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Flashcards in MSK Deck (83):
1

what is the term for bow legs

genu varum

2

pathological cause bow legs

rickets, blounts disease

3

what do bow legs look like

knees far apart

4

what is the term for knock knees

genu valgum

5

what does knock knees look like

feet wide apart

6

usual age of genu varum (bow leg)

1-3 y. normal toddler broad based gait

7

usual age of genu valgum (knock knees)

2-7y

8

what is the term for flat feet

pes cavus

9

when are flat feet common

in hypermobility

10

how do flat feet children present

standing on tiptoe

11

3 main causes of in toeing

metatarses varus (infants), medial tibial torsion, persistent anteversion of the femoral head

12

what is out toeing

uncommon, may occur in infants 6-12m

13

associations out toeing

hypermobility, Ehlers Danlos, Marfans

14

what can be a cause of toe walking

mild cerebral palsy, tightness of the Achilles tendon, inflammatory athritis

15

how do you check for DDH

neonatal screening- see if hip can be dislocated posterior out of the acetabulum (barlow manoeuvre) or relocated back in (ortolani)

16

presentation DDH

limp, abnormal gait, asymmetry skinfolds around hip, limited abduction of hip, shortening of affected leg

17

management DDH

splint or harness to keep hip flexed and abducted for a few months. surgery if fails

18

complications DDH

necrosis of femoral head

19

when do growing pains affect children

3-12 years. (nocturnal idiopathic pain)

20

presentation growing pains

wake in the night with pain, symmetrical pain in lower limbs doesnt radiate. never presents at the start of the day on waking

21

are physical activities affected in growing pains

no- no limp. physical exam normal

22

presentation hypermobility

MSK pain in the lower limbs often worse after exercise, join swelling absent. hyperextendable thumbs, elbows, knees, flat feet

23

advice for hypermobility

footwear, exercises, orthotics

24

associations hypermobility

downs, collagen- Ehlers Danlos, Marfans

25

causes of acute onset limb pain

trauma, NAI, osteomyelitis, tumour

26

what is osteomyelitis

infection of metaphysis of long bones. distal femur and proximal tibia

27

how is the infection spread in osteomyelitis

haem or direct spread from infected wound

28

what may osteomyelitis lead to

septic arthritis

29

what is the main cause of osteomyelitis

staph aureus (others- strep, H influenza)

30

presentation of osteomyelitis

painful immobile limb, acute febrile illness, swelling and tender over site, erythematous and warm, moving the limb causes severe pain

31

investigations in osteomyelitis

cultures, MRI, WCC and acute phase reactant increased, X ray, radionuclide bone scan increases uptake

32

treatment osteomyelitis

antibiotics. initially in a splint then mobilise the affected limb

33

what do you want to prevent in osteomyelitis

necrosis, chronic infection, limb deformity

34

bone pain due to malignant disease

ALL, neuroblastoma, osteogenic sarcoma, osteoid osteoma

35

what is a benign tumour present in teenagers especially males

osteoid osteoma

36

what is important when assessing a painful knee

check the hip as pain from the hip can be referred to the knee

37

what is osgood schlatter disease

osteochondritis of the patellar tendon inserting into knee

38

who does osgood schlatter disease affect

adolescent active males

39

presentation osgood schlatter disease

knee pain after exercise, tender, swelling, hamstring tenderness.

40

management osgood schlatter

decreased activity, physio, strengthening, hamstring stretches, orthotics

41

what is chondromalacia patellae

softening of articular cartilage of patella

42

who does chondromalacia patellae typically affect

adolescent females

43

presentation chondromalacia patellae

pain when standing up from sitting, walking up the stairs

44

associations chondromalacia patellae

flat feet and hypermobility

45

is back pain worrying in young

yes

46

mechanical causes back pain

muscle spasm, soft tissue pain- sport related, poor posture, abnormal loading

47

causes back pain

mechanical, tumours, vertebral osteomyelitis, spinal cord/root entrapment, spondylosis, complex regional pain syndrome

48

red flags back pain

young age, high fever, night waking, persistent pain, painful scoliosis, focal neuro signs, weight loss, systemic malaise

49

causes of acute limp in 1-3 yr

infection, transient synovitis, trauma, malignancy

50

causes chronic limp 1-3 y

DDH, talipes, neuromusc eg CP, JIA

51

causes acute limp 3-10 yrs

transient synovitis, septic arthritis/osteomyelitis, trauma, perthes, JIA, malignancy, complex regional pain syndrome

52

causes chronic limp 3-10 yrs

perthes, NMD eg DMD, JIA, tarsal coalition

53

causes acute limp 11-16 yrs

mechanical- trauma, sport, slipped capital femoral epiphyses, avascular necrosis of femoral head, reactive arthritis, JIA, septic arthritis, bone tumours/malignancy, CRPS

54

what is the most common cause of acute hip pain in children 2-12yr

transient synovitis

55

what does transient synovitis usually accompany

viral infection

56

presentation transient synovitis

sudden onset, no pain at rest, decreased range of movement, may be referred to the knee, afebrile or mild fever, doesn't appear ill

57

what can transient synovitis precede in some children

perthes disease

58

what is perthes disease

avascular necrosis of capital femoral epiphysis of femoral head due to interruption of blood supply

59

who does perthes disease mainly affect

boys. 5-10y

60

how does recovery take place in perthes

revascularisation and reossification follows it over 18-36m.

61

presentation perthes disease

insidious onset- limp, hip or knee pain. bilat in 10-20%.

62

what signs are seen on x ray in perthes

early- increased density femoral head. fragments and irregularities

63

management perthes

early- bed rest and traction. if seen late- maintain hip in abduction with plaster or calpers. pelvic or femoral osteotomy

64

what is the prognosis of perthes

good. but if older, and more extensive involvement can have deformity of femoral head

65

signs of an acute arthritis

pain, redness, swelling, heat, restricted movement, systemically unwell with fever

66

what is the most common form arthritis in children

reactive arthritis

67

presentation reactive arthritis

transient joint swelling

68

what does reactive arthritis follow

extra articular infection. in children- enteric bacteria- shigella, salmonella, campylobacter, yersinia

69

other causes reactive arthritis

viral infections, STI, mycoplasma

70

treatment reactive arthritis

NSAIDs

71

when is septic arthritis common

72

what organism is implicated beyond the neonatal period in septic arthritis

staph aureus

73

what can lead to septic arthritis

osteomyelitis

74

presentation septic arthritis

erythematous, warm, acutely tender joint, reduced range of movement, acutely unwell febrile child, infants often hold limbs still (pseudoparesis), usually affects only one joint

75

what may initial presentation be in septic arthritis

limp referred to knee

76

investigations in septic arthritis

incr WCC, incr acute phase reactant, cultures, ultrasound, x ray, bone scan, MRI

77

management septic arthritis

joint aspiration- definitive investigation. prolonged course of antibiotics

78

what is juvenile idiopathic arthritis

joint swelling >6 weeks before 16yrs in absence of infection or other cause

79

features JIA

gelling (stiff after periods of rest), morning joint stiffness and pain. in the young child- limp or behaviour change

80

long term results of JIA

may be expansion of bone from overgrowth- leg lengthening causing valgus deformity, hands, wrist.

81

complications JIA

chronic anterior uveitis, flexion contractures of joints, growth failure, osteoporosis, constitutional, amyloidosis

82

management JIA

NSAIDs, joint injections (1st line oligoarthritis) , methotrexate (polyarthritis), corticosteroids, biologics and immunotherapies

83

how many patients go on to have active adult disease in JIA

1/3