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msk lower limb > (9) Paeds Msk > Flashcards

(9) Paeds Msk Flashcards

1
Q

What factors influences a child evolution?

A
  • genetics
  • physical trauma
  • nutrition
  • socioeconomic factors
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2
Q

Where do greenstick fractures usually occur?

A

metaphysis

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3
Q

Where do buckle fractures usually occur?

A

diaphysis

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4
Q

How do bones fail first in children after trauma?

A
  • during rapid growth, bone lengthens before muscle and tendon can stretch sufficiently
  • ligaments are strong so bone fails first
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5
Q

What is the weakest part in the growing bone?

A

Epiphysis (growth plate)

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6
Q

What is the salter harris classification?

A

system to categorize fractures the physis, or growth plate in children

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7
Q

What are avulsion fractures?

A

severe ligamentous injury unlikely to occur by itself in children

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8
Q

Where do Apophyseal avulsion fractures occur?

A

at all main apophyses usually as a result of forceful eccentric/concentric contraction of the attached muscle

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9
Q

What is osteochondrosis?

A
  • Group of conditions characterized by sclerosis and fragmentation of the epiphysis or apophysis in the immature skeleton
  • focal disturbance of endochondral ossification
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10
Q

What can happen as a result of osteochondrosis?

A
  • interruption to the blood supply
  • necrosis of the ossification centre
  • Bony regrowth
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11
Q

What is a Slipped Capital Femoral Epiphysis?

A

Displacement of the upper femoral epiphysis on the metaphysis

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12
Q

What are the causes of a Slipped Capital Femoral Epiphysis?

A
  • increased stress across physis
  • possible hormonal contribution
  • underlying endocrine abnormality
  • renal failure
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13
Q

What are the signs of a SCFE?

A
  • hip/groin pain
  • if chronic, may be thigh or knee pain
  • Limp
  • unable WB (acute slips)
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14
Q

What is Perthes (aka Legg-Calve-Perthes disease)?

A

idiopathic juvenile avascular necrosis of femoral head

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15
Q

What may cause an LCPD?

A
  • SCFE
  • trauma
  • steroid use
  • congenital dislocation of hip
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16
Q

What is the pathophysiology of an LCPD?

A
  • fragmentation
  • revascularization
  • remodeling
  • whole process may take 3-4 years
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17
Q

What are symptoms of LCPD?

A
  • painful limp
  • pain referred to groin, thigh or knee
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18
Q

What are signs of LCPD?

A
  • Loss of medial rotation
  • Loss abduction
  • Flexion adduction contracture
  • Trendelenburg gait
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19
Q

What is the management of LCPD?

A
  • maintaining femur abducted and IR
  • bracing no longer favoured over surgery
  • older with marked head involvement do not do well with surgery
20
Q

What is Osgood Schlatter’s Disease?

A

stress related partial avulsion of the tibial tubercle apophysis

21
Q

What are signs of Osgood Schlatter’s Disease?

A

Pain, swelling and tenderness at the tibial tubercle

22
Q

What is Sinding-Larson and Johansson syndrome?

A
  • an overuse traction apophysitis
  • repetitive micro trauma at insertion point of proximal patellar tendon
23
Q

What is seen on examination of Sinding-Larson Johansson syndrome?

A
  • proximal tibial swelling & tenderness
  • enlargement of prominence of tubercle
  • agg jumping or direct pressure
  • pain resisted knee extension
  • Full knee ROM
  • Hamstring tightness
24
Q

What is PFJ Instability?

A

patellar recurrent subluxation / instability

25
Q

What are signs of PFJ instability?

A
  • joint laxity
  • ext tibial torsion
  • genu valgum
  • “J” sign
  • patellar apprehension
26
Q

What is the treatment for PFJ instability?

A
  • symptomatic management
  • quads regime
  • stretches: tight hamstrings and tight calf muscles
  • patellar tendon strap
  • activity modification
  • education
27
Q

What is Sever’s Disease?

A

painful inflammation of the calcaneal apophysis

28
Q

How does Sever’s Disease Occur?

A

microfractures occur due to shear stress

29
Q

What are symptoms of Sever’s Disease?

A
  • pain at posterior heel made worse by sports
  • onset gradual
  • relived with rest
  • pain interferes with sport performance & ADL
30
Q

What are signs of Sever’s Disease on examination?

A
  • 60% bilateral
  • pain on deep palpation of achilles tendon
  • pain toe raises
  • weak ankle dorsiflexors
  • mild swelling
  • may have calcaneal enlargement
31
Q

What are red flags to look out for?

A
  • fevers
  • night pain
  • weight loss
  • swelling
  • other sites pain
  • decreasing motor skills/ADLs
32
Q

What are oncology red flags?

A
  • malignant bone tumours
  • osteosarcoma (night pain)
  • Ewings sarcoma
  • mass present
  • abrupt onset pain with low trauma
33
Q

What are signs of inflammatory conditions?

A
  • Morning stiffness
  • Swelling post activity
  • chronic synovitis
  • rash
  • eye issues
34
Q

What are the key Ax points?

A
  • careful & thorough history taking
  • general well being child
  • Hx
  • development to date
  • function (school etc)
  • gait
  • symmetry
  • child protection
35
Q

What is scoliosis?

A
  • lateral curvature of the spine > 10 degrees
  • associated vertebral rotation
36
Q

What causes adolescent idiopathic scoliosis?

A
  • disproportionate rates of growth in different areas of the spine
  • develops and worsens during adolescent growth phase
37
Q

What are the risks of progression?

A
  • curves of >50 degrees
  • double curve pattern
  • Low Risser sign
  • Females
  • Location of curve
  • onset of pubertal growth spurt
38
Q

What are key points of spinal Ax?

A
  • pre or post menarche
  • nature of any pain
  • red flags/ special questions
  • yellow flags
  • observation & function
  • adams forward bend
  • special tests
39
Q

What is spondylolysis?

A
  • defect of pars interarticularis, most common at L5
  • often described as stress fracture
40
Q

What can cause spondylolysis?

A
  • repetitive micro trauma
  • acute shearing forces
  • acute loading forces
41
Q

What are symptoms of spondylolysis?

A
  • back pain that eases with rest
  • activities include repetitive flexion and extension
42
Q

What are signs of spondylolysis?

A
  • pain reproducible with extension
  • stork test
  • forward bending painful
  • tight hamstrings
  • pain on palpation
43
Q

What is spondylolisthesis?

A

slip of one vertebral body on the adjacent one

44
Q

What are symptoms of spondylolisthesis?

A
  • complains of NSLBP
  • activity related
45
Q

What are the signs of spondylolisthesis?

A
  • tenderness at L5/S1
  • prominence may be detectable
  • para spinal muscle spasm
  • ## tightness hamstrings

msk lower limb (8 decks)

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