Joint pain and swelling Flashcards
What are the causes of joint pain and swelling in children
Infection: septic arthritis, osteomyelitis, viral arthritis
Trauma
Reactive arthritis
Haemophilia
Juvenile idiopathic arthritis/mixed connective tissue disease
Inflammatory disorders: Kawasaki disease, acute rheumatic fever, IBD
Vasculitis: Henoch-Schonlein purpura
Hypersensitivity: serum sickness
Malignancy: leukaemia, bone/soft tissue malignancy
Endocrine: Rickets
Ehlers Danlos
What are the red flags for acute joint pain and swelling
Fever
Night pain
Constant, severe pain
Refusal to weight bear
Unexplained bruising
Weight loss
What is Ehlers Danlos syndrome
Autosomal dominant condition that effects type II collagen
Tissue becomes more elastic → joint hypermobility and increased elasticity of the skin
What are the symptoms and signs of Ehlers Danlos
Repetitive injury
Recurrent subluxation/dislocation
Fatigue
Chronic pain
easy bruising or scarring
Hx SAH
Joint laxity
Hyperextensible skin
Aortic regurgitation, mitral valve prolapse, aortic dissection
Define Osgood-Schlatter Disease (OSD)
Osteochondritis (inflammation of cartilage or bone) at the tibial tuberosity / patellar tendon insertion at the knee
What is the aetiology and epidemiology of Osgood-Schlatter disease
May be caused by multiple small avulsion fractures from contractions of quadriceps muscle at their insertion into proximal tibial apophysis (ossification centre) – during growth spurt
Epidemiology = 4% of 10-15yo physically active
What are the symptoms of Osgood-Schlatter Disease (OSD)
Knee pain after exercise (gradual onset) → relieved by rest (Bilateral in 25-50%)
Localised tenderness and swelling over tibial tubercle/tuberosity
Hamstring tightness
What investigations should be done for Osgood-Schlatter disease
Clinical diagnosis
± XR (may be indicated by Ottawa knee rules): fragmentation of the tibial tubercle + overlying soft tissue swelling
What is the management of Osgood-Schlatter Disease (OSD)
Analgesia (paracetamol or NSAIDs)
Ice packs (intermittent and over the tibial tuberosity, 10-15 minutes, ≤3/day, including after exercise)
Protective knee pads (may relieve pain when kneeling)
Stretching
Reassure - This will resolve over time but may persist until the end of a growth spurt
Advise stopping/reducing all sporting activity (intensity, frequency or duration)
- Could change type of exercise to limit running and jumping requiring powerful quadriceps contraction
- As symptoms decrease, they can gradually increase their exercise levels
- Introduce low-impact quadriceps exercises (e.g. straight leg raises, cycling or swimming)
Define Chondromalacia patellae
Anterior knee pain from degeneration of articular cartilage on posterior surface of patella
Common in young adults from overuse in physical activity
What are the signs and symptoms of Chondromalacia patellae
Anterior knee pain
Pain exacerbated by running, climbing stairs or getting up from a chair
Painless passive movements but repeated extension → pain and grating sensation
What is the management for Chondromalacia patellae
Physiotherapy (strengthen the quadriceps)
What is Osteochondritis dissecans
Pathological process affecting the subchondral bone (most often the knee joint) with secondary effects on the joint cartilage
Reduced blood flow → cracks form in the articular cartilage and subchondral bone → avascular necrosis → fragmentation of bone and cartilage with free movement of fragments → activity-related joint pain
What are the signs and symptoms of Osteochondritis dissecans
Pain after exercise
Catching, locking and giving way
Swelling
Oedema
Joint effusion
Lateral femoral condyle: Feeling a painful ‘clunk’ when flexing or extending the knee
Medial femoral condyle:
- Tenderness on palpation of the articular cartilage of the medial femoral condyle when the knee is flexed
- Wilson’s sign: with the knee at 90° flexion and tibia internally rotated, the gradual extension of the joint leads to pain at about 30°, external rotation of the tibia at this point relieves the pain
What investigations should be done for Osteochondritis dissecans
X-ray (anteroposterior, lateral and tunnel views): may show the subchondral crescent sign or loose bodies
MRI: used to evaluate cartilage, visualise loose bodies, stage and assess the stability of the lesion
