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Flashcards in MSK Deck (51):
1

Management for sprains/strains (PRICE), plus other points

Protect - splint/brace, crutches
Rest for 24-72 hours or until pain resolves
Ice
Compression with elastic bandage
Elevation above heart

- NSAIDS
- mild exercise = passive ROM and stretching after 1-2 days rest
- strengthening exercises
- return to sports/physical activity when fully recovered

2

Most common cause of hip pain in kids

transient synovitis

3

stretch or tear in a muscle or tendon

strain

4

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

5

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

muscular dystrophy

6

management of osgood-schlatter

treat the pain (ice, analgesics), rest, stretching

7

stretch or tear in the ligaments or connective tissue

sprain

8

obese male teen with new onset knee pain on left side, concern for

SFCE (slipped femoral capital epiphysis)

9

3 maneuvers to check for DDH

1. barlow (bring in)
2. ortolani (out)
3. galezzi test (difference in knee height)

10

DDH:
- more common in females or males?
- which hip more common?
- higher frequency in which children?

females to males 6:1

left hip more

firstborn children
breech babies at increased risk

11

Fractures suspicious for abuse

- under age 1
- unknown/unwittnesed
- delay in treatment
- changing stories
- fracture doesn't match story

12

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

nursemaid's elbow

13

peak incidence of osteosarcoma

15-19 years

14

most common form of bone cancer in children

osteosarcoma

15

What x-rays would you order for SFCE assessment (3)

AP, lateral, frog-leg

16

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

17

talipes equinovarus (club foot) - chance of occurring bilaterally? males vs females?

50% chance

males females 2:1

18

Diagnosis of osteosarcoma made by what 3 diagnostics

- radiographs
- CT or MRI
- biopsy

19

Management of septic arthritis

- emergent referral for surgical drainage of joint
- IV antibiotics

20

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

50% bilateral

21

If patient present with high fever, hip pain, refusal to bear weight, extreme pain, and joint that may be red, swollen, and warm, think

septic arthritis

22

higher incidence strain or sprain

strain

23

Definitive diagnosis for DDH

ultrasound

24

physical signs of DDH in older children (5)

- painless limp
- waddling gait
- short leg with toe walking
- marked lordosis
- trendelenburg sign

25

nursemaids elbow is the most common elbow injury what age?

1-4 yrs

26

femoral anteversion most common in what age? most cases resolve by what age?

3-8 years ("W" sit)

99% resolve by 8

27

___% of cases of brachial plexus injuries will recover complete function with just PT - this is why tx is conservation

95

28

when would you refer for internal tibial torsion?

if persists past age 8

29

gene varum is what? normal until what age? usually resolves how? when is further evaluation needed?

bowleg

normal until age 2

resolves spontaneously

further eval if:
- past age 2
- progressive after child starts to walk
- unilateral or severe

30

___% of childhood fractures involve the growth plate

15

31

gene valgum is what? normal until what age? usually resolves how? when is further evaluation needed?

knock-knee

normal alignment should be reached at 7-8 yrs

self-resolving

further evaluation:
- present after 7 years
- unilateral

32

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)

33

management for DDH

refer to ped orthopedist
may need hip spica cast, pavlik harness, surgery

34

two main bacterial infection causes of septic arthritis

staph and strep

35

If on physical exam pt has pain reproduced by extending the knee under resistance, and focal swelling and point tenderness over tibial tuberosity, think

osgood-schlatter disease

36

transient synovitis commonly preceded by

viral URI

37

Labs for septic arthritis would show what? Whats the confirmation DX?

Labs: elevated WBC and ESR

Dx confirmed with CT or ultrasound guided aspiration

38

if child presents with local pain, local swelling, mass at the end of a long bone, decreased ROM, think

osteosarcoma

39

most common hip problem in adolescents

SFCE

40

Management of transient synovitis

- NSAIDs
- rest
- return to activity as tolerated
- self-limiting

41

which hip is most often affected in SFCE?

left

42

if child noted to have adducted forefoot, limited dorsiflexion, prominent crease in arch of foot this would be

club foot

43

injury rates increase with what 4 points

- level of competition
- frequency of participation (year round)
- age (older children and teens)
- specliazation/1 sport

44

legg calve' perthes most common in what age? male or female? what's the management

4-8 years
male to female 4:1
ortho referral, bedrest with femoral abduction traction to reduce hip, PT and maybe surgery

45

management for club foot

referral to ortho - casting with manipulation begins at birth

46

Hip exam for DDH done at all well visits up to ___ months

12

47

internal tibial torsion usually resolves by what age? whats the management?

2 year

most kids have spontaneous correction as they grow

48

most common type of muscular dystrophy? muscular dystrophy is what type of autosomal issue?

duchenne's

autosomal dominant trait sex linked

49

child who has an in-toeing gait, runs awkwardly, frequent falls, sits in a "w" - think

femoral anteversion

50

Management for SFCE

- immediate referral to orthopedist
- absolutely non weight bearing
- surgery to pin hip together

51

If patient comes in with low trade temp, painful limp, does not appear severely ill and labs show negative CBC and ESR?

transient synovitis