MSK Flashcards
1
Q
What is the medical word for knock-kneed?
A
Genu Valgum
2
Q
What is the medical word for bow legged?
A
Genu Varum
3
Q
True or False: Genu varus is typically a normal condition and only requires reassurance?
A
True
4
Q
What is the word for growth plate?
A
Physeal or Physis
5
Q
What is the metaphysis (or metaphyseal)?
A
End of the long bone adjacent to the growth plate or physis.
6
Q
What separates the epiphysis from the metaphysis?
A
Growth plate (physis)… in adults the metaphysis is no longer separated from the rest of the long bone
7
Q
What is varus or varum?
A
When the distal part of the deformity points towards the midline
8
Q
What is valgus or valgum?
A
When the distal part of the deformity points away from the midline
9
Q
What is the epiphysis (or epiphyseal)?
A
Rounded end of a long bone
*During development it is separated from the long bone… once growth plate closes it is part of the long bone
10
Q
When is intervention required for genu varus?
A
With abnormal findings…
- Unilateral
- Worsens after age 1
- Doesn’t resolve after age 2
11
Q
What XR findings would indicate need for intervention in genu valgum?
A
Physeal and epiphyseal distortion
12
Q
If genu varus is present after age 2 what things should you consider?
A
More significant causes..
- Rickets
- Blount’s disease
13
Q
Where is the pathology in Blount’s disease?
A
- Proximal tibial physis
2. Epiphysis
14
Q
Who is infantile Blount’s disease seen in?
A
African Americans
15
Q
What disease is it important to not confuse infantile Blount’s disease with?
A
Rickets (Both occur more frequently in African Americans)
16
Q
Why does rickets occur more frequently in African Americans?
A
Due to decreased absorption of UV light
17
Q
What is treatment for infantile Blount’s disease?
A
No treatment needed
18
Q
How can you tell between Rickets and Blount’s disease?
A
If it’s Rickets they will refer to other signs of the disease
19
Q
Who do you usually see adolescent Blount’s disease in?
A
African Americans, overweight
20
Q
What is the treatment for adolescent Blount’s disease?
A
Bracing, surgery… something needs done
21
Q
What is a type 1 Salter Harris fracture?
A
Separation of the epiphysis and metaphysis (fracture is directly through the physis)
22
Q
True or False: Type 1 Salter Harris fractures aren’t seen on XR?
A
True- XR may be negative (tenderness may be your only sign)
23
Q
What is the treatment for a type 1 Salter Harris fracture?
A
Casting for 2-3 weeks
24
Q
What is a type 2 Salter Harris fracture?
A
A piece of the metaphysis splits as well as some physis (Above)
25
What is done for Salter Harris type 2 fracture?
Closed reduction casting for 3-6 weeks
26
What is a type 3 Salter Harris fracture?
Through the growth plate, extending through the epiphysis (Lower)
27
What is treatment for a type 3 Salter Harris fracture?
Open reduction
28
Which is worse, a type 2 or 3 Salter Harris fracture?
Type 3 because it goes through epiphysis into the joint space
29
What is a type 4 Salter Harris fracture?
Cracks through all layers (epiphysis, metaphysis, and physis)
30
What is treatment for a type 4 Salter Harris fracture?
Reduction in OR to avoid growth disruption
31
What is a type 5 Salter Harris fracture?
Crush type injury/compression fracture
32
Which type of Salter Harris fracture results in microvascular compromise?
Type 5
33
What is the prognosis for a Type 5 Salter Harris fracture?
High rate of poor growth after the injury
34
What usually causes a greenstick fracture?
Fall on an outstretched hand
35
What is the name for a cortical break on one side of the bone and intact periosteum on the opposite side?
Greenstick fracture
*Break isn't through the bone...one side is broken and the other is bent
36
What is the mnemonic for Salter Harris fractures?
```
S: Straight through physis (separated)
A: Above growth plate
L: Lower- through lower portion
T: Totally through metaphysis, growth plate, and epiphysis
R: cRush- compression fracture
```
37
How is osteogenesis imperfecta type 1 inherited?
AD
38
Which type of osteogenesis imperfecta has blue sclera?
1
39
When do fractures occur in osteogenesis imperfecta?
