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Pediatric MSK Flashcards

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1
Q

How does growth and development influence pediatric musculoskeletal assessment and disease?

A
  • Change from cartilage to bone
  • More vascular and porous
  • Ability to remodel faster
  • Vulnerable to infection
  • Possible infarct
  • Laxity of ligaments
  • Always refer to age-related normal x-rays
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2
Q

What is the pathophysiology of Congenital torticollis?

A
  • SCM is very tight
  • Usually congenital and due to sternocleidomastoid fibrosis
  • Rarely vertebral anomaly
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3
Q

What is the diagnostic evaluation for Congenital torticollis?

A

Inspect-palpate-ROM

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4
Q

What is the management for Congenital torticollis?

A
  • Stretching, referral to PT

- If persistent can lead to plagiocephaly and potential helmet use

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5
Q

What is the pathophysiology of Developmental dysplasia?

A
  • Breech delivery - increased risk of developmental dysplasia of the hips
  • Spontaneous dislocation due to lax hip ligaments
  • Improper development of femoral head and acetabulum
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6
Q

What are the diagnostic evaluations of Developmental dysplasia?

A
  • Ultrasound recommended
  • Typically > 1 month old
  • Femoral head ossification starts at 4-6 months so early radiographs may not be helpful
  • X-ray can be an alternative if infant is >5-6 months of age
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7
Q

What are the clinical findings of Developmental dysplasia?

A
  • Barlo and Ortolani testing
  • Palpate and range of motion
  • Older infants: Galeazzi sign and decreased range of motion
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8
Q

What is the management of Developmental dysplasia?

A
  • Keep the formal head in the acetabulum
  • Pavlik harness ( in 1st 4 months)
  • Casting (+/- traction)
    Surgery (open reduction)
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9
Q

What is the pathophysiology of Legg-Calvé-Perthes disease?

A

Avascular necrosis of the femoral head

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10
Q

What is the epidemiology of Legg-Calvé-Perthes disease?

A
  • Boys > girls

- Peak ages 4-8 years

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11
Q

What are the clinical findings of Legg-Calvé-Perthes disease?

A

2-3 weeks history of limp, +/- aching

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12
Q

What are the diagnostic evaluations of Legg-Calvé-Perthes disease?

A
  • PE: limited abduction

- Hip films: AP and frog

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13
Q

What is the management of Legg-Calvé-Perthes disease?

A
  • Containment and limit weight bearing
  • Non-surgical: Muscle strengthening/ROM, casting, can take 2 to 5 years for resolution
  • Surgical: Femoral osteotomy, pelvic osteotomy
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14
Q

What is the epidemiology of Slipped capital femoral epiphysis?

A
  • Boys 12 - 15 years (MC)
  • Girls 10 - 13 years
  • Increased in obesity
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15
Q

What is the pathophysiology of Slipped capital femoral epiphysis?

A

Femoral head (epiphysis) slips posterior and inferior at the growth plate

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16
Q

What are the clinical findings of Slipped capital femoral epiphysis?

A
  • Limp, pain (acute of chronic limiting)
  • Pain can be located in groin, thigh, or knee region
  • PE: decreased internal rotation, abduction, flexion
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17
Q

What is the diagnostic evaluation of Slipped capital femoral epiphysis?

A

X-Ray: ice cream slipped off cone

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18
Q

What is the management of Slipped capital femoral epiphysis?

A
  • Immediate management: stop weight-bearing and refer immediately
  • Surgical pinning
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19
Q

What is the pathophysiology/3 levels of Torsional and angular deformities

A
  • Femoral anteversion
  • Tibial torsion
  • Metatarsus adductus
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20
Q

What are the clinical findings of Torsional and angular deformities

A
  • Physiologic causes of intoeing vary with age

- Decreased external and internal ROM

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21
Q

What is the diagnostic evaluation of Torsional and angular deformities

A

Refer to age-appropriate norms

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22
Q

S/sx of Femoral anteversion?

