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Flashcards in Pediatrics musculoskeletal Deck (36):
1

Definition of osgood-schlatter disease

Inflammation of the tibial tubercle as a result of repetitive stressors (avulsion injury) in patients with immature sketetal development

2

s/sx osgood-schlatter

pain, tenderness, enlargement

3

management of osgood-schlatter disease

self-limiting, limit activity to control pain, knee immobilizer may provide some relief

4

Toxic synovitis

Self-limiting inflammation of the hip, most likely due to a viral or immune disease

5

s/sx of toxic synovitis

painful limp
unilateral involvement
insidious onset
INTERNAL ROTATION OF HIP CAUSES PAIN
no obvious signs of infection on inspection/palpation

6

What will X-ray look like for toxic synovitis

normal

7

management of toxic synovitis

analgesics, bed rest as needed, typically benign and self-limiting,
hospitalization should be considered if the patient has a high fever or septic arthritis is suspected

8

what is a hallmark of septic arthritis

fever

9

Definition of Legg-Calve-Perthes Disease (LCPD)

Aseptic or avascular necrosis of the femoral head

10

s/sx of Legg-Calve-Perthes Disease (LCPD)

Insidious onset of LIMP
Knee pain up the thigh and migrate towards groin/lateral hip
Pain less acute and severe than transient synovitis or septic arthritis
Limited passive internal rotation and abduction of the hip joint

11

Aggressive treatment for Legg-calve-perthes disease indicated

when more than one half of the femoral head is involved and children under 6 yo

12

Definition of slipped capital femoral epiphysis

spontaneous dislocation of the femoral head (capital epiphysis) both downward and backward relative to the femoral neck and secondary to disruption of the epiphyseal plate

13

s/sx of slipped capital femoral epiphysis

pain in the groin referred to thigh and/or knew, severe, inability to move hip or walk, may observe limb shortening

14

management of slipped capital femoral epiphysis

immobilize and urgent referral to ortho

15

what is genu varum?

bowleg, lateral bowing of the tibia often due to joint laxity

16

When is genu varum considered normal until?

2 years old

17

What is genu valgum?

Knock-knee, knees are abnormally close and ankle space is increased, typically evolves to normal alignment by 7

18

What age is genu valgum normal until

7 years old

19

What is Adams Forward Bend Test?

Asymmetry of the shoulders, ribs, hips and waistline when bending

20

Management of scoliosis

further evaluation is any degree of pain occurs
Observe if no pain exists and if less than 25 degrees curvature
Refer is pain or greater than 25 degrees curvature

21

What are the physical examination findings of developmental dysplasia of the hip?

Galeazzi sign-
-Compare knee height with infant supine, hips and knees flexed
-Asymmetry suggests DDH
-NOt helpful if DDH is bilateral
Barlow until 6 months, ortolanis until 1 year
Painless
May present as a limp when child walks
decreased abduction in older children

22

S/sx of muscular dystrophy

Abnormalities of gain and posture
Developmental clumsiness
Cannot keep up with developing peers
Gower's Maneuver- child "walks" hands up legs to attain standing position when getting up, suggests pelvic girdle weakness
Firm, large, woody calves (healthy muscle replaced by degenerative tissue)
Decreased proximal muscle strengh
Wheelchair dependent by 12, heart failure and death

23

Labs/dx for muscular dystrophy

*Creatine kinase markedly elevated
EMG: Mypothy
ECG: abnormal
muscle fiber biopsy: Necrotic degenerating fibers
DNA analysis of gene

24

Ankle sprain

tearing of the ligaments around the ankle

25

definition and s/sx of grade I ankle sprain

Stretching but no tearing of ligament, no joint instability
1) Local tenderness
2)minimal edema
3) ecchymoses typically insignificant or absent
4)full ROM although discomfort
5) patient retains weight bearing ability

26

Definition and s/sx of grade II ankle sprain

Partial (incomplete) tearing of ligament; some joint instability but definite endpoint laxity
1) pain immediately upon injury
2)localized edema and ecchymosis
3)significant pain with weight bearing
4) ROM limited

27

Grade III ankle sprain s/sx and definition

Complete ligamentous tearing; joint unstable with no definite endpoint to ligamentous stressing
1) severe pain immediately upon injury
2)significant edema along foot and ankle
3) proud eccymoses due to hemorrhage; worsens over several days
4) patient cannot weight bear
5) No ROM

28

Ottawa Ankle Rule

Radiograph for ankle sprain criteria; if any +:
a. Pain near the malleoli AND
Bone tenderness is present at the posterior edge of the distal 6cm or the tip of either the malleolus
OR
The patient is unable to bear weight for at least 4 steps at the time of injury and evaluation

29

Management of ankle sprain

RICE
Rest: Weight bearing should be avoided for the first several days
Ice: 30 min on and off alternately
Compression: Immediate to minimize edema and support stability
Elevation: for several days
NSAIDS with FOOD

30

S/Sx of elbow fracture

Fat pad sign:
NO factor on X-ray, the lateral view demonstrates elevation of the anterior and posterior fat pads. Even if no fracture on X-ray, fat pad sign suggests the prescence of an occult fracture

31

Nursemaid elbow definition

Injury resulting from pulling childs arm: radial head subluxation

32

s/sx of nursemaid elbow

inability/refusal to use affected arm, PAIN WITH SUPINATION, holds arm across body with thumb up, significant swelling and bruising justifies XRAY

33

Management of nursemaid elbow

supportive, NSAIDS

34

what is the most sensitive test for synovitis

log roll test (involuntary muscle guarding of one side)

35

what is the hallmark of septic arthritis?

acute joint inflammation marked by severe pain and swelling

36

what are s/sx of juvenile RA

high fever, transient rash, inflammation and warm joints