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PED Musculoskeletal
| Question | Answer |
|---|---|
| Plagiocephaly | flattened occiput. Prevention: tummy time, alternating orientation. |
| craniosynostosis | premature fusion of suture, defined ridge over lambdoidal suture |
| bossing | knob-like swelling |
| Torticollis (refer for surgical consult if not improved in 6 months) | trauma or malpositioning result in SCM fibrosis and shortening. small non-tender mass in SCM. Head tilts to side of lesion and rotates away. Head can't be returned to neutral. Dx: Pe, US, X-ray. Rx: PT with active and passive stretching. Botulinum inject |
| Optimal excision time for polydactyly | 6-9 months. |
| Painful thickened flexor tendon or nodule at the A-1 pulley | Trigger finger (stenosing tenosynovitis). Tx: surgical release |
| SALTER HARRIS classification of | physeal fxs. Straight, above, lower, through, ram |
| buckle fx wtih intact periosteum | torus fx |
| most common elbow fx in children | supracondylar fx. FOOSH. Neurovascular injury common |
| Epicondyle fx | medial epicondyle most common (lateral is rare) |
| CRITOL | Order of elbow ossification: capitellum, radius, internal epicondyle, trochlea, olecranon, lateral epidcondyle |
| Toddler's fx tx | long leg cast for 3 weeks |
| Scoliosis of 25 degrees | referral. Scoliosis in teen females is more common. MRI for onset before 8 y/o |
| spondylolysis | pars interarticularis stress fx, L5 most common, scotty dog on oblique x-ray |
| spondylolisthesis | vertebral sliding/step off |
| "clunk" on Barlow and Ortolani | suggests developmental dysplasia of the hip. Do until about 6 months (according to lecture). Slide says by 8-12 weeks these maneuvers are not useful. US most accurate for dx |
| Hilgenreiner's line | horizontal line through triradiate cartilage |
| Perkin's ine | vertical line at lateral edge of acetabulum |
| Shenton's line | obturator foramen in line with the femoral curve |
| Growing pains | more common in 2-5 yo boys, overactivity, migratory pattern common, calf most common. Consider imaging if: fever, wt. loss, night sweats, pain in specific location. Tx: reassurance, analgesics, ice, massage, heat |
| Osgood-Schlatter | Tibial tubercle apophysitis. M>F, 10-14 yo, running, jumping sports. worse with growth spurt or increased activity. Pe: localized swelling and pain. Dx: x-ray to r/o tibial apophysis avulsion |
| Tx of osgood-schlatter | decreased activity, infrapatellar strap, quad strength, self-limiting when apophysis fuses |
| Differential diagnosis of limp | transient synovitis, septic joint, Legg-Calve-Perthes, SCFE, Fractures,Contusion, Malignancy |
| avascular necrosis of the femoral head | legg-calve-perthes disease. Mottled, desinegrating femoral head appearance. Insidious groin and anteior thigh pain, limp |
| slipped ice cream off cone | slipped femoral capital epiphysis; femoral head displaced from femoral neck through the physis. Obese, hypogonadic, adolescent boys. 60% bilateral |
| #1 bone tumor in children | osteochondroma. Pain free mass, rarely malignant. Tx: remove |
| Osteosarcoma | pain or mass in long bone. 30% 5 yr survival, mets to lung. Tx: chemo/radio/surgery |
| Ewing Sarcoma | Pain, fever, increased WBC. Rx: chemo/radio/surgery. Poor prognosis in large pelvic lesions. |
| osteoid Osteoma | Sx: night pain, Rx: Excision. Not malignant, recurs |
| Differential Diagosis of intoeing | metatarsus adductus, internal tibial torsion, increased femoral anteversion, genu varum |
| most common deformity of the newborn | Metatarsus adductus. etiology: uterine packing. Medial forefoot varus. Can be passively corrected by 12-180 months. Passive stretching helpful |
| Tibial Torsion | internal twisting of the tiiba results in "intoeing". Self corrects by 2-4 years. Avoid belly sleeping and "tv" position. Encourage sitting indian style |
| Bow legs | distal tibia varus. Primarily physiologic. X-ray if increasing after 16 months or with asymmetry. D/D: Ricket's, Blount's dz. Spontaneous correction by 2-3 year |
| Genu Valgum | return to |
| Talipes Equinovarus (club foot) | more common in males, may be associated with spinal deformities. Tx: serial casting, surgical tendon release |
| Sever's Disease | Heel pain. Calcaneal apophysitis (very common in 7-15 yo). PE: well localized heel pain. X-ray not indicated. Tx: relative rest, heel cups, ice, stretching, NSAIDs |
| Pes Planus | bilateral, absent longitudinal arch. arch forms with jack toe test. |
| Toe walking | D/D: tight heel cords, Muscular dystrophy, cerebral palsy, high arched foot |
| Posterior fat pad sign in adults indicates | radial head fx; in kids supracondylar |
| Most common elbow fracture in children | supracondylar fracture; neurovascular injury common |
Created by:
ltm12