Clinical (Weeks 3, 4 +5) Flashcards Preview

Year 2 - Musculoskeletal (DP) > Clinical (Weeks 3, 4 +5) > Flashcards

Flashcards in Clinical (Weeks 3, 4 +5) Deck (166)
Loading flashcards...
1

What are risk factors for childhood hip disorders (Developmental Dysplasia of the Hip [DDH])?

Breech birth
FHx
Other MSK abnormalities:
- Club foot
- Torticollis

2

What populations are most commonly affected by childhood hip disorders?

1st born
Girls

3

What hip is more commonly affected?

Left

4

What should you look for on examination of a suspected DDH?

Asymmetry:
- Leg position
- Leg length
- Thigh creases
Feel for click
Check abduction!

5

What special instability tests are useful in diagnosing hip disorders?

Barlow:
- Attempt to dislocate/sublux
- By flexion adduction
Ortolani:
- Relocate dislocated by abduction

6

In a 2 month old child what is the best imaging technique for a suspected hip problem?

Ultrasound

7

In a 6 month old child what is the best imaging technique for a suspected hip problem and why?

X-ray
Epiphysis has calcified

8

What is the most successful treatment for DDH?

Pavlik harness (95% success)

9

What surgical options for treatment are available for DDH at the following ages:
- Age > 3/12
- Age > 9/12
- Age > 2 years

> 3/12:
- Closed reduction
> 9/12:
- Open reduction
> 2 years:
- Bony surgery (?Femoral/?Pelvic Osteotomy)

10

A preschool child presents with a limp. What questions are important to ask?

Painful or painless?
History of injury?
Generally well or ill?

11

What questions may help include/exclude infection?

Pain at rest/movement?
Resistance to movement?
Fever?
Infection elsewhere?
Susceptibility to infection?

12

If there is a joint effusion what investigation might we carry out?

Ultrasound

13

How would a late DDH present?

Painless limp
Short leg
Asymmetric creases - Xray
Trendellenburg limp

14

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.

Perthes Disease

15

What is Perthes disease?

Idiopathic AVN of the femoral head

16

How is Perthes treated?

Influencing the shape of the recovering femoral head:
- Ensure it is contained in acetabulum

17

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)

18

What is seen on x-ray of a SUFE?

Trethowans sign (AP)
Lateral view is imperative

19

What ages is transient synovitis most common in?

2-5 year olds

20

What typically precedes transient synovitis?

An URTI (viral)

21

What is the commonest cause of hip pain in kids? What conditions must be excluded?

Transient synovitis
Exclude:
- Septic arthritis
- Perthes
- Juvenile OA
- RA

22

What must you prevent in a patient who cannot bear weight?

Any weight bearing - Assume SUFE until it is excluded

23

What are red flag symptoms in back pain?

Non-mechanical pain:
- No variation with exercise
- Night pain
Systemic upset
Major, new neurological defect
Saddle anaesthesia:
- Painless urinary retention
- Overflow
- Bowel incontinence

24

What signs might be seen on observation of a patient presenting with back pain?

Deformity
Hair patches
Asymmetry
Neurofibroma

25

What neurological symptoms can be present in back pain?

Numbness
Weakness
Paraesthesia
Temperature disturbance

26

What myotomes should be tested in the presentation of back pain?

L1/L2:
- Hip flexion
L3/L4:
- Knee extension
L5:
- Foot dorsiflexion and EHL
S1/S2:
- Ankle plantarflexion

27

What is the sciatic stretch test?

Straight leg raise with foot extension
(Testing for nerve irritation)

28

What is the bowstring test?

Straight leg raise with pressure behind knee
(Testing for nerve irritation)

29

When will an x-ray be useful in back pain?

If spinal stenosis:
- Degenerate + hypertrophic spine
- Narrow interpedicular distance
- Obliteration of IV foraminae

30

What signs may be seen on a spinal MRI?

White triangle:
- Annular tear
'Hamburger' sign:
- Disc inflammation
- White patches either side in vertebral bodies