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Msk Disorders Flashcards

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1
Q

How common is developmental dysplasia of the hip? What is included in DDH?

A

5/100

Dislocated hips - other acetabular dysplasia (where femoral head is in position but acetabulum is shallow)

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2
Q

Screening of DDH ? Manoeuvres called? Why are they unhelpful tests as the baby gets older?

A

Screened at birth and at 6 weeks
Barlow’s / ortolani’s
Contractures form

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3
Q

What are the warning signs (features) of DDH

A

Delayed walking
painless limp
Waddling gait

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4
Q

What two features are common in babies and do not represent DDH? How common?

A

Asymetrical skin creases -30% of all infants

Hip clicks - 10%

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5
Q

How is a diagnosis of DDH made?

A

uss is diagnostic
Femur may be shortened - Allis sign
O/e - limited abduction

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6
Q

What level of hip abduction should be achieved by children? Up to what age?

A

Supine children should be able to abduct a flexed hip fully until 2 years old

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7
Q

Why are X-Ray’s not useful for diagnosis of DDH

A

Femoral head doesn’t ossify until 4/12 (becomes useful then)

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8
Q

Management of DDH in

A
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9
Q

How often does a harness for DDH have to be worn? How often is it adjusted?

A

Constantly

Every 2 weeks

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10
Q

What happens if there is accelerated degenerative changes in DDH?

A

Open surgery

Often have total hip replacement in early adult life

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11
Q

What is (legg-calve-) perthes disease ? What happens? How long does it take?

A

Osteonecrosis of the skeletal head prior to skeletal maturity.
Idiopathic ischemia -> avascular necrosis at the upper femoral epiphysis with flattening and fragmentation of the femoral head.
Revascularisation & reossification occur and growth resumes (may not be normal)
3-4 years

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12
Q

Risk factors leg-calve-perthes disease?

A

Males 5:1

Family Hx

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13
Q

Features / presentation of leg clave perthes disease

A
  • insidious* onset of lump (+/- hip pain) between 3 and 12 years -> pain may be felt in hip, thigh or knee
  • Abduction and rotation are limited O/E*
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14
Q

Diagnosis of legg calve perthes

A

Hip X-ray - shows decreased height (flattening) and increased density of femoral head

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15
Q

Can you have more than one hip affected in LCP disease

A

Bilateral in 20%

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16
Q

Management in LCP disease if

A

Prognosis is good

Bracing with analgesia & mild activity restriction

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17
Q

Prognosis / Management of LCP in older children / more than 1/2 femoral head involved

A

Permanent deformity in 40% with early degenerative arthritis/
Several surgical options

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18
Q

What is transient synovitis often called

A

Irritable hip

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19
Q

Usual course of transient synovitis

A

Self limiting. Common esp in children 2-12yrs following viral URTI

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20
Q

Features of transient synovitis ? O/e?

A

Sudden onset hip pain (NON AT REST), limp and refusal to weight bare on affected side.
Limited abduction / rotation in otherwise well afebrile child

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21
Q

What is the key differential to transient synovitis ? When should this be queried ?

A

Septic arthritis

Febrile with pain at rest & refusal to even move affected joint

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22
Q

Why do you investigate transient synovitis ? What do you use to make a diagnosis?

A 
To exclude septic arthritis
Acute phase reactants - CRP, WBC, ESR (only *mildly raised*)
Blood cultures - should be *-ve*
X-ray hip - normal
Hip USS - may be small effusion
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23
Q

Management of transient synovitis

A

Supportive - bed rest and analgesia

Should resolve spontaneously in 2 weeks

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24
Q

What is slipped upper femoral epiphysis (SUFE)

