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MSK Flashcards

1
Q

Which JIA has a particularly poor prognosis?

A

RhF +ve polyarthritis

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2
Q

Which JIA is more common in boys than girls?

A

Ethesitis-related arthritis

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3
Q

DDx for limp in children

A

Traumatic/mechanical

  • Scoliosis
  • Fracture
  • SUFE
  • Sprain/contusion
  • Leg length discrepancy

Inflammatory

  • JIA
  • Transient synovitis
  • Osgood Schlatter’s

Vacular
- Perthe’s

Infectious

  • Osteomyelitis
  • Septic arthritis
  • Reactive arthritis

Malignancy

  • Osteoma
  • Ewing’s sarcoma

Neuromuscular

  • CP
  • Musculr dystrophy
  • Peripheral neuropathy

Metabolic
- Ricket’s

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4
Q

Traumatic/mechanical causes of limp

A
  • Scoliosis
  • Fracture
  • SUFE
  • Sprain/contusion
  • Leg length discrepancy
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5
Q

Infectious causes of limp/joint pain

A
  • Osteomyelitis
  • Septic arthritis
  • Reactive arthritis
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6
Q

Inflammatory causes of limp/joint pain

A
  • JIA
  • Transient Synovitis
  • Osgood-Schlatter’s
  • Reiter’s
  • Lupus
  • Ank spond
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7
Q

Vacular causes of limp/joint pain

A

Perthe’s (AVN)

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8
Q

Three “severities” of DDH

A

Dysplasia, subluxation, dislocation

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9
Q

When is DDH normally picked up?

A

NIPE - in Barlow/Ortolani manoeuvres

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10
Q

Which manoeuvres are used to assess DDH?

A

Barlow and Ortolani

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11
Q

Signs of DDH

A

Asymmetry of skin folds around buttocks and hips. Limited abduction. One leg may be shorter than the other

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12
Q

What is DDH

A

Developmental dysplasia of the hip - ball and socket joint is not formed completely

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13
Q

What happens in most cases of DDH

A

Resolves spontaneously by 3-6 weeks

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14
Q

Mx DDH

A

R/f for ORTHOPAEDIC OPINION

1) Observation - use USS if under 6 months, XR after
2) >6mos. Place in Pavlik harness/splint up to 6mos. Keeps hip flexed and abducted.
3) Surgery if conservative measures have failed - with spica casting

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15
Q

Which infants are at highest risk of DDH? How should they be monitored?

A

Breech
FHx
- Monitored with USS at 6/52

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16
Q

Which imaging modality is best in assessing DDH?

A

USS < 6months

XR > 6mos

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17
Q

Mx of fractures

A

Consider safeguarding

Pain management - PO ibuprofen/paracetamol. IV opioids
Immobilisation

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18
Q

Mx distal radius #

A

Manipulation

K-wire fixation if fracture off-ended

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19
Q

Mx of femoral shaft #

A

ADMIT
Orthopaedic management

0-6 mos: Pavlik’s harness, Gallow’s traction
2-18mos: Gallow’s traction
1-6yrs: straight leg skin traction, hip spica cast
6-12yrs: elastic intramedullary nail
11yrs+: elastic intramedullary nail, end caps, ridid intramedullary nails, submuscular plating

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20
Q

Signs/symptoms of SUFE

A

Acute onset hip/groin pain/referred knee pain

Restricted abduction and internal rotation
- Legs presents as slightly shorter and externally rotated

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21
Q

Commonest age of presentation SUFE

A

Adolescents (10-15 years)

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22
Q

Pathophysiology of SUFE

A

Posterior-inferior slippage after fracture through the growth plate

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23
Q

What is a SUFE?

A

Slipped upper femoral epiphysis - a fracture through the growth plate in the femoral head
Posterior-inferior slippage

