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AANP FNP: Pediatrics > Pediatric MSK > Flashcards

Flashcards in Pediatric MSK Deck (17):

Toxic synovitis

- inflammation of the hip with insidious painful limp
- internal rotation of hip causes spasm, no redness/warmth/fever
- Tx: typically self-limiting, bedrest PRN and analgesics, hospitalize for suspected septic arthritis


Legg-Calve-Perthes disease (LCPD)

- necrosis of the femoral head
- insidious limp with knee pain that migrates up to groin/hip
- limited range of motion
- Tx: refer if older than 6yo or more than half of the femoral head is affected (seen on x-ray)- may require hip replacement; goal of treatment is to restore range of motion


Slipped Capital Femoral Epiphysis (SCFE)

- spontaneous dislocation of femoral head, generally without
- obese, sedentary, African American
- acute limited range of motion, pain from groin that migrates to knee, limb shortening
- x-ray, immediate referral to ortho, BED REST, often need ORIF


Genu Varum (Bowleg)

- normal variant until age 2
- refer to ortho if older than 2, unilateral, or progressive worsening


Genu valgum (knock knee)

- normal variant up to age 7
- x-ray and refer to ortho if over age 7 or if unilateral involvement



- rarely painful
- positive Adam's Forward Bend Test (shows asymmetry)
- x-ray to check degree of curve
- refer if painful or curve is greater than 25 degrees
- may refer to PT for strengthening


Developmental dysplasia of the hip (DDH)

- Galeazzi's or Allis' sign
- Barlow until 6mo, Ortolani until 1yo
- may present as a limp when the child starts to walk
- decreased hip range of motion
- x-ray, refer to ortho (may need to splint with Pavlick harness)


Muscular dystrophy

- progressive neuromuscular disease
- average age of diagnosis is 3-5 years; rare in girls
- Gower's maneuver, firm woody calves
- wheelchair by 12yo, eventual cardiopulmonary failure/death
- diagnosis: elevated CK, EMG, abnormal EKG, muscle


Ankle sprain

- stretching/tearing of the ligaments, typically lateral ligament
- usually related to a forced inversion or eversion
- x-ray according to Ottowa ankle rule


Gower's maneuver

Child "walks" hands up legs to attain standing position when getting up; highly suggestive of muscular dystrophy; suggests pelvic girdle weakness


Ottowa Ankle Rule

x-ray indicated if pain near the malleoli AND bone tenderness is present at either malleolus or 6cm distal to it, OR if patient is unable to bear weight for at least 4 steps


Grade I ankle sprain

- stretching but no tearing of the ligament
- local tenderness, minimal swelling, full ROM remains (although may be uncomfortable), able to bear weight


Grade II ankle sprain

- partial tearing of the ligament
- localized edema and bruising, significant pain with weight bearing, ROM limited


Grade III ankle sprain

- complete ligament tearing; joint unstable
- severe pain, significant edema, profound bruising (worsens over several days), cannot bear weight, no ROM to ankle


Elbow fracture

- often assoc with FOOSH injury
- S/sx: "fat pad sign" or "sail sign" on x-ray suggests occult fracture- follow up with oblique views
- refer to ortho


Nursemaid elbow

- radial head subluxation (swinging child)
- holds arm across body with thumb up
- significant bruising and swelling justifies x-ray
- supportive care at home with NSAIDs (ER can put it back into joint)


Osgood-Schlatter Disease

- tibial tubercle inflammation with point tenderness, enlargement
- young athletes, rapid growth spurts
- self-limiting disease, limit activity to control pain, knee immobilizer