A
  • “W” sitting
  • girls > boys
  • intoeing ages 3-10
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23
Q

S/sx of internal tibial torsion?

A
  • MC intoeing in toddlers

- patellae straight w/ feet turned inwards

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24
Q

S/sx of Metatarsus adductus?

A
  • MC foot deformity of infants
  • usually flexible
    convex lateral surface of foot
  • poss. d/t intrauterine postion
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25
What is the epidemiology of Blount disease?
More common in early walkers, obese, African Americans
26
What is the pathophysiology of Blount disease?
- Inhibited growth of medical aspect of proximal tibial growth plate - 2 types = infantile and adolescent
27
What are the clinical findings of Blount disease?
- Asymmetric and extreme
28
What is the management of Blount disease?
- Surgery if bracing fails or if onset > age 4: guided growth or tibial osteotomy
29
What is the epidemiology of Flatfoot (pew planus)?
>6 years
30
What is the pathophysiology and tx of flexible Flatfoot (pew planus)?
- Normal variant | - If painful, consider heel cord stretches
31
What is the pathophysiology and tx of rigid Flatfoot (pew planus)?
- May be tarsal coalition | - Treatment: casting and resection (painful)
32
What is the epidemiology of Clubfoot?
75% isolated, sporadic but look for other abnormalities
33
What is the pathophysiology of Clubfoot?
Tendons develop abnormally
34
What are the clinical findings of Clubfoot?
- Rigid inverted foot - Equinus (plantar flexion at ankle) - Varus of heel (inversion) - Adduction of forefoot
35
What is the management of Clubfoot?
- Serial casting (Ponseti) followed by bracing to prevent relapse - May require achilles tenotomy
36
What is the epidemiology of Scoliosis?
- Adolescence | - Girls > boys
37
What is the pathophysiology of idiopathic Scoliosis?
- MC | - Usually no pain
38
What are some causes of Scoliosis?
- Vertebral malformation (hemivertebrae) or disease (tumor) - Neuromuscular disease - Spinal cord disease (tethered)
39
What are some clinical findings of Scoliosis?
- Unequal shoulder and pelvic height | - Rib prominence on forward bending
40
What is the diagnostic evaluation of Scoliosis?
10 degree Cobb angle
41
What is the management of Scoliosis?
- Observation in most cases - Bracing (20-50 degrees) - Surgery (greater than 50 degrees)
42
What is the epidemiology of Kyphosis?
Similar frequency boys and girls
43
What is the pathophysiology of Kyphosis?
Congenital - progressive
44
What are the clinical findings of Kyphosis?
Postural - flexible
45
What are the diagnostic evaluations of Kyphosis?
- Scheuermann disease - Early teens during rapid growth - Often in pain - >3 adjacent wedge-shaped vertebrae - Usually thoracic - Refer
46
What is the management of Kyphosis?
- Brace | - Surgery >80 degrees
47
What is needed during the evaluation of a fracture?
- History - Physical - Imaging - Stability of fracture - Alignment - Biomechanics of injury
48
What is the usual management of a fracture?
Casting and/or referral
49
What is the evaluation of a Radial head subluxation?
- Sudden jerk to forearm <3 years old | - Radiographs not needed
50
What is the management of a Radial head subluxation?
- Manipulation | - Normal use in 5-10 minutes
51
What is the evaluation of a brachial plexopathy (stinger or burner) sports injury?
Neck-shoulder traction, direct blow, and compression
52
What is the management of a brachial plexopathy (stinger or burner) sports injury?
- Work up if bilateral or persistent - Return to play once asymptomatic with full range of motion - Tend to reoccur
53
What are S/Sx of Little Leaguer’s shoulder?
Excessive overhead throwing can cause proximal humeral epiphysitis
54
What are S/Sx of Little Leaguer’s elbow?
- Overuse injuries can occur in any of the elbow's 6 ossification centers - Traction apophysitis - widening - avulsion