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24
Q

Patients at higher risk of SUFE

A

Boys
Obesity
Metabolic abnormalities - hypoCa, hypothyroid, hypogonad

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25
What views should be requested in SUFE XR?
AP | Frog lateral
26
Mx of SUFE
Surgical repair - screw fixation
27
Age of presentation Perthe's
5-10 years
28
What is Perthes?
AVN of capital femoral epiphysis of femoral head due to interruption of the blood supply, followwd by revascularisation and ossification over 18-36 months
29
Signs/symptoms of Perthes
Insidious limp, hip pain | Referred knee pain
30
What percentage of Perthes is bilateral
10-20%
31
Ix requested in suspected Perthes
AP Frog lateral (+MRI/bone scan)
32
Findings on XR Perthes
Increased density in femoral head Fragmented/irregular femoral head Widening of joint space
33
Most important factor in Perthes prognosis?
Early diagnosis - if 1/2 femoral head affected, bed rest and traction If >1/2 affected, plaster/calipers to keep femoral head close to acetabulum to use as mould for reossification
34
Mx for Perthes
Supportive care (analgesia, ice packs, etc.) Continued activity Physical therapy - stretching and strengthening of quads and hamstrings Surgical treatment if fail to resond to conservative measures
35
Commonest chronic inflammatory joint disease in children/adolescents
JIA
36
What is JIA?
Juvenile idiopathic arthritis - persistent joint swelling for more than 6 weeks before 16 years old. Absence of an infecive cause.
37
How many subtypes of JIA? exist? Give examples
``` 7 Poly (>4 joints) Oligo (<4 joints) Systemic (if ever presents with rash) RhF/B27 tissue subtypes ```
38
What percentage of JIA diagnoses are distinct from RhA in adulthood?
95%
39
Signs/symptoms of JIA?
"Gelling" - stiffness after rest/in morning Swollen joints - swelling of the joint fluid, inflammation, thickening of synovium. - High fever (paroxysmal) - Malaise - Salmon rash - Raised APPs (ESR) Difficulty eating - TMJ involvement Intermittent limp Behavioural/mood change
40
What are the features of uncontrolled JIA?
Overgwoth of inflammed synovium = limb/digit length discrepancy, valgus deformity Chronic anterior uveitis Flexion contractures of joints Growth failure Osteoporosis (non weight bearing, steroids)
41
Management of JIA?
Specialist paediatric rheum MDT PTOT Continued activities such as cycling and swimming Medical: analgesia, NSAIDs, STEROIDS (IV, PO, intra-articular) DMARDs - if failure to respond. Methotrexate and sulfasalazine TNF-alpha inhibitors
42
Complications of reduced activity due to MSK conditions
Deconditioning Disability Decreased bone mass --> osteoporosis
43
Which DMARDs can be used in JIA failing to respond to conventional treatments?
Methotrexate | Sulfasalazine
44
Why are steroids avoided in JIA if possible?
Growth suppression | Osteoporosis
45
DDx joint swelling
``` JIA Transient synovitis Lupus Reiter's Septic arthritis Reactive arthritis ```
46
What is transient synovitis?
"Irritable hip" - inflammation of the synovium
47
Commonest cause of acute hip pain in children
Transient synovitis
48
Age of presentation transient synovitis
2-12 years
49
Major differences between transient synovitis and septic arthritis
SA: fever, hip held flexed, severe pain, High WCC, Raised APPs, widened joint space
50
Common features of transient synovitis
Often a preceding viral infection (but tend to be afebrile at the time of presentation) Sudden onset hip pain/limp No pain at rest Reduced ROM, particularly internal rotation Normal WCC/APP
51
Ix for transient synovitis
USS (fluid in joint) XR (normal) Joint aspiration - only if fears of septic arthritis
52
Mx of transient synovitis
Conservative - Analgesia (paracetamol/NSAIDs) - Bed rest
53
How long does it take for transient synovitis to self resolve?
2-3 days
54
Mx of ricket's
``` Vitamin D (Ergocaliciferol (D2), Cholecalciferol (D3). Calcium ```
55
What is Osgood-Schlatter's syndrome?
Osteochondritis of the patellar tendon insertion at the knee.
56
Commonest demographic presentation of OSS?
Adolescent, physically active males (particularly running/jumping)
57
Signs/symptoms OSS?
Knee pain after exerise. Localised tenderness. Tibial tuberosity tenderness Hamstring tightness OFTEN BILATERAL
58
What percentage of OSS is bilateral?
25-50%
59
Mx OSS
