Flashcards in MSK Deck (51):
nursemaids elbow is the most common elbow injury what age?
What x-rays would you order for SFCE assessment (3)
AP, lateral, frog-leg
Management for sprains/strains (PRICE), plus other points
Protect - splint/brace, crutches
Rest for 24-72 hours or until pain resolves
Compression with elastic bandage
Elevation above heart
- mild exercise = passive ROM and stretching after 1-2 days rest
- strengthening exercises
- return to sports/physical activity when fully recovered
Child 4-8 years of age comes in with pain, limp, decreased abduction, internal rotation of the hip, this would be
legg calve' perthes (unknown cause of avascular necrosis of femoral head)
Diagnosis of osteosarcoma made by what 3 diagnostics
- CT or MRI
when would you refer for internal tibial torsion?
if persists past age 8
Disease evident by 3-6 years of age, failure to achieve motor milestones, toe walking, fatigue with activity, good and bad days, large firm calf muscles, doughy feel to muscles, waddling gait, lower extremities showing earlier weakness, think
Management of septic arthritis
- emergent referral for surgical drainage of joint
- IV antibiotics
talipes equinovarus (club foot) - chance of occurring bilaterally? males vs females?
males females 2:1
Management of transient synovitis
- return to activity as tolerated
Hip exam for DDH done at all well visits up to ___ months
gene valgum is what? normal until what age? usually resolves how? when is further evaluation needed?
normal alignment should be reached at 7-8 yrs
- present after 7 years
obese male teen with new onset knee pain on left side, concern for
SFCE (slipped femoral capital epiphysis)
___% of childhood fractures involve the growth plate
transient synovitis commonly preceded by
Fractures suspicious for abuse
- under age 1
- delay in treatment
- changing stories
- fracture doesn't match story
nursemaid elbow reduction maneuver (3 points)
1. child in parent/guardian lap
2. flex elbow 90 degrees with gentle pressure of thumb on radial head
3. fully or hyper pronate wrist, then fully supinate wrist. feel a click
If patient present with high fever, hip pain, refusal to bear weight, extreme pain, and joint that may be red, swollen, and warm, think
which hip is most often affected in SFCE?
stretch or tear in a muscle or tendon
Management for SFCE
- immediate referral to orthopedist
- absolutely non weight bearing
- surgery to pin hip together
Labs for septic arthritis would show what? Whats the confirmation DX?
Labs: elevated WBC and ESR
Dx confirmed with CT or ultrasound guided aspiration
legg calve' perthes most common in what age? male or female? what's the management
male to female 4:1
ortho referral, bedrest with femoral abduction traction to reduce hip, PT and maybe surgery
internal tibial torsion usually resolves by what age? whats the management?
most kids have spontaneous correction as they grow
If on physical exam pt has pain reproduced by extending the knee under resistance, and focal swelling and point tenderness over tibial tuberosity, think
3 maneuvers to check for DDH
1. barlow (bring in)
2. ortolani (out)
3. galezzi test (difference in knee height)
___% of cases of brachial plexus injuries will recover complete function with just PT - this is why tx is conservation
physical signs of DDH in older children (5)
- painless limp
- waddling gait
- short leg with toe walking
- marked lordosis
- trendelenburg sign
most common form of bone cancer in children
management of osgood-schlatter
treat the pain (ice, analgesics), rest, stretching
Most common cause of hip pain in kids
management for club foot
referral to ortho - casting with manipulation begins at birth
peak incidence of osteosarcoma
if child has full ROM of the tibia but internal rotation of the affected leg, flat feet, lumbar lordosis, and is under 2 years old, think
internal tibial torsion
most common hip problem in adolescents
if child presents with local pain, local swelling, mass at the end of a long bone, decreased ROM, think
injury rates increase with what 4 points
- level of competition
- frequency of participation (year round)
- age (older children and teens)
- specliazation/1 sport
most common type of muscular dystrophy? muscular dystrophy is what type of autosomal issue?
autosomal dominant trait sex linked
two main bacterial infection causes of septic arthritis
staph and strep
gene varum is what? normal until what age? usually resolves how? when is further evaluation needed?
normal until age 2
further eval if:
- past age 2
- progressive after child starts to walk
- unilateral or severe
management for DDH
refer to ped orthopedist
may need hip spica cast, pavlik harness, surgery
child who has an in-toeing gait, runs awkwardly, frequent falls, sits in a "w" - think
If patient comes in with low trade temp, painful limp, does not appear severely ill and labs show negative CBC and ESR?
osgood-schlatter disease males: female, when does it occur in adolescence?, bilateral or unilateral?
male to female 7:1
occurs in teens after rapid growth spurt
if child noted to have adducted forefoot, limited dorsiflexion, prominent crease in arch of foot this would be
femoral anteversion most common in what age? most cases resolve by what age?
3-8 years ("W" sit)
99% resolve by 8
If child 1-4 years old comes in refusing to use their left arm, holding it close to their body, elbow bent, palm down - happened unintentionally from "pulling" child's hand or arm to prevent them from falling or by swinging child by arms think
higher incidence strain or sprain
Definitive diagnosis for DDH
- more common in females or males?
- which hip more common?
- higher frequency in which children?
females to males 6:1
left hip more
breech babies at increased risk