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MSK Flashcards

1
Q

What is the medical word for knock-kneed?

A

Genu Valgum

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2
Q

What is the medical word for bow legged?

A

Genu Varum

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3
Q

True or False: Genu varus is typically a normal condition and only requires reassurance?

A

True

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4
Q

What is the word for growth plate?

A

Physeal or Physis

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5
Q

What is the metaphysis (or metaphyseal)?

A

End of the long bone adjacent to the growth plate or physis.

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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

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7
Q

What is varus or varum?

A

When the distal part of the deformity points towards the midline

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8
Q

What is valgus or valgum?

A

When the distal part of the deformity points away from the midline

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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

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10
Q

When is intervention required for genu varus?

A

With abnormal findings…

  1. Unilateral
  2. Worsens after age 1
  3. Doesn’t resolve after age 2
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11
Q

What XR findings would indicate need for intervention in genu valgum?

A

Physeal and epiphyseal distortion

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12
Q

If genu varus is present after age 2 what things should you consider?

A

More significant causes..

  1. Rickets
  2. Blount’s disease
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13
Q

Where is the pathology in Blount’s disease?

A
  1. Proximal tibial physis

2. Epiphysis

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14
Q

Who is infantile Blount’s disease seen in?

A

African Americans

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15
Q

What disease is it important to not confuse infantile Blount’s disease with?

A

Rickets (Both occur more frequently in African Americans)

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16
Q

Why does rickets occur more frequently in African Americans?

A

Due to decreased absorption of UV light

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17
Q

What is treatment for infantile Blount’s disease?

A

No treatment needed

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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

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19
Q

Who do you usually see adolescent Blount’s disease in?

A

African Americans, overweight

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20
Q

What is the treatment for adolescent Blount’s disease?

A

Bracing, surgery… something needs done

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21
Q

What is a type 1 Salter Harris fracture?

A

Separation of the epiphysis and metaphysis (fracture is directly through the physis)

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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)

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23
Q

What is the treatment for a type 1 Salter Harris fracture?

A

Casting for 2-3 weeks

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24
Q

What is a type 2 Salter Harris fracture?

A

A piece of the metaphysis splits as well as some physis (Above)

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25
Q

What is done for Salter Harris type 2 fracture?

A

Closed reduction casting for 3-6 weeks

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26
Q

What is a type 3 Salter Harris fracture?

A

Through the growth plate, extending through the epiphysis (Lower)

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27
Q

What is treatment for a type 3 Salter Harris fracture?

A

Open reduction

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28
Q

Which is worse, a type 2 or 3 Salter Harris fracture?

A

Type 3 because it goes through epiphysis into the joint space

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29
Q

What is a type 4 Salter Harris fracture?

A

Cracks through all layers (epiphysis, metaphysis, and physis)

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30
Q

What is treatment for a type 4 Salter Harris fracture?

A

Reduction in OR to avoid growth disruption

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31
Q

What is a type 5 Salter Harris fracture?

A

Crush type injury/compression fracture

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32
Q

Which type of Salter Harris fracture results in microvascular compromise?

A

Type 5

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33
Q

What is the prognosis for a Type 5 Salter Harris fracture?

A

High rate of poor growth after the injury

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34
Q

What usually causes a greenstick fracture?

A

Fall on an outstretched hand

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35
Q

What is the name for a cortical break on one side of the bone and intact periosteum on the opposite side?

A

Greenstick fracture

*Break isn’t through the bone…one side is broken and the other is bent

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36
Q

What is the mnemonic for Salter Harris fractures?

A 
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
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37
Q

How is osteogenesis imperfecta type 1 inherited?

A

AD

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38
Q

Which type of osteogenesis imperfecta has blue sclera?

A

1

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39
Q

When do fractures occur in osteogenesis imperfecta?

A

Preschool years (they are rarely born with fractures)

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40
Q

Besides fractures, what is considered to be a major feature of osteogenesis imperfecta type 1?

