Msk-Ics-Common Ortho Prob In Peds

Front 1

torticollis

Back 1

turning of the head preferentially to one side

Front 2

"wry neck"

Back 2

torticollis (turning of head preferentially to one side) acquired after infancy

Front 3

coengenital causes of torticollis

Back 3

1. Klippel-Feil Syndrome (congenital synostosis of cervical vertebra, short neck, decr neck motion, scoliosis)

2. Sprengel's deformity (congenital elevatio of scapula; cervical spine abnl)

Front 4

causes of torticollis

Back 4

A. Positional Preference of the head

B. Infanile Muscular Torticollis (subset of "A")

C. "Wry Neck"

Front 5

Infantile Muscular Torticollis-
presentation?
sequelae?
prognosis?

Back 5

present:
@ birth or 1-2 wks later
head tilted toward affected SCM muscle and chin rotated away
-firm swelling in SCM

sequealae:
-ipsilateral flattening of face
-plagiocephaly (lopsided head)

Prognosis: 90% resolve spontaneously

Front 6

Positional Preference of the head:
-who gets it?
-presentation?
-sequealae?

Back 6

Molded baby syndrome AKA squint baby syndrome:

Infants get it, assoc w:
-scoliosis
-congenital hip dysplasia (limited ABduction contralateral hip)
-foot abnl

-present: head turned toward one side, usu R
-sequealae: plagiocephaly (lopsided)

Front 7

who gets wry neck?

Back 7

children and teenagers

Front 8

Obstetrical palsy

Back 8

-results from injury to brachial plexus during delivery

-Erb's palsy (C4,5,6)
-Erb-Duchenne-Klumpke (entire plexus: C4-T1)
-Klumpke's (C8, T1)

Front 9

Erb's palsy:
-root levels
-clinical findings
-nature of injury
-prognosis

Back 9

-C4,5,6
-clinical features:
*adduction, internal rotation
*contracture of shoulder, w/loss of elbow extension

nature of injury: incomplete
-pronosis: excellent, spontaneously resolve

Front 10

Erb-Duchenne-Klumpke
-root levels
-clinical findings
-nature of injury
-prognosis

Back 10

-entire plexus (C4-T1)
-clinical findings: total flaccid paralysis
-nature of injury: rupture of lower roots
-prognosis: fair, most have full recovery

Front 11

Klumpke's:
-root levels
-clinical findings
-nature of injury
-prognosis

Back 11

-C8-T1
-clinical findings:
*Claw Hand (d/t C8=ulnar nerve; muscles of forearm and
arm)
*Horner's (d/t loss of SNS; miosis, enopthalmos)

-nature of injury: rupture sympathetic chain
-prognosis: poor

Front 12

clavicle fracture:
-how get?
-where break?
-present?

Back 12

mechanism: fall on shoulder>direct blow>fall on outstreched hand
-present: crepitus, shoulder drop
-whefe break:
middle 1/3 >
lateral 1/3 >
medial 1/3

Front 13

causes of anterior knee pain

Back 13

A. Osgood-Schlatter Apophysitis
B. Patellofemoral pain
C. Patellar Subluxation/Dislocation
D. Patellar tendonitis
E. Pre-patellar bursitis ("wrestler's knee"

Front 14

Osgood-Schlatter Apophysitis:
-et?
-present?

Back 14

(apophysis=site of attachment for large muscle; growth plate grows b/w and separates apophysis from tibia)

et: =prototypical "apophysitis";
stress fracture of physis at tibial tubercle from overuse

-present:
pain localized to tibial tubercle;
in active old child/teen

Front 15

patellofemoral pain:
-present?
-exam?

Back 15

-present: pain after prolonged sitting or deep knee flexion

-exam: benign except tenderness of medial and lateral patellar facets

Front 16

patellar subluxation/dislocation
-who gets?
-present?
-exam?
-labs?

Back 16

-present:
girls>boys
patellar dislocation is a violent event in which pt has extreme pain + "pop"

-exam: large soft-tissue swelling+ecchymosis
*(+) apprehension test is pathognomonic for patellar sublux/dislocation

*do x-ray to r/o fracture in acute dislocation

Front 17

(+) apprehension test when push laterally on patella

Back 17

patellar subluxation/dislocation

Front 18

patellar tendonitis:
-et?
-present?

Back 18

-et= "jumper's knee"
-present: atletes, sharp pain below patella

Front 19

pre-patellar bursitis
-et?
-present?

Back 19

AKA "wrestler's knees" (spend lots of time on knees)

-et: inflamm of pre-patellar bursa d/t repetitive trauma/friction

-present: burning pain + swelling over patella

Front 20

growing pains

Back 20

Dx of exclusion which must meet the following criteria:

1. pain localized to calves, thighs, knees
2. no leg pain during activity (leg pain after activity(
3. Heavy daytime activity
4. ROS not suggestive of systemic dz, bone or joint prob
5. phys exam is nl

Front 21

what causes back pain in kids

Back 21

A. Scoliosis
B. Spondylolysis
C. Spondylolisthesis

Front 22

scoliosis: et?.

Back 22

infants to pre-school: congenital/pathological

elementary school: 50/50 idiopathic vs. pathologic

adolescence: idiopathic

Front 23

scoliosis; tx?

Back 23

curves w/Cobb angle >25 degrees req surgery

Front 24

scoliosis: idiopathic vs pathologic

Back 24

idiopathic:
1. thoracic, convex R
2. thoracic, double major R
3. single L lumbar

PATHOLOGIC:'
1. thoracic, convex L
3. cervicothoracic curve
4. "tight" curve

Front 25

spondylolysis:
-mech?
-X ray?

Back 25

-mech: stress fracture or acute fracture of pars interarticularis ("Scottie dog collar") after hyperextension of back

X-ray: fracture of "Scottie dog collar" @ L5 or L4

Front 26

Spondylolisthesis:
et?

Back 26

slipping forward or vertebra with rspect to adjacement distal vertebra

*occurs at L4-5 or L5-S1

Front 27

causes of elbow injuries?

Back 27

A. Nursemaid's elbow
B. Elbow trauma (fat pad sign)

Front 28

Nursemaid's elbow:
-et?
-present?

Back 28

-et: subluxation (partial dislocation) of radial head w/stretching or tearing of annular ligament
**caused by pulling extended, pronated forearm
-present: children present with forearm flexed and pronated @ elbow

Front 29

elbow trauma--
where?
what suggests?

Back 29

-elbow trauma=condylar or supracondylar fracture

-X-ray: "fat pad sign" (wedge shapred lucency about the distal humerus; most sensitive radiological indicator of traumatic elbow effusions)

Front 30

most sensitive radiological indicator of traumatic elbow effusions

Back 30

"fat pad sign"

Front 31

MC occult fracture with +fat pad sign and no obvious fracture

Back 31

fracture of radial head

Front 32

MC acute joint injury in peds?

Back 32

-ankle sprains (usu lateral ankle ligament)

Front 33

ankle sprain: tenderness over what ligaments

Back 33

anterior talo-fibular>
calcaneio-fibular>
psoterial talo-fibular

Front 34

ankle sprain: grades?

Back 34

Grade I: pain but no ligament laxity (looseness)

Grade II: moderate pain;
some ligament laxity/joint instab

Grade III: mod-severe pain;
marked ligamentous laxity (usu indicates rupture of lateral ligament)

Front 35

ankle sprain: indications for X-rays (Ottawa Ankle Rules: USMLE)

Back 35

1. unable to bear weight
2. bony tenderness
3. tenderness in area of tibio-fibular syndesmosis