Perthes = Primary school (4-10)
SUFE = starting secondary school
overuse can upresent as what? What is osgoopds schlatter?
chrondromalacia
Osgoods schlatters = when the patella tendon has been tugging too much at the tibia whilst it is growing and it causes pain (small avulsion fractures)
hip issues can present where\/
Knee or leg
CAN YOU GET STRESS FRACTURES AS A CHILD?
yes
whAT DO WE WANT T O FIND OUT IN THE HISTROY?
Duration, progression, trauma? Pain and socrates, weakness, times when worse, weight bear? normal activities? Sysetmic symptoms (including flu, loss of appitite)? Med history - birth history etc
whO DO WE GET THE HISTORY FROM?
The kid! Parents can congtribute in primary school aged kids. But in younger kids then you have to rely on parents as sadly babys who can’t talk can’t giv eyou a comprehensive history.
hOW DO WE GO ABOUT THE EXAMONATION?
OBervation is key.
Look sick?
Limp?
Absolute refusal to weight bear?
Localising area- ankle/ tibia/ knee/ thigh/ hip
Hip - obligatory ER?
- which movements hurt?
Ankle- distal tibia or joint line?
Knee- joint line or metaphyseal area?
Upper limb disuse
Remember check: Soles of feet, rom, symettry, shoes, dimples, scoliosis, hairy backs (bifida), circumfrence
If someone child is ill what do we do?
Hand over to those with the knowledge to deal with
Creatine kinase is elevates in what type of muscelular issues?
Muscular dystrophies
transient synovitis vs septic arthritis vs osteromyelitis
Basicailly says iton the tin -> Transient is transient. Septic arthritis and osteomyelitis are a lot more severe and have worse symptoms and presentation.
What bloods do we do?
CRP, ESR, Cultures, WBC, creatine kinase
most common cause of septic arthritis (how bugs get there)
Through the blood!! Then throughthe bone -> remember in kids the growth plate is very active, so loadsa blood supply and easy access for bugs to infect the bone and then suprise! pop out into the joint capsule. THen is throughcellulitis/skin/soft tissue ifection, then therapeuric and THEN trausma!!
MOst cmomon bug (septic arthritis)
Staph AUreus. (Obviously) Its the one creeping round yo skin and lovessss a good joint space
How do we treat septic arthrissi?
You clean it all out and then give them IV antibiotics (2 weeks!) and then oral antibiotics (4 weeks!)
Acuts osteomyelitits is common when?
6yo, (10yo for pelvis). Blunt trauma/revent indection.
Symptoms of osteomyeltitis?
pain, localised symptoms - most common
, fever, reduced rom and reduced weight bearing
high dose abx for 48h then what?
If no better then you need help! Remmeber yo FBC, CRP, ESR, Culures, Xray, ULTRASOUND!!! Synovial fluid: WCC, Gram and culture
What tests for transient synovitis/what do we find in patient
Slightly unwell
History of viral infection eg URTI/ ear
Apyrexial
Allowing joint to be examined
Low CRP, normal WCC
May have joint infusion
Not that unwell
What are thediffertnt types of JIA?
Pau (4 and under), poly and systemic
Who does JIA ususally affect?
young girls
What is pauci arthriti and what is it important that we do in terms of referal?
it is when there is an early onset of 4 or less joints. Manily guys. Need to refer to opthalmology for geeting the eye checked (associated with uveitis)