A

Hearing loss (conductive and sensorineural)

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41
Q

What is the most severe form of osteogenesis imperfecta?

A

2- Usually lethal

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42
Q

How is osteogenesis imperfecta type 2 inherited?

A

Dominant new mutation or germinal mossaicism

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43
Q

How do children with osteogenesis imperfecta type 2 present?

A

Born with multiple fractures- described as a bag of bones appearance

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44
Q

Which type of osteogensis imperfecta are usually stillborn are rarely live past the neonatal period?

A

Type 2

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45
Q

True or False: If a child has made it past infancy they cannot have osteogenesis imperfecta type 2?

A

True

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46
Q

In osteogenesis imperfecta type 2, what is the size of the head in relation to the rest of the body?

A

Head is large in proportion to the rest of the body

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47
Q

What type of osteogenesis imperfecta is known as the progressive deforming type?

A

3

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48
Q

How do kids with osteogenesis imperfecta type 3 present?

A

Born with fractures- deformities are progressive

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49
Q

What are the eye findings with osteogenesis imperfecta type 3?

A

Born with gray sclerae that lighten over time

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50
Q

Besides fractures and gray sclerae, what are 2 other characteristics of osteogenesis imperfecta type 3?

A

Macrocephly and short stature

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51
Q

What is it called when a defect exits in germinal cells but not in regular somatic cells?

A

Germinal mosaicism

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52
Q

What does germinal mosaicism mean in terms of inheritance?

A

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)

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53
Q

Describe osteogenesis imperfecta type 4

A

Similar to type 1, but sclerae are white (not blue)

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54
Q

What type of torticollis usually results from positioning or trauma?

A

Muscular

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55
Q

What is paroxysmal torticollis?

A

Migraine variant (may even manifest in infants)

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56
Q

How does paroxysmal torticollis present?

A

Repeated attacks of head tilting, only last for minutes at a time. Often accompanied by vomiting, irritability, and pallor

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57
Q

What is done for paroxysmal torticollis?

A

Nothing

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58
Q

What cause of torticollis is obviously present from birth and diagnoseable by XR?

A

Vertebral anomalies

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59
Q

Head tilt (torticollis) in addition to upper motor neuron findings (like increased DTRs)…?

A

Posterior fossa tumor

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60
Q

What cause of torticollis requires an MRI to diagnose?

A

Posterior fossa tumor

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61
Q

Name 3 descriptors that make you think congenital torticollis

A
  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
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62
Q

What is treatment for congenital torticollis?

A

Daily stretching and PT… if this isn’t done or doesn’t work after one year, surgical intervention is required

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63
Q

What other finding can congenital torticollis be associated with?

A

Hip dysplasia

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64
Q

What is due to fusion of the cervical vertebrae and may present as congenital torticollis?

A

Klippel-Feil syndrome

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65
Q

Name 8 findings seen in Klippel-Feil Syndrome

A
  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
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66
Q

What results from failure of the scapula to descend to its normal position during fetal development?

A

Sprengel deformity

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67
Q

How does Sprengel deformity mimic torticollis?

A

Affected side of neck (where scapula didn’t descend to normal position) will seem broader and shorter… thus mimics torticollis

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68
Q

How if the affected scapula in Spregnel deformity positioned?

A

Abnormally high and medially rotated

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69
Q

Name 5 risk factors for developmental dysplasia of the hip

A
  1. Breech
  2. Family history of DDH
  3. Female
  4. First born
  5. Oligohydramnios
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70
Q

Name 3 other conditions frequently associated with DDH

A
  1. Torticollis
  2. Metatarsus adductus
  3. Calcaneovalgus (club foot)
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71
Q

What is barlow exam?

A

Knees adducted with downward pressure to try to dislocate the hip

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72
Q

What is Ortolani exam?