Preschool years (they are rarely born with fractures)
40
Besides fractures, what is considered to be a major feature of osteogenesis imperfecta type 1?
Hearing loss (conductive and sensorineural)
41
What is the most severe form of osteogenesis imperfecta?
2- Usually lethal
42
How is osteogenesis imperfecta type 2 inherited?
Dominant new mutation or germinal mossaicism
43
How do children with osteogenesis imperfecta type 2 present?
Born with multiple fractures- described as a bag of bones appearance
44
Which type of osteogensis imperfecta are usually stillborn are rarely live past the neonatal period?
Type 2
45
True or False: If a child has made it past infancy they cannot have osteogenesis imperfecta type 2?
True
46
In osteogenesis imperfecta type 2, what is the size of the head in relation to the rest of the body?
Head is large in proportion to the rest of the body
47
What type of osteogenesis imperfecta is known as the progressive deforming type?
3
48
How do kids with osteogenesis imperfecta type 3 present?
Born with fractures- deformities are progressive
49
What are the eye findings with osteogenesis imperfecta type 3?
Born with gray sclerae that lighten over time
50
Besides fractures and gray sclerae, what are 2 other characteristics of osteogenesis imperfecta type 3?
Macrocephly and short stature
51
What is it called when a defect exits in germinal cells but not in regular somatic cells?
Germinal mosaicism
52
What does germinal mosaicism mean in terms of inheritance?
A trait can be transmitted as a dominant trait, but appear to be recessive since it isn't an expressed phenotype in the parents... (defect in germinal cells, but not in regular somatic cells)
53
Describe osteogenesis imperfecta type 4
Similar to type 1, but sclerae are white (not blue)
54
What type of torticollis usually results from positioning or trauma?
Muscular
55
What is paroxysmal torticollis?
Migraine variant (may even manifest in infants)
56
How does paroxysmal torticollis present?
Repeated attacks of head tilting, only last for minutes at a time. Often accompanied by vomiting, irritability, and pallor
57
What is done for paroxysmal torticollis?
Nothing
58
What cause of torticollis is obviously present from birth and diagnoseable by XR?
Vertebral anomalies
59
Head tilt (torticollis) in addition to upper motor neuron findings (like increased DTRs)...?
Posterior fossa tumor
60
What cause of torticollis requires an MRI to diagnose?
Posterior fossa tumor
61
Name 3 descriptors that make you think congenital torticollis
1. Infant with head tilted to one side
2. Infant with mass in SCM muscle (bleeding into this after birth)
3. Infant with facial asymmetry
62
What is treatment for congenital torticollis?
Daily stretching and PT... if this isn't done or doesn't work after one year, surgical intervention is required
63
What other finding can congenital torticollis be associated with?
Hip dysplasia
64
What is due to fusion of the cervical vertebrae and may present as congenital torticollis?
Klippel-Feil syndrome
65
Name 8 findings seen in Klippel-Feil Syndrome
1. Congenital torticollis (fusion of cervical vertebrae)
2. Short neck
3. Low occipital hairline
4. Scoliosis
5. Spina bifida
6. Renal problems (missing one kidney)
7. Sprengel deformity
8. Deafness
66
What results from failure of the scapula to descend to its normal position during fetal development?
Sprengel deformity
67
How does Sprengel deformity mimic torticollis?
Affected side of neck (where scapula didn't descend to normal position) will seem broader and shorter... thus mimics torticollis
68
How if the affected scapula in Spregnel deformity positioned?
Abnormally high and medially rotated
69
Name 5 risk factors for developmental dysplasia of the hip
1. Breech
2. Family history of DDH
3. Female
4. First born
5. Oligohydramnios
70
Name 3 other conditions frequently associated with DDH
1. Torticollis
2. Metatarsus adductus
3. Calcaneovalgus (club foot)
71
What is barlow exam?
Knees adducted with downward pressure to try to dislocate the hip
72
What is Ortolani exam?
Attempt to relocate a dislocated femoral head
73
After what age are the Ortolani and Barlo maneuvers not reliable?
3 months
74
After 3 months of age what is the most common sign of DDH?
Limitations in hip abduction
75
Besides limitations in hip abduction what are 2 other findings you can see in kids over 3 months with DDH?
1. Unequal knee height (Galeazzi sign)
| 2. Asymmetric gluteal folds
76
Which needs to be worked up, a hip click or a hip clunk?
