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MSK Flashcards

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1
Q

what is the term for bow legs

A

genu varum

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2
Q

pathological cause bow legs

A

rickets, blounts disease

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3
Q

what do bow legs look like

A

knees far apart

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4
Q

what is the term for knock knees

A

genu valgum

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5
Q

what does knock knees look like

A

feet wide apart

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6
Q

usual age of genu varum (bow leg)

A

1-3 y. normal toddler broad based gait

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7
Q

usual age of genu valgum (knock knees)

A

2-7y

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8
Q

what is the term for flat feet

A

pes cavus

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9
Q

when are flat feet common

A

in hypermobility

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10
Q

how do flat feet children present

A

standing on tiptoe

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11
Q

3 main causes of in toeing

A

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

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12
Q

what is out toeing

A

uncommon, may occur in infants 6-12m

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13
Q

associations out toeing

A

hypermobility, Ehlers Danlos, Marfans

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14
Q

what can be a cause of toe walking

A

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

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15
Q

how do you check for DDH

A

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

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16
Q

presentation DDH

A

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

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17
Q

management DDH

A

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

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18
Q

complications DDH

A

necrosis of femoral head

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19
Q

when do growing pains affect children

A

3-12 years. (nocturnal idiopathic pain)

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20
Q

presentation growing pains

A

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

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21
Q

are physical activities affected in growing pains

A

no- no limp. physical exam normal

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22
Q

presentation hypermobility

A

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

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23
Q

advice for hypermobility

A

footwear, exercises, orthotics

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24
Q

associations hypermobility

A

downs, collagen- Ehlers Danlos, Marfans

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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

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