A

Displacement of the epiphysis of the femoral head posterio-inferiorly

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25
When does SUFE most commonly occur? In who?
10-15 (usually occurs around growth spirt / minor trauma) Male (black / obese) Delayed skeletal maturation & endocrine disorders Family Hx
26
Presentation of SUFE ? O/e?
*limp* or with referred hip / knee pain | O/e - restricted abduction & internal rotation of hip
27
Diagnosis / treatment of SUFE
Hip X-ray (may require frog leg lateral view) | Surgical - usually pin fixation
28
2 common knee disorders (male / female)
Osgood - schlatter (physically active males) | Chondromalacia patellae - adolescent females
29
When should back pain be referred ?
Before adolescence - ?significant pathology
30
Causes of back pain in adolescence
Muscle spasm / soft tissue injury Schearmann's disease Spondylolisthesis / spondylolisis Tumours
31
Usual cause of muscle spasm / soft tissue injury
Sports
32
What is shearmanns disease ? Features?
Osteochonditis (avascular necrosis of ossification centre) of *lower thoracic vertebrae)* Localised pain, tenderness, kyphosis
33
Usual location of spondylo- things ? What happens if there is anterior shift of the vertebral body?
L4/5 | *lower back pain exacerbated by bending backwards (spondylisthesis)
34
What is scoliosis ? How many children affected?
Lateral deformity of the spine with rotational deformity | 4%
35
How is scoliosis classified ? Egs?
``` Vertebral abnormalities (eg. Ostegenesis imperfecta / hemivertebra) Neuro muscular (eg. Polio / cerebral palsy) Mischellaenous (eg. Idiopathic (most common) / dysmorphic syndromes) ```
36
What is hemivertebra
Lack of formation of one half of the vertebral body
37
How can you demonstrate rotation in scoliosis
Child bends forwards - rib hump noted
38
When does idiopathic scoliosis occur ? Who is it more common in ?
85% in adolescence | Females with FHx
39
Management of various idiopathic scoliosis
Mild - none Moderate - brace Severe - surgery
40
What is torticollis also called? Who is it usually in? What is the usual cause? Prognosis?
Wry neck - head turned persistently to one side Common, self limiting in young children (often with URTI) *sternomastoid tumour* Usually resolves in 1 year
41
What is osteomyelitis
Infection of the metaphysis of long bones - any bone can be affected
42
When can osteomyelitis cause septic arthritis
When joint capsule is inserted distal to the epiphysis (eg. The hip)
43
Usual cause of osteomyelitis
Haematogenous spread | Can occur directly from infected wound
44
Usual pathogen in osteomyelitis ? Neonates?
Staph aureus (group B strep and E.coli in neonates)
45
What disease has an increased risk of osteomyelitis and which types
Staphylococcal & *salmonella osteomyelitis* | In Sickle cell disease
46
Features of osteomyelitis
Painful and immobile limb (*pseudoparesis*) in a febrile child O/e - erythermatous, warm, swollen, and very tender
47
How does osteomyelitis present in infants
More insidious, swelling and decreased limb movements
48
Investigations in osteomyelitis
Acute phase reactants raised - CRP, ESR, WCC Blood cultures - +ve in 50% X-rays - takes 7-10 days
49
What to do if +ve blood cultures in osteomyelitis
Joint aspiration for M, C & S
50
What is seen on X-ray 7-10 days after infection? What can be done initially?
Subperiosteal elevations & localised decreased density. | Radionuclide scans can be used to elicit a likely site of infection (as there is increased uptake)
51
Treatment of osteomyelitis
IV Abx until there is clinical recovery & acute phase reactants normalise followed by oral therapy for several weeks. Surgical drainage if unresponsive to Abx
52
Complications of osteomyelitis
Septic arthritis, growth disturbance & limb deformity (if epiphyseal plate infected)
53
What is septic arthritis ? Vs OM more common?
Infection of the joint space | Yes it's more common
54
What can septic arthritis lead to ?
Disability and bone destruction
55
Usual age for septic arthritis? Origin? How many joints? Usual cause?
56
Features of septic arthritis
Painful joint -> limp, irritability, refusal to bear weight | Limb is held rigid (pseudoparesis) with tenderness and varying degrees of swelling / warmth
57
Investigations for septic arthritis
Elevated acute phase reactants Aspiration of joint for M, C & S USS - can show effusions X-rays - exclude trauma & other bony lesions
58
Management of septic arthritis