A

Attempt to relocate a dislocated femoral head

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73
Q

After what age are the Ortolani and Barlo maneuvers not reliable?

A

3 months

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74
Q

After 3 months of age what is the most common sign of DDH?

A

Limitations in hip abduction

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75
Q

Besides limitations in hip abduction what are 2 other findings you can see in kids over 3 months with DDH?

A
  1. Unequal knee height (Galeazzi sign)

2. Asymmetric gluteal folds

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76
Q

Which needs to be worked up, a hip click or a hip clunk?

A

Clunk

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77
Q

How is diagnosis of DDH made?

A

Real-time US with manipulation in first 4 months of life (by pelvic XR after this)

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78
Q

What is the treatment for DDH?

A

Pavlik harness (this is more reliable than double or triple diapers)

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79
Q

What position does the Pavlik harness hold the hips in?

A

Abduction, flexion, external rotation

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80
Q

True or False: You can use double diapers to treat DDH?

A

False: Ineffective- often applied to loose and don’t provide any degree of correction

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81
Q

What are 2 consequences in a child whose DDH wasn’t corrected?

A

Waddling gait or leg length discrepancy

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82
Q

What are 4 considerations in a kid with a waddling gait?

A
  1. Uncorrected DDH
  2. Rickets
  3. Legg-Calve-Perthes
  4. Slipped capital femoral epiphysis
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83
Q

Waddling gait and leg bowing?

A

Rickets

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84
Q

Waddling gait, limp, child around 7?

A

Legg-Calve-Perthes

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85
Q

Waddling gait, knee pain, overweight young adolescent?

A

Slipped capital femoral epiphysis

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86
Q

What is the typical presentation of viral myositis?

A

Weakness and tenderness localized to a muscle

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87
Q

What muscle is common affected in viral myositis?

A

Calf

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88
Q

True or False: The neurological exam in viral myositis is unremarkable?

A

True

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89
Q

What lab marker will be elevated in viral myositis?

A

Creatinine kinase

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90
Q

What will be a common finding in the history for viral myositis?

A

Recent respiratory illness or influenza

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91
Q

What is the treatment for viral myositis?

A

No treatment necessary

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92
Q

What can present similarly to a viral myositis?

A

Metabolic myopathies (due to mitochondrial dysfunction)

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93
Q

How can you distinguish between viral myositis and metabolic myopathy?

A

In metabolic myopathies you will have rhabdomyolysis as well (described as dark urine)

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94
Q

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?

A

Toxic synovitis (post-infectious arthritis)

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95
Q

What is the usual cause of toxic synovitis?

A

Viral-

  1. Parvovirus B19
  2. Influenza
  3. Hepatitis B
  4. Rubella
  5. EBV
  6. Really any other virus
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96
Q

Kid with hip pain and flushing of the cheeks?

A

Parvovirus B19 (fifth disease)

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97
Q

Vague joint aches, otherwise well, got MMR several weeks ago, otherwise not been ill… most likely explanation for joint aches?

A

Post-infectious arthritis (MMR is live vaccine and rubella component can cause this)

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98
Q

What group is most likely to have post-infectious arthritis after MMR (from rubella component)?

A

Post-pubertal female

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99
Q

What is treatment for toxic synovitis?

A

Reassurance (no matter how severe pain is)

*Remember toxic synovitis is a diagnosis of exclusion after other more serious infections are ruled out

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100
Q

What age group typically gets septic arthritis?

A

Under 2

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101
Q

True or False: Septic arthritis is very serious and requires aggressive intervention

A

True

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102
Q

What typically causes septic arthritis?

A

Hematogenous spread

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103
Q

How does a kid with septic arthritis usually present?

A
  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
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104
Q

True or False: US, CT, MRI, and bone scan are helpful to make the diagnosis of septic arthritis?

A

False- they are useful to rule out osteomyelitis, but won’t diagnose septic arthritis

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105
Q

What are the 2 most important things if you suspect septic arthritis?