Clunk
77
How is diagnosis of DDH made?
Real-time US with manipulation in first 4 months of life (by pelvic XR after this)
78
What is the treatment for DDH?
Pavlik harness (this is more reliable than double or triple diapers)
79
What position does the Pavlik harness hold the hips in?
Abduction, flexion, external rotation
80
True or False: You can use double diapers to treat DDH?
False: Ineffective- often applied to loose and don't provide any degree of correction
81
What are 2 consequences in a child whose DDH wasn't corrected?
Waddling gait or leg length discrepancy
82
What are 4 considerations in a kid with a waddling gait?
1. Uncorrected DDH
2. Rickets
3. Legg-Calve-Perthes
4. Slipped capital femoral epiphysis
83
Waddling gait and leg bowing?
Rickets
84
Waddling gait, limp, child around 7?
Legg-Calve-Perthes
85
Waddling gait, knee pain, overweight young adolescent?
Slipped capital femoral epiphysis
86
What is the typical presentation of viral myositis?
Weakness and tenderness localized to a muscle
87
What muscle is common affected in viral myositis?
Calf
88
True or False: The neurological exam in viral myositis is unremarkable?
True
89
What lab marker will be elevated in viral myositis?
Creatinine kinase
90
What will be a common finding in the history for viral myositis?
Recent respiratory illness or influenza
91
What is the treatment for viral myositis?
No treatment necessary
92
What can present similarly to a viral myositis?
Metabolic myopathies (due to mitochondrial dysfunction)
93
How can you distinguish between viral myositis and metabolic myopathy?
In metabolic myopathies you will have rhabdomyolysis as well (described as dark urine)
94
What orthopedic problem will you have if they describe a recent URI, passive ROM, normal ESR, negative gram stain, and normal or slightly elevated temperature?
Toxic synovitis (post-infectious arthritis)
95
What is the usual cause of toxic synovitis?
Viral-
1. Parvovirus B19
2. Influenza
3. Hepatitis B
4. Rubella
5. EBV
6. Really any other virus
96
Kid with hip pain and flushing of the cheeks?
Parvovirus B19 (fifth disease)
97
Vague joint aches, otherwise well, got MMR several weeks ago, otherwise not been ill... most likely explanation for joint aches?
Post-infectious arthritis (MMR is live vaccine and rubella component can cause this)
98
What group is most likely to have post-infectious arthritis after MMR (from rubella component)?
Post-pubertal female
99
What is treatment for toxic synovitis?
Reassurance (no matter how severe pain is)
*Remember toxic synovitis is a diagnosis of exclusion after other more serious infections are ruled out
100
What age group typically gets septic arthritis?
Under 2
101
True or False: Septic arthritis is very serious and requires aggressive intervention
True
102
What typically causes septic arthritis?
Hematogenous spread
103
How does a kid with septic arthritis usually present?
1. Fever
2. Won't walk or move the joint
3. High WBC count
4. High sed rate
5. Positive gram stain
6. Increased joint space on XR
7. Joint is warm, red, swollen
8. Child will fight you trying to touch or move it
104
True or False: US, CT, MRI, and bone scan are helpful to make the diagnosis of septic arthritis?
False- they are useful to rule out osteomyelitis, but won't diagnose septic arthritis
105
What are the 2 most important things if you suspect septic arthritis?
1. Joint aspiration
| 2. Start antibiotics- Start IV abx pending culture and sensitivities
106
When can you switch from IV to PO antibiotics in septic arthritis?
When there is clinical improvement (continue PO antibiotics for another 3 weeks)
107
What is the most difficult joint to diagnose septic arthritis in?
Hip
108
What should you do if history suggests a septic hip?
Begin treatment (even before diagnosis is confirmed since septic hip is so difficult to diagnose)
109
What is the most common pathogen overall in septic arthritis?
S. Aureus
110
What 2 bacteria have to be a consideration for septic arthritis in a neonate?
1. Group B strep
| 2. E. Coli
111
For infants and children that 3 bacteria do you have to consider for septic arthritis besides S. Aureus?
1. Strep Pneumo
2. Group A Strep
3. H. Flu
112
What needs to be considered as a cause for septic arthritis in a teenager?