Early and prolonged IV Abx | Surgical drainage - if recurrent or hip affected
59
What is the most common childhood arthritis
Reactive
60
What are the features of reactive arthritis
Transient joint swelling
61
Usual cause of reactive arthritis ? Other causes?
Bacterial - salmonella, shigella, campylobacter, versilsia | Viral - rubella, parvovirus B19, influenza, herpes, cozsackie
62
What is juvenile idiopathic arthritis
Children and adolescents with persistent joint swelling >6 weeks in the absence of infection or any other defined cause
63
What are the types of JIA? What is the classification according to ?
Oligoarthrits 4, systemic (Still's disease), psoriatic arthritis, enthesitis RF/HLA B27
64
Who gets affected by still's disease ? Where does it affect? What are the other features ?
<5 hips, ankles, knees, High fever, salmon pink rash, lymphadenopathy, myalgia, malaise NO ARTHRITIS INITIALLY
65
Seen on investigations for still's disease?
Anaemia on FBC Neutrophilia Increased acute phase reactants
66
Two types of polyarthrits and prognosis
RF -ve - good prognosis | RF +ve - Bad prognosis
67
RF -ve polyarthrits joints affected ? Ages?
All ages and all joints *typically (not always) spares MCP joints* Cervical spine and TMJ's may be involved
68
Who is usually affected by RF +ve polyarthrits ? Which joints are affected? Other features?
*Females >8* *small joints of hands and feet* (hip and knee also affected) Early rheumatoid nodules in 10%, might be systemic vasculitis
69
Who is usually affected by oligoarthrits ? Type of arthritis ? Affecting?
*Girls
70
Investigations for oligoarthrits
Increased acute phase reactants | ANA (antinuclear antibodies) are almost always present
71
Associations with oligoarthrits
1/3 will develop chronic iridocyclitis (uveitis)
72
What happens if >4 joints are affected after 6/12 in oligoarthrits
Called 'extended oligoarthrits ' - poor prognosis
73
Management of JIA
MDT 1- Physiotherapy to optimise joint mobility, prevent deformity and increase muscle strength 2- medication -analgesia and reduced inflammation (NSAIDs), systemic steroids for severe disease / severe uveitis, methotrexate used early to reduce joint damage
74
Egs of primary bone diseases
Achondroplasia, osteopetrosis, osteogenesis imperfecta
75
What is the cause of achrondroplasia
Autosomal Dominant Chromosome 4 *fibroblase growth factor gene (FGFR3) (Half are new mutations)
76
Clinical features of achondroplasia
Limbs - shortened (proximal>distal), bow legs (genu varum) Neurological - hydrocephalus, delayed motor development, normal intelligence Spine - short, lumbar lordosis, throacolumbar kyphosis Ear - recurrent otitis media
77
What is the other name for osteopetrosis ? What is it?
Marble bone disease | Hyper density of bones due to osteoclasts dysfunction - *deficient carbonic anhydrase* - bones are very brittle
78
What is osteogenesis imperfecta often called ? What causes it? What are the characteristics?
Brittle bone disease Group of disorders caused by *mutations in type 1 collagen genes* *fragile bones & frequent fractures*
79
What are the normal genes for mutation in osteogenesis imperfecta
*COL1A1 / 1A2* genes in 90%
80
Types of osteogenesis imperfecta
1- most common, autosomal dominant 2- lethal, usually multiple fractures before birth (often stillborn) 3- severe, progressively bone deformities, survival to adulthood rare 4 - moderate, bone fragility without other features of type 1
81
How does type 1 osteogenesis imperfecta present ?
Recurrent fractures, *blue tinged sclerae*, sometimes hearing loss
82
Management of osteogenesis imperfecta
BisPhosphonates - strengthens bone bit doesn't areas underlying problem
83
What is rickets
Failed mineralisation of growing bones
84
What are the X-ray changes of rickets
Cupping of ends of bones Splaying Osteopenia
85
What are the clinical findings in rickets
Bow legs, wide wristed with delayed motor development due to associated myopathy Rickettic rosary
86
What is rickettic rosary
Prominent knobs of bone at costochrondiral joints (ribs)
87
Causes of rickets
``` Vit d deficiency (nutritional, 1a-hydroxylase deficiency) Phosphate deficiency (usually due to poor renal absorption Calcium deficiency ```
88
What's seen in bloods of rickets
Decreased - serum 25-OH vit D, phosphate | Increased - PTH, alkaline phosphatase
89
Treatment of rickets
Vitamin D- calcitriol | Calcium in infants

Peadiatrics (14 decks)

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