A
  1. Joint aspiration

2. Start antibiotics- Start IV abx pending culture and sensitivities

106
Q

When can you switch from IV to PO antibiotics in septic arthritis?

A

When there is clinical improvement (continue PO antibiotics for another 3 weeks)

107
Q

What is the most difficult joint to diagnose septic arthritis in?

A

Hip

108
Q

What should you do if history suggests a septic hip?

A

Begin treatment (even before diagnosis is confirmed since septic hip is so difficult to diagnose)

109
Q

What is the most common pathogen overall in septic arthritis?

A

S. Aureus

110
Q

What 2 bacteria have to be a consideration for septic arthritis in a neonate?

A
  1. Group B strep

2. E. Coli

111
Q

For infants and children that 3 bacteria do you have to consider for septic arthritis besides S. Aureus?

A
  1. Strep Pneumo
  2. Group A Strep
  3. H. Flu
112
Q

What needs to be considered as a cause for septic arthritis in a teenager?

A

N. gonorrhea

113
Q

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?

A

Rheumatic fever- Recent immigrant, migratory arthritis involving large joints coupled with rash

114
Q

What empiric antibiotics for septic arthritis in a neonate?

A

Cloxacillin/gentamicin

115
Q

What empiric antibiotics for septic arthritis in infants through 3 months?

A

Cefuroxime or cefotaxime

116
Q

What empiric antibiotics for septic arthritis in children?

A

Cefazolin

117
Q

What empiric antibiotics for septic arthritis in adolescents?

A

Must azithromycin to ceftriaxone or cefixime (cover for GC)

118
Q

What antibiotic and what bug do you need to cover for in kids with sickle cell disease and septic arthritis?

A

Cefotaxime, Salmonella

119
Q

What antibiotic needs to be added for septic arthritis if they hint at MRSA?

A

Vancomycin

120
Q

Who do you need to consult if there is involvement of the hip, knee, or shoulder in septic arthritis?

A

Ortho- Joint drainage is often necessary

121
Q

What is osteomyelitis?

A

Infection of the bone

122
Q

What is septic arthritis?

A

Infection of the joint

123
Q

How does osteomyelitis present initially?

A

Localized tenderness over the metaphysis as well as pain on weight bearing

124
Q

Name 2 things that can cause osteomyelitis

A
  1. Direct injury/infection (stepping on a nail)

2. Hematogenous spread

125
Q

How is diagnosis of osteomyelitis made?

A

Direct aspiration of the metaphysis (send for culture and sensitivity)

126
Q

What is the most common cause of acute hematogenous osteomyelitis in all ages?

A

S. Aureus

127
Q

What usually causes osteomyelitis in neonates?

A

Hematogenous spread

128
Q

What bones does osteomyelitis usually affect in neonates?

A

Femur and tibia

129
Q

What care 3 common bacteria that cause osteomyelitis in neonatse?

A
  1. S. Aureus
  2. Group B strep
  3. E. Coli
130
Q

What % of the time is a septic joint present among neonates with osteomyelitis?

A

50% (even though it is typically contracted via hematogenous spread)

131
Q

True or False: A septic joint is rarely seen with osteomyelitis beyond the neonatal period?

A

True

132
Q

What are some bacteria to consider in osteomyelitis in age groups beyond the neonatal period?

A
  1. S. Aureus
  2. GAS (Strep pyogenes)
  3. Kingelle kingae
  4. H. flu type B
133
Q

When are bone scans useful for osteomyelitis?

A

Early… when exact location of the infection needs to be identified and infection is too early to be detected on plain film

134
Q

What time frame can a bone scan pick up abnormalities associated with osteomyelitis in?

A

Within 3 days of onset

135
Q

When do XR findings in osteomyelitis present?

A

10-14 days after infection

136
Q

Why is MRI with contrast more useful in osteomyelitis?