- Pain relief: paracetamol, NSAIDs, ice packs, protective knee pads - Stretching - Reduce quad-heavy activity, e.g. running and jumping - Increased quad-light activity e.g. swimming, cycline
60
Commonest organism in psoas abscess
S.aureus
61
Mx for psoas abscess
Drainage and abx
62
Which joints does reactive arthritis most commonly affect?
Knees and ankles
63
What is reactive arthritis?
Transient joint swelling and pain after preceding extrarticular infection (<6 weeks)
64
How long does reactive arthritis usually last?
<6 weeks
65
Which infections does reactive arthritis often follow?
Enteric: salmonella, shigella, campylobacter (children) STIs Mycoplasma Lyme
66
Signs/symptoms of reactive arthritis
Joint pain/swelling after extra-articular infection Low grade fever Normal or mildly elevated APPs
67
XR findings reactive arthritis
Normal
68
Mx reactive arthritis
Self-resolving Pain relief: NSAIDs, paracetamol Steroids if severe DMARDs if ongoing - methotrexate, sulfasalazine
69
Where is the infection in osteomyelitis?
Metaphysis (commonly of long bones). Often distal femur/proximal tibia
70
Why is joint destruction from osteomyelitis less common younger children than adolescents?
The growth place limits spread. | But can lead to growth arrest
71
Signs and symptoms of osteomyelitis
Limp Limb/joint pain/swelling - painful and immobile Fever Sterile effusion of adjacent joint
72
Complications osteomyelitis
Spread to cause septic arthritis
73
Ix and results osteomyelitis
FBC (rasied WCC, APPs) BC: positive XR: initially normal but subperiostal new bone formation shows after 7-10 days + localised bone rarefaction MRI: to distinguish between bone and soft tissue infection
74
Acute osteomyelitis mx
High dose empirical IV abx (2-4 weeks) - depending on culture from MC&S Can swith to PO once clinical recovery Immobilise affected limb Analgesia Surgical debridement/decompression if dead bone
75
When should blood cultures be taken in osteomyelitis/septic arthritis?
BEFORE STARTING ABX
76
Septic arthritis
Infection of joint space
77
Commonest causative organism septic arthritis (after neonatal period)
S. aureus
78
Signs/symptoms infective arthritis
``` Acute onset joint pain/swelling NON-weight bearing High grade fever Erythematous, warm Pseudoparesis (hip held in flexed position) - severe pain at rest ```
79
Septic arthritis Ix
FBC (Raised WCC, ESR, CRP) BC: positive (MC&S) XR: widened joint space USS: joint fluid JOINT ASPIRATION UNDER USS
80
Septic arthritis mx
Prolonged abx - 2 weeks IV - 4 weeks PO (+ve: vanc; -ve: cef) Joint aspiration/washing out/drainage
81
Appropriate abx in septic arthritis gram +ve
Vancomycin
82
Appropriate abx in septic arthritis gram -ve
Ceftriaxone
83
Osteoid osteoma
Benign tumour Adolescent boys Femur, tibia, spine More painful at night
84
Osteoid osteoma common sites
Femur, tibia, spine
85
Inheritance pattern of achondroplasia
AD
86
Features of achondroplasia
``` Short stature (due to short limbs) Large head Frontal bossing Depressed nasal bridge Lumbar lordosis ```
87
What is the pathophysiology osteogenesis imperfecta?
Disorder of collagen metabolism leading to bone fragility
88
Features of T1 osteogenesis imperfecta
Childhood fractures Blue sclera Hearing loss
89
Mx osteogenesis imperfecta
Bisphosphonates
90
Features of hypermobility
Knees "giving way" Flat foot w/ arch on tip toes Younger female girls Mechanical joint/muscle pain
91
Features of growing pains
``` Nocturnal idiopathic pain Symmetrical Not limited to joints NEVER present at start of day No limp Physical acitvity not limited Physical examination normal ```
92
Commonest cause torticollis
SCM tumour (mobile, non-tender nodule) Restriction in head turning/tilting
93
Pes cavus
High arch - indicative of neuromuscular disorders
94
Positional talipe
Club foot caused by intrauterine compression Normal size foot, corrected by manipulation Passive exercises from physio
95
Equinovarus talipe
Entire foot inverted and supinated Shorter foot with thinner calf muscles Often BILATERAL
96
Signs and symptoms of chrondromalacia patellae
``` Young adults (overuse in physical activity) Passive movements usually painless Repeated extension = grating/crepitus/small effusion ```
97
Pathophysiology chrondomalacia patellae
Degeneration of the articular ligament on the posterior surface of the patella

Sarah Paeds (20 decks)

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