N. gonorrhea
113
Recent immigrant, sore ankle that is painful to passive and active movement, red, and mildly swollen, similar symptoms in knee yesterday which have improved, diffuse macular rash...diagnosis?
Rheumatic fever- Recent immigrant, migratory arthritis involving large joints coupled with rash
114
What empiric antibiotics for septic arthritis in a neonate?
Cloxacillin/gentamicin
115
What empiric antibiotics for septic arthritis in infants through 3 months?
Cefuroxime or cefotaxime
116
What empiric antibiotics for septic arthritis in children?
Cefazolin
117
What empiric antibiotics for septic arthritis in adolescents?
Must azithromycin to ceftriaxone or cefixime (cover for GC)
118
What antibiotic and what bug do you need to cover for in kids with sickle cell disease and septic arthritis?
Cefotaxime, Salmonella
119
What antibiotic needs to be added for septic arthritis if they hint at MRSA?
Vancomycin
120
Who do you need to consult if there is involvement of the hip, knee, or shoulder in septic arthritis?
Ortho- Joint drainage is often necessary
121
What is osteomyelitis?
Infection of the bone
122
What is septic arthritis?
Infection of the joint
123
How does osteomyelitis present initially?
Localized tenderness over the metaphysis as well as pain on weight bearing
124
Name 2 things that can cause osteomyelitis
1. Direct injury/infection (stepping on a nail)
| 2. Hematogenous spread
125
How is diagnosis of osteomyelitis made?
Direct aspiration of the metaphysis (send for culture and sensitivity)
126
What is the most common cause of acute hematogenous osteomyelitis in all ages?
S. Aureus
127
What usually causes osteomyelitis in neonates?
Hematogenous spread
128
What bones does osteomyelitis usually affect in neonates?
Femur and tibia
129
What care 3 common bacteria that cause osteomyelitis in neonatse?
1. S. Aureus
2. Group B strep
3. E. Coli
130
What % of the time is a septic joint present among neonates with osteomyelitis?
50% (even though it is typically contracted via hematogenous spread)
131
True or False: A septic joint is rarely seen with osteomyelitis beyond the neonatal period?
True
132
What are some bacteria to consider in osteomyelitis in age groups beyond the neonatal period?
1. S. Aureus
2. GAS (Strep pyogenes)
3. Kingelle kingae
4. H. flu type B
133
When are bone scans useful for osteomyelitis?
Early... when exact location of the infection needs to be identified and infection is too early to be detected on plain film
134
What time frame can a bone scan pick up abnormalities associated with osteomyelitis in?
Within 3 days of onset
135
When do XR findings in osteomyelitis present?
10-14 days after infection
136
Why is MRI with contrast more useful in osteomyelitis?
More specific and can distinguish infection from other causes of inflammation
137
True or False: An MRI can tell the difference between bone infection and infarction for a child with sickle cell disease?
True (bone scan can't do this)
138
What is the general difference in utility for a bone scan versus an MRI?
Bone Scan: Where is the problem
| MRI: What is the problem
139
What is the most common cause of osteomyelitis in kids with sickle cell disease?
Salmonella
140
What is a common cause of osteomyelitis in a child who stepped on a nail?
Pseudomonas
141
How should initial antibiotics be given in sickle cell disease?
IV
142
How long should osteomyelitis be treated for?
4-6 weeks
143
What 3 antibiotics would you consider for osteomyelitis due to S. Aureus or GAS?
1. Oxacillin/Nafcillin
2. 1st or 2nd generation cephalosporin
3. Clindamycin (for patients allergic to penicillin)
144
What antibiotic should you use for osteomyelitis caused by H. Flu?
2nd or 3rd generation cephalosporin
145
What antibiotic should you use for osteomyelitis in a kid with sickle cell?
3rd generation cephalosporin (until culture and sensitivities back)- Have to cover for salmonella
146
What antibiotic should you use for osteomyelitis if there is a concurrent puncture wound?
Need to cover for pseudomonas and/or anaerobic organisms
147
What are 3 requirements in order for a child to be sent home on oral antibiotics who has osteomyelitis?
1. Good response to IV meds and specific organism identified
2. Trial of PO antibiotics and good serum levels documented while still in hospital
3. Compliance assured (parental reliability)
148
What is the most common complication of osteomyelitis?