55
What is the evaluation of Little Leaguer’s shoulder and elbow?
- History - Physical exam: palpate and check range of motion, neurovascular integrity - Radiographs if bony lesions suspected
56
What is the management of Little Leaguer’s shoulder and elbow?
- Complete rest 4-6 weeks, ice, NSAIDs - PT, splinting - Refer if not improving
57
What are S/Sx of Spondylosis?
- Back stress + hypertension - Separation in vertebral pars interarticularis (90% L5) - Pain w/ lumbar extension
58
What are S/Sx of Spondylolisthesis?
- Instability due to spondylolysis can lead to anterior slippage of vertebral body - Limited forward bend and straight leg lifting - May feel a "step-off" at slippage
59
What is the management of Spondylosis and Spondylolisthesis?
- Pain relief, restrict activity, physical therapy - Follow until growth complete - Remove from aggravating sport - Surgical fusion if: slippage >25%, progressive, and has neurologic symptoms
60
What is the pathophysiology of Osgood-Schlatter disease?
- Tibial traction apophysitis - Adolescent with knee pain during and after activity - Boys > girls
61
What is the evaluation of Osgood-Schlatter disease?
Point tenderness of tibial tubercle, knee joint stable
62
What is the management of Osgood-Schlatter disease?
- Ice, prn analgesia - Rest/decreased activity - Bracing during activity - Resolves once physically mature
63
What is the pathophysiology of Sever Disease?
- Calcaneal apophysitis - Heal pain - Limp in pre-pubertal children
64
What is the evaluation of Sever Disease?
- Painful posterior calcaneus | - +/- tight heel cord
65
What is the management of Sever Disease?
- Ice, change activity, heel cord stretching, shoe modification - Outgrown as growth plate closes
66
What is the etiology of Osteomyelitis?
- Source of most bone infections in the blood | - MC sites: femur and tibia
67
What are the clinical findings of Osteomyelitis?
- Pain and reduced function - Redness and swelling - Fever
68
What are the diagnostic evaluations of Osteomyelitis?
- Increased ESR - Increased CRP - CBC: sometimes WBC > 12,000 cells/uL - Blood culture - Plain films - Bone scan, MRI if needed
69
What is the management of Osteomyelitis?
- IV antibiotics until CRP decreased by 50%, then oral for 4-6 weeks - Staph aureus, consider MRSA - May need surgical debridement
70
What is the etiology of Septic arthritis?
Bacterial source: - Blood stream - Cellulitis - Puncture wound
71
What are the clinical findings of Septic arthritis?
- Painful single join - Swelling - Erythema - Warmth - Fever (+/-)
72
What are the diagnostic evaluations of Septic arthritis?
- Aspirate joint ASAP - Blood tests: □ ESR and CRP elevated □ CBC may be abnormal □ Blood culture
73
What is the management of Septic arthritis?
- IV antibiotics, then po (follow CRP) - Staph and Strep coverage - May need repeated drainage - Course typically 3 weeks
74
What is the etiology of Transient synovitis?
- Joint inflammation in response to preceding viral or bacterial infection elsewhere
75
What are the clinical findings of Transient synovitis?
- Afebrile with limp after URI | - Peak age 3-8 years
76
What are the diagnostic evaluations of Transient synovitis?
- Normal labs and imaging | - Send out viral cultures and viral panel
77
What is the management of Transient synovitis?
- Rest - Pain management - Close follow up
78
What is the etiology of Juvenile idiopathic arthritis (or RA)?
- Arthritis in >1 joint for >6 weeks in a child | - Autoimmune inflammation that targets the synovium
79
What are the clinical findings of Juvenile idiopathic arthritis (or RA)?
- Joint pain - Stiffness - Erythema - Swelling
80
What are the three types of Juvenile idiopathic arthritis (or RA)?
- Oligoarticular < 5 joints (MC) - Polyarticular > 5 joints - Systemic
81
What are the diagnostic evaluation for the Oligoarticular type of Juvenile idiopathic arthritis (or RA)?