A

More specific and can distinguish infection from other causes of inflammation

137
Q

True or False: An MRI can tell the difference between bone infection and infarction for a child with sickle cell disease?

A

True (bone scan can’t do this)

138
Q

What is the general difference in utility for a bone scan versus an MRI?

A

Bone Scan: Where is the problem

MRI: What is the problem

139
Q

What is the most common cause of osteomyelitis in kids with sickle cell disease?

A

Salmonella

140
Q

What is a common cause of osteomyelitis in a child who stepped on a nail?

A

Pseudomonas

141
Q

How should initial antibiotics be given in sickle cell disease?

A

IV

142
Q

How long should osteomyelitis be treated for?

A

4-6 weeks

143
Q

What 3 antibiotics would you consider for osteomyelitis due to S. Aureus or GAS?

A
  1. Oxacillin/Nafcillin
  2. 1st or 2nd generation cephalosporin
  3. Clindamycin (for patients allergic to penicillin)
144
Q

What antibiotic should you use for osteomyelitis caused by H. Flu?

A

2nd or 3rd generation cephalosporin

145
Q

What antibiotic should you use for osteomyelitis in a kid with sickle cell?

A

3rd generation cephalosporin (until culture and sensitivities back)- Have to cover for salmonella

146
Q

What antibiotic should you use for osteomyelitis if there is a concurrent puncture wound?

A

Need to cover for pseudomonas and/or anaerobic organisms

147
Q

What are 3 requirements in order for a child to be sent home on oral antibiotics who has osteomyelitis?

A
  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
Q

What is the most common complication of osteomyelitis?

A

Recurrence

149
Q

When is surgical intervention required in osteomyelitis?

A

Chronic infection- especially if abscess is suspected

150
Q

What is Legg Calve Perthes Disease?

A

Avascular necrosis of the femoral head

151
Q

How does Legg Calve Perthes Disease present?

A

Hip pain and or limp

152
Q

Which children often get Legg Calve Perthes Disease?

A

Boys, Peak Age 5-7 years

153
Q

What are classic XR findings for Legg Calve Perthes Disease

A

One femoral head being smaller than the other

154
Q

What should you consider if a kid has knee pain?

A

That it is from the hip…hip pain can frequently be referred to the knee

155
Q

What should you do for a kid with Legg Clave Perthes Disease?

A

Make them non weight bearing

Refer to ortho (splinting and possible surgery)

156
Q

How does SCFE present?

A

Teenager (usually male/obsess) with limp and knee pain (knee pain is actually referred hip pain)

157
Q

How do kids with SCFE hold their leg?

A

Extended and externally rotated

158
Q

How does SCFE look on XR?

A

One hip normal and other like an ice cream scoop falling off the cone (ice scream scoop is acetabular head)

159
Q

What lab abnormalities might you see with a SCFE?

A

Endocrine labs being off (SCFE can occur with various endocrinopathies)

160
Q

What type of osteomyelitis is prone to abscess formation?

A

Pelvic osteomyelitis

161
Q

`Who do you typically see pelvic osteomyelitis in?

A

Boys around age 8

162
Q

Which side do you usually see pelvic osteomyelitis on?

A

Right

163
Q

What bacteria causes pelvic osteomyelitis?

A

S. Aureus

164
Q

Where is the pain usually located for pelvic osteomyelitis?

A

Referred to hip or thigh.

Sometimes presents as abdominal pain

165
Q

What happens to the WBC count and XR in pelvic osteomyelitis?

A

WBC count normal

Plain film negative

166
Q

What are the studies of choice for pelvic osteomyelitis?

A

MRI and bone scan

167
Q

What should you keep in mind with any description of knee pain on boards?

A

Hip pathology

168
Q

How is SCFE treated?