Recurrence
149
When is surgical intervention required in osteomyelitis?
Chronic infection- especially if abscess is suspected
150
What is Legg Calve Perthes Disease?
Avascular necrosis of the femoral head
151
How does Legg Calve Perthes Disease present?
Hip pain and or limp
152
Which children often get Legg Calve Perthes Disease?
Boys, Peak Age 5-7 years
153
What are classic XR findings for Legg Calve Perthes Disease
One femoral head being smaller than the other
154
What should you consider if a kid has knee pain?
That it is from the hip...hip pain can frequently be referred to the knee
155
What should you do for a kid with Legg Clave Perthes Disease?
Make them non weight bearing
| Refer to ortho (splinting and possible surgery)
156
How does SCFE present?
Teenager (usually male/obsess) with limp and knee pain (knee pain is actually referred hip pain)
157
How do kids with SCFE hold their leg?
Extended and externally rotated
158
How does SCFE look on XR?
One hip normal and other like an ice cream scoop falling off the cone (ice scream scoop is acetabular head)
159
What lab abnormalities might you see with a SCFE?
Endocrine labs being off (SCFE can occur with various endocrinopathies)
160
What type of osteomyelitis is prone to abscess formation?
Pelvic osteomyelitis
161
`Who do you typically see pelvic osteomyelitis in?
Boys around age 8
162
Which side do you usually see pelvic osteomyelitis on?
Right
163
What bacteria causes pelvic osteomyelitis?
S. Aureus
164
Where is the pain usually located for pelvic osteomyelitis?
Referred to hip or thigh.
| Sometimes presents as abdominal pain
165
What happens to the WBC count and XR in pelvic osteomyelitis?
WBC count normal
| Plain film negative
166
What are the studies of choice for pelvic osteomyelitis?
MRI and bone scan
167
What should you keep in mind with any description of knee pain on boards?
Hip pathology
168
How is SCFE treated?
1. Immobilization
2. No weight bearing
3. Stabilization (pins and/or bone grafts)
169
What is the result of stress from excessive activity at the insertion of the patellar tendon at the anterior tibial tubercle?
Osgood-Schlatter
170
What is the location of a specialized growth center called the apophysis?
Tibial tuberosity
171
Where does the quadriceps muscle attach (and through what tendon)?
Tibial tuberosity (patellar tendon)
172
Why are adolescents prone to Osgood Schlatter Disease (overuse injury) during periods of rapid growth?
Because it affects tibial tuberosity (location of specialized growth center- apophysis)
173
What is typically described in an athletic adolescent who presents with pain just below the patella?
Osgood-Schlatter disease
174
How is Osgood Schlatter disease treated?
Couple weeks of rest then gradual resumption of activity
Ice
NSAIDs (pain/inflammation)
175
What is the Osgood-Schlatter of the heel?
Sever's syndrome
176
What presents as heel pain in young athletes (especially soccer, basketball, gymnastics, and running)?
Sever's Syndrome
177
Is Sever's Syndrome more common in boys or girls and at what age does this peak?
Somewhat more common in boys than girls- Peaks at 8-12 years
178
What is treatment for Sever's Syndrome?
Rest, ice, NSAIDs
179
What will history imply for an occult fracture?
No systemic symptoms, no recent viral illness, no signs of infectious etiology, no history to suspect missed trauma
180
What type of fracture can occur during the course of learning to walk?
Toddler's Fracture
181
True or False: A Toddler's fracture may not be apparent on XR?
True
182
What is a common finding on exam for an occult fracture?
Point tenderness (might be only clue pointing to this diagnosis)
183
True or False: Underlying bone is stronger than ligaments in children?
False (ligaments are stronger)
184
Force strong enough to cause a ligament tear in a child would more likely result in what?
Fracture
185
What are fluid-filled cysts usually seen prior to skeletal maturity that are typically found at the proximal humerus or femur?
Unicameral bone cysts (simple bone cyst)
186
True or False: Unicameral bone cysts are not precancerous?
True
187
How do unicameral bone cysts usually present?
Typically asymptomatic
| Diagnosed as a pathological fracture after minor trauma
188
Where are aneurysmal bone cysts typically seen?
1. Tibia
| 2. Femur
189
How does an aneurysmal bone cyst usually present?