- Medium to large joints (knee, ankle, wrist) | - Early childhood and pre-adolescent
82
What are the diagnostic evaluation for the Polyarticular type of Juvenile idiopathic arthritis (or RA)?
- Small to medium joints (hands, feet, ankles, wrists) - Usually symmetrical - Early childhood and adolescence
83
What are the diagnostic evaluation for the Systemic type of Juvenile idiopathic arthritis (or RA)?
- Starts with recurring fever and rash, malaise - Organ involvement - Polyarticular arthritis weeks-months - Across childhood
84
What is the management of Juvenile idiopathic arthritis (or RA)?
- Primary care - Rheumatology - Meds: NSAIDs and limited corticosteroids - Ophthalmology - Physical therapy: range of motion and splinting
85
What are some distinguishable characteristics of a benign Osteochondroma?
- MC benign bone tumor (10-20 years) - MC in males - Begins in childhood and grows until skeletal maturity
86
What are the diagnostic findings of a benign Osteochondroma?
Often pedunculated, grows away from growth plate. | - Often involves medullary tissue
87
What is the management of a benign Osteochondroma?
Observation
88
What is the pathophysiology of a malignant Osteosarcoma?
- Bone pain - Swelling - Pathologic fracture
89
What are some distinguishable characteristics of a malignant Osteosarcoma?
- MC bone malignancy - MC in adolescents (80% occur <20 years) - Produces osteoid (immature bone) - 90% occur in the metaphysis of long bones (MC in femur --> tibia, humerus - MC mets to the lungs (usually the cause of death
90
What are the clinical manifestations of a malignant Osteosarcoma?
- Bone pain/joint swelling | - Palpable soft tissue mass
91
What are the diagnostic findings of a malignant Osteosarcoma?
- Radiographs: "hair on end" or "sunray/burst" appearance of the soft tissue mass
92
What is the management of a malignant Osteosarcoma?
- Limb-sparing resection (if not neovascular) - Radical amputation (if neovascular) - Chemotherapy as adjuvant treatment
93
What are some distinguishable characteristics of a malignant Ewing Sarcoma?
- Giant cell tumor - MC in children - MC in males 5-25 yrs - Sites: Femur (MC) and pelvis
94
What are the clinical manifestations of a malignant Ewing Sarcoma?
- Bone pain - +/- palpable mass - +/- joint swelling - +/- fever - Bone MC site of metastasis
95
What are the diagnostic findings of a malignant Ewing Sarcoma?
- Lytic lesion | - Layered periosteal reaction "onion skin" appearance on radiographs
96
What is the management of a malignant Ewing Sarcoma?
Options include chemotherapy, surgery and radiation therapy
97
What are some characteristics of benign and pathologic musculoskeletal pain?
- Difficult for children to localize so may present in non-specific manner - Prevalence of pain increases with age
98
When does the likelihood of pathology increases with benign and pathologic musculoskeletal pain?
- The younger the child - The more activity is limited by pain - If the pain awakens child from sleep
99
What are some S/Sxs of benign musculoskeletal pain?
- At rest pain decreases - Simple analgesia and massage for nighttime pain relief - Absent joint swelling - Hypermobile joints - Absent bony tenderness
100
What are some S/Sxs of pathologic musculoskeletal pain?
- At rest pain present - Simple analgesia and massage for nighttime pain gives no change - Present joint swelling - Stiff joints - Present bony tenderness
101
What are S/Sxs of Osteogenesis Imperfect?
- Tibial fracture - Long-standing complaints of back pain - Bruises easily - Blue sclera - Angular Cheilitis
102
When does the anterior fontanelle line close?
1-3 yrs
103
When does the posterior fontanelle line close?
2-3 mos after birth
104
When does the sphenoidal fontanelle line close?
6 months after birth
105
When does the mastoid fontanelle line close?
6-18 months after birth

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