A
  1. Immobilization
  2. No weight bearing
  3. Stabilization (pins and/or bone grafts)
169
Q

What is the result of stress from excessive activity at the insertion of the patellar tendon at the anterior tibial tubercle?

A

Osgood-Schlatter

170
Q

What is the location of a specialized growth center called the apophysis?

A

Tibial tuberosity

171
Q

Where does the quadriceps muscle attach (and through what tendon)?

A

Tibial tuberosity (patellar tendon)

172
Q

Why are adolescents prone to Osgood Schlatter Disease (overuse injury) during periods of rapid growth?

A

Because it affects tibial tuberosity (location of specialized growth center- apophysis)

173
Q

What is typically described in an athletic adolescent who presents with pain just below the patella?

A

Osgood-Schlatter disease

174
Q

How is Osgood Schlatter disease treated?

A

Couple weeks of rest then gradual resumption of activity
Ice
NSAIDs (pain/inflammation)

175
Q

What is the Osgood-Schlatter of the heel?

A

Sever’s syndrome

176
Q

What presents as heel pain in young athletes (especially soccer, basketball, gymnastics, and running)?

A

Sever’s Syndrome

177
Q

Is Sever’s Syndrome more common in boys or girls and at what age does this peak?

A

Somewhat more common in boys than girls- Peaks at 8-12 years

178
Q

What is treatment for Sever’s Syndrome?

A

Rest, ice, NSAIDs

179
Q

What will history imply for an occult fracture?

A

No systemic symptoms, no recent viral illness, no signs of infectious etiology, no history to suspect missed trauma

180
Q

What type of fracture can occur during the course of learning to walk?

A

Toddler’s Fracture

181
Q

True or False: A Toddler’s fracture may not be apparent on XR?

A

True

182
Q

What is a common finding on exam for an occult fracture?

A

Point tenderness (might be only clue pointing to this diagnosis)

183
Q

True or False: Underlying bone is stronger than ligaments in children?

A

False (ligaments are stronger)

184
Q

Force strong enough to cause a ligament tear in a child would more likely result in what?

A

Fracture

185
Q

What are fluid-filled cysts usually seen prior to skeletal maturity that are typically found at the proximal humerus or femur?

A

Unicameral bone cysts (simple bone cyst)

186
Q

True or False: Unicameral bone cysts are not precancerous?

A

True

187
Q

How do unicameral bone cysts usually present?

A

Typically asymptomatic

Diagnosed as a pathological fracture after minor trauma

188
Q

Where are aneurysmal bone cysts typically seen?

A
  1. Tibia

2. Femur

189
Q

How does an aneurysmal bone cyst usually present?

A

Pain- can be in absence of swelling

190
Q

What can aneurysmal bone cysts be associated with?

A

Underlying bone tumors (may require orthopedic referral)

191
Q

If there is an aneurysmal bone cyst on the vertebrae, what do you need to check for?

A

Signs of nerve compression

192
Q

How does Ehlers-Danlos present?

A

Skin that stretches
Joints are hypermobile
Poor wound healing

193
Q

Why would a kid with Ehlers-Danlos present to orthopedics or rheumatology?

A

Hypermobile joints that become painful

194
Q

True or False: Most types of Ehlers-Danlos Syndrome have normal life expectancy?

A

True

195
Q

What are 3 descriptions that should make you think of growing pains?

A
  1. Bilateral
  2. Worse at bedtime
  3. Joint pain without swelling
196
Q

Why might Ehlers-Danlos be mistaken for child abuse?

A

Easy bruisability

197
Q

How is hypermobility in Ehlers-Danlos described?

A

Loose joints

Get injured/Sustain sprains easily

198
Q

What do you need to counsel Ehlers-Danlos patients on regarding hypermobility?

A

Stretch before sports
Be vigilant in sports they play
(No other specific intervention)

199
Q

How might they describe scoliosis based on physical exam?

A

Asymmetry of hips, shoulders, and/or scapula

200
Q

When does congenital scolosis present?