Pain- can be in absence of swelling
190
What can aneurysmal bone cysts be associated with?
Underlying bone tumors (may require orthopedic referral)
191
If there is an aneurysmal bone cyst on the vertebrae, what do you need to check for?
Signs of nerve compression
192
How does Ehlers-Danlos present?
Skin that stretches
Joints are hypermobile
Poor wound healing
193
Why would a kid with Ehlers-Danlos present to orthopedics or rheumatology?
Hypermobile joints that become painful
194
True or False: Most types of Ehlers-Danlos Syndrome have normal life expectancy?
True
195
What are 3 descriptions that should make you think of growing pains?
1. Bilateral
2. Worse at bedtime
3. Joint pain without swelling
196
Why might Ehlers-Danlos be mistaken for child abuse?
Easy bruisability
197
How is hypermobility in Ehlers-Danlos described?
Loose joints
| Get injured/Sustain sprains easily
198
What do you need to counsel Ehlers-Danlos patients on regarding hypermobility?
Stretch before sports
Be vigilant in sports they play
(No other specific intervention)
199
How might they describe scoliosis based on physical exam?
Asymmetry of hips, shoulders, and/or scapula
200
When does congenital scolosis present?
Could be in infancy or much later (depends on degree of curvature)
201
What are causes of congenital scoliosis?
Malformation of spinal column or ribs
202
True or False: Most cases of congenital scoliosis aren't hereditary
True- Even though congenital scoliosis is often associated with other malformations
203
When is bracing helpful for congenital scoliosis?
Post-op (not helpful as primary treatment)
204
What are the 3 tests you should do for screening in kids with congenital scoliosis?
1. Renal US
2. Cardiac ECHO
3. Spinal MRI
High association between congenital scoliosis and renal/cardiac disease and spinal abnormalities
205
True or False: Chromosome analysis, ophthalmologic evaluation, and head US aren't routinely indicated in kids with congenital scoliosis?
True
206
What are 3 signs you should watch for with concern for secondary scoliosis?
1. Delayed pubertal development
2. Neurological deficits
3. Dermatologic lesions
207
What type of MSK problem should you consider with a kid who has neurofibromatosis?
Secondary scoliosis
208
What type of scoliosis is seen in kids with muscular dystrophy, myopathies, cerebral palsy, tethered cord syndrome, spinal muscular atrophy, DDH, OI, Klippel-Feil syndrome, connective tissue disorders (Marfan syndrome/Ehlers-Danlos syndrome), spina bifida, spinal cord injury?
Neuromuscular or paralytic scoliosis
209
True or False: The degree of curvature tends to progress in neuromuscular or paralytic scoliosis?
True
210
What is idiopathic scoliosis?
Isolated scoliosis with no identified cause
211
What % of cases in real life are idiopathic scoliosis?
80%
212
How does idiopathic scoliosis progress?
Worsen by 1 degree per month during the growth spurt until skeletal maturity
213
When should you get an MRI, orthopedic consultation, bracing, and possibly surgery in idiopathic scoliosis?
If the degree of curvature increases by more than 1 degree per month during the growth spurt (may be more than just idiopathic scoliosis)
214
Curvature of what requires observation only in scoliosis?
Under 25
215
When is bracing required for scoliosis curvature between 25-40 degrees?
Is there is more than 2 years of growth still expected (child is still growing)
216
When is surgery needed in scoliosis?
For a lumbar or thoracic curvature greater than 40 degrees
217
Who is at the risk for highest degree of progression of scoliosis?
Young premenarchal patients with large initial curves
218
When is manipulation or electrical stimulation the correct answer for scoliosis management?
Never- No FDA approval
219
What is kyphosis?
Convex alignment of the thoracic spine in the sagittal plane (side view)
220
What is the normal range for kyphosis?
20-40 degrees
221
Kyphosis less than what requires just follow-up (no other intervention)?
Less than 60
222
True or False: PFTS wouldn't be indicated in an asymptomatic patient unless kyphosis is well above 60 degrees?
True
223
Teenager who can never stand up straight, chronic upper back pain. Kyphosis on PE with distended abdomen. Most likely diagnosis?
Scheuermann Disease
224
What is a fixed kyphosis which presents at puberty?
