MSK

Question 1

What causes torticollis?

Answer 1

injury to the SCM during delivery
OR
disease affecting the spine in infancy

Question 2

Acute torticollis may follow ______ in children

Answer 2

upper respiratory infection (URI)

Question 3

URI’s in torticollis can lead to swelling n the upper spine, especially to what vertebrae?

Answer 3

C1-C2

Question 4

Babies with toticollis are susceptible to _______

Answer 4

rotatory subluxation

Question 5

S/S of torticollis

Answer 5

contacture of the SCM: chin is rotated to the side OPPOSITE of the AFFECTED muscle causing the head to tilt TOWARD the side of conracture

Question 6

Dx of torticollis if rotatory subluxation is present

Answer 6

CT Scan

Question 7

Tx for torticollis

Answer 7

FIRST LINE: PASSIVE STRETCHING is effective in 97% of cases

If that fails: surgery

Question 8

Tx for **acquired **torticollis

Answer 8

**traction or a cervical collar usually
results in resolution of symptoms
within 1-2 days

Question 9

What is Osgood Schlater- Disease, OSD (Tibial Tubersoity Avulsion)?

Answer 9

Apophysitis (infflammation to
the growth plates) of tibial
tuberosity

Question 10

What causes OSD?

Answer 10

recurrent
traction on the tibial tubercle
apophysis (growth plate)

Question 11

What population does OSD most commonly occur in?

Answer 11

MC in males 12-15, during
growth spurts, athletes.
(SHAQ had this)

Highly active pts (typically
running and jumping sports).

overuse injury that occurs during periods of rapid growth.

An overuse injury→ rep knee
extension and quads
contraction.

Question 12

S/S of OSD?

Answer 12

1. ANTERIOR related knee pain and swelling with NO known trauma.
2. Swelling or bump, and tenderness over the anterior tibial tubercle.**
3. Pain is WORST with activity**

Question 13

oWhat shuld be on the DDx for a young kid who comes in with bone pain with no trauma?

Answer 13

osteosarcoma

Question 14

What will the XR for a patient with OSD show?

Answer 14

fragmentation or irregular osification over the tibial tubercle ossification of the tibial tubersoity

Question 15

Tx of OSD?

Answer 15

**Conservative: rest and ice is MOST important
**
- Condition resolves spontneously as the athlete reaches skeletal maturity.
- NSAIDS for any activity
**very hard to get kids to be LESS
active

Question 16

When will the pain in OSD go away?

Answer 16

when the tubercle fuses (physis closes)

Question 17

What is Developmental Dysplasia (DD)?

Answer 17

congential deformity: abnormal relationship between the femoral head and the acetabulum

Question 18

What population is DD most commonly in?

Answer 18

MC in
1. females
2. 1st born
3. BREECH BIRTH

Question 19

What is found on the physical examination of DD?

Answer 19

1. leg shortened
2. Externally rotated
3. Skin folds uneven on the buttocks and thigh
4. Barlow and Ortolani sign

Question 20

Barlow’s sign

Answer 20

examiner:
ADDucts the hip while applying a** POSTERIOR force on the knee to promote DISLOCATION **

Question 21

Ortolani’s sign

Answer 21

**ABDucts **the hip while applying ANTERIOR force on the femur to **REDUCE **the hip joiint

Question 22

What are some possible complications that occur with DD?

Answer 22

**- Recurrent dislocations
**- Leg-length discrepancies
**- Early arthritis
**- Duck walk gait.

Question 23

What is the diagnostic test of chocie for DD?

Answer 23

Ultrasound

Question 24

Tx of DD if within 1st year of life?

Answer 24

**FIRST LINE: CLOSED treatment:
*** 0-6 months: Pavlik harness
* 7-12 months: Spica cast

Question 25

Tx of DD if AFTER 18 months?

Answer 25

surgial fixation via ORIF

Question 26

Slipped Capital Femoral Epiphysis (SCFE)

Answer 26

Weakening of epiphyseal plate (growth plate) leading to the displacement of thefemoral head.

Question 27

Risk Factors for SCFE

Answer 27

1. adolscents 11-16 yrs old 2. obesity 3. African Americans 4. Hypothyroidism

Question 28

S/S of SCFE?

Answer 28

* insidious onset of hip, groin, thigh, or knee pain * **PAINFUL** limp ( pain an ltered gait or may not be able to bear weight *** DECREASED (or limited) ABDucton and INTERNAL rotation **

Question 29

# Wah What direction is the leg rotated in SCFE?

Answer 29

EXTERNALLY rotated leg

Question 30

Dx of SCFE

Answer 30

AP AND FROG LATERAL" show widening of the physis and epiphyseal dispalcement aka** ICE CREAM SLIDING OFF A CONE**

Question 31

Tx of SCFE

Answer 31

Initial: **STRICT NWB** (need to prevent further slippage), initially crutches, NWB then **SURGICAL PINNING**

Question 33

What is a primary complication of SCFE?

Answer 33

avascular necrosis (AVN)

Question 34

Type 1 S-H Fracture

Answer 34

through the growth plate

Question 35

Type 2 S-H Fracture

Answer 35

through growth plate and the **METAPHYSIS**

Question 36

Type 3 S-H Fracture

Answer 36

through growth plate and the **EPIPHYSIS*

Question 37

Type 4 S-H Fracture

Answer 37

through **ALL 3 elements**

Question 38

Type 5 S-H Fracture

Answer 38

**CRUSH (rammed)** injury of the growth plate

Question 39

Subluxation of the Radial Head (Nursemaid's Elbow)

Answer 39

Result of being liften or pulled up by the hand (traction to the arm)

Question 40

Subluxation of the Radial Head (Nursemaid's Elbow)

Answer 40

*** Child will presnt with elbow fully pronated and painful.** * Common complaint: child’s elbow will **NOT **bend. *** No swelling, ecchymosis, or deformity.**

Question 41

Tx for Subluxation of the Radial Head (Nursemaid's Elbow)

Answer 41

**closed reduction **via the **hyperpronation method** (a "click" may be felt by the finger over the raidial head when the subluxation is reduced)