A

Could be in infancy or much later (depends on degree of curvature)

201
Q

What are causes of congenital scoliosis?

A

Malformation of spinal column or ribs

202
Q

True or False: Most cases of congenital scoliosis aren’t hereditary

A

True- Even though congenital scoliosis is often associated with other malformations

203
Q

When is bracing helpful for congenital scoliosis?

A

Post-op (not helpful as primary treatment)

204
Q

What are the 3 tests you should do for screening in kids with congenital scoliosis?

A
  1. Renal US
  2. Cardiac ECHO
  3. Spinal MRI

High association between congenital scoliosis and renal/cardiac disease and spinal abnormalities

205
Q

True or False: Chromosome analysis, ophthalmologic evaluation, and head US aren’t routinely indicated in kids with congenital scoliosis?

A

True

206
Q

What are 3 signs you should watch for with concern for secondary scoliosis?

A
  1. Delayed pubertal development
  2. Neurological deficits
  3. Dermatologic lesions
207
Q

What type of MSK problem should you consider with a kid who has neurofibromatosis?

A

Secondary scoliosis

208
Q

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?

A

Neuromuscular or paralytic scoliosis

209
Q

True or False: The degree of curvature tends to progress in neuromuscular or paralytic scoliosis?

A

True

210
Q

What is idiopathic scoliosis?

A

Isolated scoliosis with no identified cause

211
Q

What % of cases in real life are idiopathic scoliosis?

A

80%

212
Q

How does idiopathic scoliosis progress?

A

Worsen by 1 degree per month during the growth spurt until skeletal maturity

213
Q

When should you get an MRI, orthopedic consultation, bracing, and possibly surgery in idiopathic scoliosis?

A

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
Q

Curvature of what requires observation only in scoliosis?

A

Under 25

215
Q

When is bracing required for scoliosis curvature between 25-40 degrees?

A

Is there is more than 2 years of growth still expected (child is still growing)

216
Q

When is surgery needed in scoliosis?

A

For a lumbar or thoracic curvature greater than 40 degrees

217
Q

Who is at the risk for highest degree of progression of scoliosis?

A

Young premenarchal patients with large initial curves

218
Q

When is manipulation or electrical stimulation the correct answer for scoliosis management?

A

Never- No FDA approval

219
Q

What is kyphosis?

A

Convex alignment of the thoracic spine in the sagittal plane (side view)

220
Q

What is the normal range for kyphosis?

A

20-40 degrees

221
Q

Kyphosis less than what requires just follow-up (no other intervention)?

A

Less than 60

222
Q

True or False: PFTS wouldn’t be indicated in an asymptomatic patient unless kyphosis is well above 60 degrees?

A

True

223
Q

Teenager who can never stand up straight, chronic upper back pain. Kyphosis on PE with distended abdomen. Most likely diagnosis?

A

Scheuermann Disease

224
Q

What is a fixed kyphosis which presents at puberty?

A

Scheuermann Disease

225
Q

What is the triad for Scheuermann Disease?

A
  1. Bad posture
  2. Kyphosis
  3. Back pain
226
Q

What is treatment for Scheuermann Disease?

A

NSAIDs, PT, and observation

*Surgery is sometimes required

227
Q

What are 3 considerations for infectious causes of back pain?

A
  1. Diskitis
  2. Spinal epidural abscess
  3. Vertebral osteomyelitis
228
Q

What bug typically causes infectious sources of back pain?

A

S. Aureus

229
Q

What are 2 developmental causes of back pain?

A
  1. Spondylolysis

2. Spondylolisthesis

230
Q

What is the progression of spondylolysis leading to stress fractures and subluxation of vertebral bodies?

A

Spondylolisthesis

231
Q

What are 3 traumatic causes of back pain?

A
  1. Herniated disc
  2. Vertebral stress fracture
  3. Overuse syndrome
232
Q

What are 5 tumors that can cause back pain?

