Flashcards in Clinical (Weeks 3, 4 +5) Deck (166)
What are risk factors for childhood hip disorders (Developmental Dysplasia of the Hip [DDH])?
Other MSK abnormalities:
- Club foot
What populations are most commonly affected by childhood hip disorders?
What hip is more commonly affected?
What should you look for on examination of a suspected DDH?
- Leg position
- Leg length
- Thigh creases
Feel for click
What special instability tests are useful in diagnosing hip disorders?
- Attempt to dislocate/sublux
- By flexion adduction
- Relocate dislocated by abduction
In a 2 month old child what is the best imaging technique for a suspected hip problem?
In a 6 month old child what is the best imaging technique for a suspected hip problem and why?
Epiphysis has calcified
What is the most successful treatment for DDH?
Pavlik harness (95% success)
What surgical options for treatment are available for DDH at the following ages:
- Age > 3/12
- Age > 9/12
- Age > 2 years
- Closed reduction
- Open reduction
> 2 years:
- Bony surgery (?Femoral/?Pelvic Osteotomy)
A preschool child presents with a limp. What questions are important to ask?
Painful or painless?
History of injury?
Generally well or ill?
What questions may help include/exclude infection?
Pain at rest/movement?
Resistance to movement?
Susceptibility to infection?
If there is a joint effusion what investigation might we carry out?
How would a late DDH present?
Asymmetric creases - Xray
A 7 year old boy is brought to the GP with a painful right hip and limp. His mother informs you he enjoys playing football regularly. On examination he is in the 5th height centile for his age (short) and has a positive Trendellenburg gait.
What is Perthes disease?
Idiopathic AVN of the femoral head
How is Perthes treated?
Influencing the shape of the recovering femoral head:
- Ensure it is contained in acetabulum
A 14 year old African-American boy is brought to you with the inability to bear weight on his left leg, with associated knee pain. On examination he is obese, pre-pubescent and his hip cannot be internally rotated
Slipped Upper Femoral Epiphysis (SUFE)
What is seen on x-ray of a SUFE?
Trethowans sign (AP)
Lateral view is imperative
What ages is transient synovitis most common in?
2-5 year olds
What typically precedes transient synovitis?
An URTI (viral)
What is the commonest cause of hip pain in kids? What conditions must be excluded?
- Septic arthritis
- Juvenile OA
What must you prevent in a patient who cannot bear weight?
Any weight bearing - Assume SUFE until it is excluded
What are red flag symptoms in back pain?
- No variation with exercise
- Night pain
Major, new neurological defect
- Painless urinary retention
- Bowel incontinence
What signs might be seen on observation of a patient presenting with back pain?
What neurological symptoms can be present in back pain?
What myotomes should be tested in the presentation of back pain?
- Hip flexion
- Knee extension
- Foot dorsiflexion and EHL
- Ankle plantarflexion
What is the sciatic stretch test?
Straight leg raise with foot extension
(Testing for nerve irritation)
What is the bowstring test?
Straight leg raise with pressure behind knee
(Testing for nerve irritation)
When will an x-ray be useful in back pain?
If spinal stenosis:
- Degenerate + hypertrophic spine
- Narrow interpedicular distance
- Obliteration of IV foraminae