Scheuermann Disease
225
What is the triad for Scheuermann Disease?
1. Bad posture
2. Kyphosis
3. Back pain
226
What is treatment for Scheuermann Disease?
NSAIDs, PT, and observation
*Surgery is sometimes required
227
What are 3 considerations for infectious causes of back pain?
1. Diskitis
2. Spinal epidural abscess
3. Vertebral osteomyelitis
228
What bug typically causes infectious sources of back pain?
S. Aureus
229
What are 2 developmental causes of back pain?
1. Spondylolysis
| 2. Spondylolisthesis
230
What is the progression of spondylolysis leading to stress fractures and subluxation of vertebral bodies?
Spondylolisthesis
231
What are 3 traumatic causes of back pain?
1. Herniated disc
2. Vertebral stress fracture
3. Overuse syndrome
232
What are 5 tumors that can cause back pain?
1. Osteoid osteoma
2. Osteoblastoma
3. Aneurysmal bone cyst
4. Osteosarcoma
5. Ewing sarcoma
233
What type of tumor causing back pain usually has pain at night that is relieved by NSAIDs?
Osteoid osteoma
234
What is an osteoid osteoma greater than 1.5cm?
Osteoblastoma
235
What is annular ligament displacement called?
Nursemaids elbow
236
Child that was pulled by the arm and is now not using the involved arm..?
Nursemaids elbow (Annular Ligament Displacement)
237
What is another name for subluxed radial head?
Annular ligament displacement (Nursemaids Elbow)
*Subluxed radial head is an old name
238
What does a posterior fat pad on XR of elbow indicate?
Fracture and accumulation of fluid
239
True or False: An anterior fat pad on elbow XR is normal?
True
A- All right/Anterior
P- Poor/Posterior
240
`What 3 things need to be for XR to not be necessary for the elbow with suspected Nursemaids?
1. No swelling
2. No point tenderness
3. No discoloration
241
What is the best way to manage a Nursemaids?
Reduce it (only after checking for other injuries)
242
How is polydactyly usually inherited?
Isolated AD trait (although polydactyly can be associated with various syndromes)
243
Hos is simple postaxial polydactyly managed?
Ligation until it falls off
244
What is simple postaxial polydactyly?
Occurs off 5th finger/toe- like a little skin tag
245
What should you do for polydactyly that involves bone, soft tissues, and tendons?
Referral to hand surgeon
246
What are 3 syndromes with little or no radius?
1. TAR- Thrombocytopenia Absent Radius
2. Fanconi's Anemia
3. VATER- R is absent radius
247
What is another name for Talipes Equinovarus?
Club foot
248
What happens in club foot?
Foot is internally rotated and Achilles tendon is contracted
249
What needs to be done for club foot?
Urgent referral to ortho
250
What is treatment for club foot?
Stretching, serial casting, possible surgical release of tendon (late in first year of life)
251
When does toe walking become an issue?
When it persists after age 2-3
| When kids can't put their heels down at rest
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What is the most common cause of toe-walking?
Idiopathic
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When does idiopathic toe walking tend to present?
Right when kids learn to walk
254
What are some conditions that can cause toe-walking and need to be ruled out?
1. Cerebral Palsy
2. Spinal Cord Tumors
3. Neuromuscular problems (tethered cord)
255
What should be considered/ruled out for kids who initially walked normally and developed toe-walking later on?
1. Muscular dystrophy
2. Charcot-Marie-Tooth
3. Hereditary neuropathies
256
What is correct initial treatment for toe walking?
- Foot dorsiflexion exercises several times per day (maintain full ROM at heel cord)
- Remind child to put heel down when walking
257
What should be done for kids who persist in toe-walking who develop heel-cord contractures with no other known MSK conditions?
Refer to ortho for evaluation and possible short-term casting
258
What are 3 causes of intoeing?
1. Metatarsus adductus in infancy
2. Tibial torsion in toddlerhood
3. Femoral anteversion in early childhood
259
What 2 cause of intoeing almost always resolve spontaneously by school age?
1. Tibial torsion
| 2. Femoral anteversion
260
True or False: Use of bars and other devices hasn't been shown to correct natural in-toeing?
True
261
What is management for intoeing?
Reassurance... usually resolves spontaneously but may persist into adulthood