A
  1. Osteoid osteoma
  2. Osteoblastoma
  3. Aneurysmal bone cyst
  4. Osteosarcoma
  5. Ewing sarcoma
233
Q

What type of tumor causing back pain usually has pain at night that is relieved by NSAIDs?

A

Osteoid osteoma

234
Q

What is an osteoid osteoma greater than 1.5cm?

A

Osteoblastoma

235
Q

What is annular ligament displacement called?

A

Nursemaids elbow

236
Q

Child that was pulled by the arm and is now not using the involved arm..?

A

Nursemaids elbow (Annular Ligament Displacement)

237
Q

What is another name for subluxed radial head?

A

Annular ligament displacement (Nursemaids Elbow)

*Subluxed radial head is an old name

238
Q

What does a posterior fat pad on XR of elbow indicate?

A

Fracture and accumulation of fluid

239
Q

True or False: An anterior fat pad on elbow XR is normal?

A

True

A- All right/Anterior
P- Poor/Posterior

240
Q

`What 3 things need to be for XR to not be necessary for the elbow with suspected Nursemaids?

A
  1. No swelling
  2. No point tenderness
  3. No discoloration
241
Q

What is the best way to manage a Nursemaids?

A

Reduce it (only after checking for other injuries)

242
Q

How is polydactyly usually inherited?

A

Isolated AD trait (although polydactyly can be associated with various syndromes)

243
Q

Hos is simple postaxial polydactyly managed?

A

Ligation until it falls off

244
Q

What is simple postaxial polydactyly?

A

Occurs off 5th finger/toe- like a little skin tag

245
Q

What should you do for polydactyly that involves bone, soft tissues, and tendons?

A

Referral to hand surgeon

246
Q

What are 3 syndromes with little or no radius?

A
  1. TAR- Thrombocytopenia Absent Radius
  2. Fanconi’s Anemia
  3. VATER- R is absent radius
247
Q

What is another name for Talipes Equinovarus?

A

Club foot

248
Q

What happens in club foot?

A

Foot is internally rotated and Achilles tendon is contracted

249
Q

What needs to be done for club foot?

A

Urgent referral to ortho

250
Q

What is treatment for club foot?

A

Stretching, serial casting, possible surgical release of tendon (late in first year of life)

251
Q

When does toe walking become an issue?

A

When it persists after age 2-3

When kids can’t put their heels down at rest

252
Q

What is the most common cause of toe-walking?

A

Idiopathic

253
Q

When does idiopathic toe walking tend to present?

A

Right when kids learn to walk

254
Q

What are some conditions that can cause toe-walking and need to be ruled out?

A
  1. Cerebral Palsy
  2. Spinal Cord Tumors
  3. Neuromuscular problems (tethered cord)
255
Q

What should be considered/ruled out for kids who initially walked normally and developed toe-walking later on?

A
  1. Muscular dystrophy
  2. Charcot-Marie-Tooth
  3. Hereditary neuropathies
256
Q

What is correct initial treatment for toe walking?

A
  • Foot dorsiflexion exercises several times per day (maintain full ROM at heel cord)
  • Remind child to put heel down when walking
257
Q

What should be done for kids who persist in toe-walking who develop heel-cord contractures with no other known MSK conditions?

A

Refer to ortho for evaluation and possible short-term casting

258
Q

What are 3 causes of intoeing?

A
  1. Metatarsus adductus in infancy
  2. Tibial torsion in toddlerhood
  3. Femoral anteversion in early childhood
259
Q

What 2 cause of intoeing almost always resolve spontaneously by school age?

A
  1. Tibial torsion

2. Femoral anteversion

260
Q

True or False: Use of bars and other devices hasn’t been shown to correct natural in-toeing?

A

True

261
Q

What is management for intoeing?

A

Reassurance… usually resolves spontaneously but may persist into adulthood

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