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Paeds > Childhood limp: > Flashcards

Childhood limp: Flashcards

1
Q

List some common causes of limp/limb pain in a child:

A

Infectious - osteomyelitis, septic arthritis

Inflammatory - STILLs (systemic JIA), SLE

Reactive/post infectious - GUT/GU

Haematological - HSP, sickle cell, haemophillia (haemarthrosis)

Endocrine - Rickets

Malignancy - Ewings, osteosarcoma

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2
Q

Give 3 causes of limp in following ages of children - 1-3yrs, 3-10yrs, 10-16yrs:

A

1-3years:

  • Septic arthritis (painful)
  • Transient synovitis (painful)
  • Developmental dysplasia of hip (painless)

3-10years:

  • Tranient synovitis (painful)
  • JIA
  • Perthes’ disease (acute=painful, chronic= painless)

10-16:

  • Slipped upper/capital femoral epiphysis (SUFE/SCFE, acute = painful, chronic= painless)
  • JIA
  • Malignancy
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3
Q

What is the commonest cause of acute limp in a child?

A

Transient synovitis

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4
Q

What is transient synovitis thought to be precipitated by?

A

Viral infection

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5
Q

What is the aetiology of those with transient synovitis?

A

2-12years, usually males

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6
Q

What are the symptoms of transient synovitis?

A
  • Unilateral sudden onset painful limp
  • Pain may be referred to medial thigh/knee
  • Pain not present at rest
  • No fever
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7
Q

What are the signs of transient synovitis?

A
  • Mildly decreased ROM
  • No fever
  • CRP, Xray, FBC, blood culture all normal
  • US shows joint effusion
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8
Q

What is the treatment of Transient synovitis?

A
  • NSAIDs

- Resolves within a few days

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9
Q

What are the symptoms of septic arthritis?

A
  • Acute painful hip with pain at rest
  • Fever
  • Reduced ROM with reluctance to move hip
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10
Q

What investigations can be performed in someone with suspected septic arthritis and what would the results be?
How is the diagnosis confirmed?

A

Ix:

  • Xray
  • Aspirate - MC+S
  • USS
  • MRI

Diagnosis is confirmed by joint aspirate culture

Ix results:

  • Neutrophil and CRP raised
  • Joint aspirate culture (+ve)
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11
Q

What is the Rx for septic arthritis?

A
  • Antibiotics

- Surgical drainage

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12
Q

What can develop if there is not prompt treatment of septic arthritis?

A

Joint destruction

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13
Q

What is Juvenile Idiopathic arthritis defined as?

A

Arthritis for more than 6 weeks before age of 16.

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14
Q

What serology is typically present in those with JIA?

A

Rheumatoid factor negative

ANA negative

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15
Q

In what form of JIA is ANA positive and what else is typically present with this?

A

Pauciarticular/oligoarthritis (ANA positive).
Eye involvement
(most common form of JIA)

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16
Q

In what form of JIA may there be RF positive?

A

Polyarticular disease in some older girls. similar to rheumatoid (RF positive)

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17
Q

List the classifications of JIA:

A
  • Pauci-articular/oligoarthritis - 4 or fewer joints in the first 6 months (60%)
  • Polyarticular - 5 or more joints (20%)
  • Systemic: Stills disease (10%)
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18
Q

Who does systemic JIA usually affect?

A

<5y/o

19
Q

List 3 symptoms of Systemic JIA:

A
  • High swinging fever
  • Salmon coloured macular rash
  • Myalgia (may precede arthritis)
20
Q

List 3 features which may also be present in those with systemic JIA:

A
  • Lymphadenopthy and hepatoplenomegaly
  • Pleurisy
  • Pericarditis
21
Q

What features is not present in those with systemic JIA?

A

Eye involvement

22
Q

What is seen on investigation in those with JIA?

A
  • Raised ESR and CRP

- Anaemia

23
Q

What is the prognosis of systemic JIA?

A

Majority recover. 1/3 progress to severe arthritis.

24
Q

Who does Pauci-articular/oligoarthritis JIA typically affect?

A

Age 2-6 y/o - girls.

25
Q

What joints does pauci-articular/oligoarthritis typically affect?

A

Medium sized joints (not hip): knees, ankles, wrists.

Asymmetrical

26
Q

What additional features are sometimes present in pauci-articular JIA?

A

1/3 develop anterior uveitis (iritis) - often ANA positive.

Think Anterior Uveitis (AU) and pAUci-articular JIA.

27
Q

What joints does polyarticular JIA often affect?

A

Symmetrical involving any joint, typically hands, wrists knees. Neck and temporal-mandibular joints may be affected.

MCP joints spared.

28
Q

What group of children goes polyarticular JIA typically affect?

A

Girls >8years or Rh factor (+ve).

29
Q

How is JIA managed?

A
  • Multidisciplinary - physio, OT, educational input
  • Simple analgesia
  • Steroid injections (often in Pauci-articular disease)
  • DMARDs - methotrexate, biologicals (anti-TNFs)
30
Q

What may children who have Pauci-articular JIA require?

A

Regular eye check ups.

31
Q

What is Perthes’ disease?

A

Idiopathic ischaemia of femoral epiphysis. This leads to avascular necrosis.

32
Q

What is the epiphysis?

A

The end part of a long bone

33
Q

What is a growth plate known as?

A

Epiphyseal plate

34
Q

Who does perthes disease typically affect?

A

Males, 5-10y/o.

35
Q

How does Perthes disease present?

A
  • Gradual onset on limp
  • Initially painful
  • Decreased ROM (reduced abduction and internal rotation)
36
Q

What are the xray findings in someone with perthes disease?

A

Initially - increased density of femorla head

Later - irregular edge of femoral head

37
Q

What is the prognosis of someone with Perthes like?

A

Good prognosis if <1/2 of epiphysis involved and <6years old.

38
Q

What is the management for those with Perthes disease?

A

Conservative - re-vascularisation and re-ossification follows (over 1.5-3 years).

If severe, surgery maybe needed - cast, brace, traction.

39
Q

What is a SUFE/SCFE?

A

Slipped upper/capital femoral epiphysis. It is displacement of the femoral head - usually posteriorly and medially.

40
Q

What are the symptoms of a SUFE?

A
  • Pain may be referred to knee
  • Acute painful limp often after minor trauma
  • Reduced ROM (abduction and internal rotation)
41
Q

Who is SUFE usually seen in?

A
  • Age 10-15yrs
  • M>F
  • Obesity
42
Q

What investigation would you perform in to confirm a SCFE?

A

Frog-leg lateral X-ray.

Tretoans sign

43
Q

What is the Rx for SCFE?

A

Screw fixation to stabilise the hip. Open reduction may be needed in severe cases.

Paeds (13 decks)

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