ped limp Flashcards Preview

CSI > ped limp > Flashcards

Flashcards in ped limp Deck (34):
1

mature gait develops

around age 3, finally developed around 7

2

nonantalgic gait

There likely is no pain because of gait compensation
Stance phase is not shortened
Ex: toe walking from tight heel cord, clubfoot, limb length discrepancy, cerebral palsy

3

antalgic gait

shortening of stance phase, compensatory to prev. pain (hip, knee, ankle pain)
if intense, may not bear weight on limb

4

what else to ask

hx: birth, dev, immunization
interview sep. if suspect abuse

5

ddx

benign, cong/dev, *infection, *malignant, osteonecrosis, overuse, *trauma, limb length

6

5 most common

-limb length discrepancy
-transient synovitis (inflam. in joint)
-legg-calve-perthes (avasc. necr. of fem hd, thickening, sclerosis)
-fracture: toddler: 1 cortex to other (spiral/oblique): cast if suspect, initial XR might not show
-septic arthritis

7

intra-abdominal causes

appendicitis
neuroblastoma, posas abscess

8

intra-articular

cong., hemoarthrosis, inf, inflammation, trauma

9

neuromuscular

cerebral palsy, meningitis, musc. dystrophy, myelomeningocele (MS)

10

ST conditions

cong, inf, overuse, trauma

11

spine

vertebral osteomyelitis, spinal cord tumors, diskitis

12

steppage gait

neurologic, can't dorsiflex foot

13

tredelenburg gait

DDH, abn. in hip abduction

14

circumduction gait

neurologic, mechanical (stiffness in knee, ankle), + Galeazzi sign? : limb length discrepancy, disloc. fem head, knees diff. heights

15

equinus gait

on toes
CTEV, cerebral palsy, idio. tight Achilles tendon, calcaneal fx, foreign body in foot, limb length discrepancy

16

septic arthritis

pain in joint; infection (case: OM-->travel via blood to hip joint), look @ onset timeframe: septic: quick vs. rheumatoid: slow
-typ. one joint
aspirate joint, Gs/Cx to ID
*deal with now!

17

transient synovitis

viral inf. in joint, somewhat self-limiting

18

to det. if painful joint more serious, add this to aspiration

CBC, (left shift-infection)
ESR (sed rate >40--> more serious: bac inf) (vs virus)
CRP (>2.5, serious bac)
temp. >101
WBC >12000
*for septic arthritis, bacterial (dx from synovitis)

19

what to ask

is pain med. controlling pain?
-serious if giving ibuprofen regularly

20

leg limp: toddler

dev. dysplasia of hip,
cong limb,
neuromus. abn,
painful gait,
foreign body
*fx: spiral or oblique, thru both cortices, think abuse*
septic/reactive arthritis
transient synovitis
osteomyelitis

21

leg limp: child 3-10 yrs

*legg-calve-perthes: avasc. necrosis in fem head
stress fx
tumors
osteochondritis
kohler dis: navicular bone in foot loses blood supply
osteochondritis
osgood-schlatter
transient synovitis
osteomyelitis
leg length discrp.

22

leg limp: adolescent >10

*SCFE (slip cap fem epi): unstable is emergency: dec. blood supply-->avascular necrosis
LCP
juv. idiop. arthritis (slow)
overuse
osteochondrosis
tumor
osteochondritis
stress fx
tarsal coalition (should sep but don't)
discoid meniscus: lateral meniniscus is thick, impinges blood supply

23

test which limb 1st?

unaffected, gain trust

24

tests

Trendelenburg
Galeazzi sign
Patrick test (FABER)
Pelvic compression test
Psoas sign

25

Patrick tests (FABER)

"figure 4"
SI joint pathology if positive

26

pelvic compression test

SI joint pathology

27

psoas sign

have pt raise leg, physician resists
+ if pain: appendicitis, psoas abscess

28

physical exam signs to look for

Abdominal mass
Abdominal tender
Asymmetrical gluteal/thigh skin folds
Calf hypertrophy
Conjuctivitis, enthesitis (*inflam. where tendon and bone meet), oligoarthritis (mult. its involved), urethritis
Erythema chronicum migrans (Lyme disease)
Erythema marginatum (red patches: trunk, legs; rheumatic fever, SJS)
External hip rotation with hip flexion
Galeazzi sign
Hepatomegaly, lympadenopathy, splenomegaly

29

more physical exam

Hip joint flexed, abd, ER
Joint swelling
Localized bony tenderness
Loss of hip abduction
Loss of hip internal rotation
Malar rash
Muscular arthropathy
Neck pain & stiffness, +brudzinski and kernig
Non-weight bearing, pain ROM

30

even more PE

Obesity
Overlying warmth or erythema
Painless, non-pruritic maculopapular/vesicular rash with polyarthritis, tenosynovitis
Palpable bony mass
Positive Patrick test
Positive Pelvic compression test
Positive Trendelenburg test
Psoas sign

31

blood work to do

CBC
ESR
CRP
Joint fluid (aspiration) for Gs if septic arthritis
Blood/bone Cx

32

imaging

XR: complete skeletal exam (if abuse: see old and new fx)
U/S-fluid in joint
bone scintigraphy
CT-not used often
MRI-U/S first

33

what to do if abuse

call ambulance-->send to ED-->more support/resources, sep from parents, social work

34

emergent situations

-septic arthritis (can become septic!): go to OR, open jt to clean out joint, IV abx
-compartment syndrome: infection-->swelling, inc. pressure, pain in fascial compartment (can become gangrenous-->sepsis)
-vascular compromise: avascular necrosis: begin to kill off joint, sev. pain/inf-->limb loss
-open fx
-unstable slipped capital femoral epiphysis (SCFE)-->avascular necrosis