Musculoskeletal Condition Features
Limping child Spectrum of disorders ranging from
Dysplasia sublaxation frank dislocation
RF Female, Breech presentation, oligohydramnios, BW >5kg
DDH most common in the L. hip (20% bilateral)
Detected in neonates
Ix USS
Condition Features Developmental
Barlow test: attempts to dislocate an articulated femoral
dysplasia of the
head (posteriorly)
Most common cause of acute hip pain hip
Ortolani test: attempts to relocate a dislocated femoral
Common in boys, aged 2-12 years head on abduction
Often follows or is accompanied by a viral infection Mx Most unstable hips will stabilise by 3-6 weeks of age
Presentation Pavlik harness (dynamic flexion-abduction orthosis (children <
Transient
Sudden onset of pain, no pain at rest, decreased ROM, 4-5 months)
synovitis Older children may require surgery
particularly internal rotation
Pain may be referred to the knee Avascular necrosis of the capital femoral epiphysis of the
Afebrile/mild fever and does not appear ill femoral head- interruption of the blood supply followed by
Mx Rest, analgesia revascularisation + reossification over 18 -36 months
Serious infection of joint space bone destruction Mainly affects boys of 5-10 years
Most common <2 years old Presentation
Increased density in the femoral head (XR)
Haematogenous spread Perthes disease
Mx
Usually one joint affected- hip is of concern
Early bed rest and traction
S. aureus Late femoral head needs to be covered by the
Septic arthritis Presentation acetabulum to act as a mould for the re-ossifying
Erythematous, warm, acutely tender, reduced ROM, febrile epiphysis- maintain hip in abduction with plaster or
child calipers/ pelvic osteotomy
Hold the limb still and cry if it is moved Displacement of the epiphysis of the femoral head postero-
Mx Joint aspiration, under USS guidance inferiorly ?avascular necrosis (if untreated)
Prolonged Abx, rest + analgesia Common in 10-15 year olds during adolescent growth spurt,
Slipped upper
Infection of metaphysis of long bones: distal femur + particularly obese boys and is bilateral in 20%
femoral
proximal tibia Presentation
epiphysis
Haematogenous spread Limp/hip pain that may refer to the knee
Presentation Restricted abduction + internal rotation of the hip O/E
Osteomyelitis Mx Surgical, usually with pin fixation in situ
Painful, immobile limb, acutely febrile illness
Mx Parenteral Abx to prevent bone necrosis Commonest chronic inflammatory joint disease
Rested initially in splint then mobilised Persistent joint swelling < 16 years old w/o infection/any
Surgical drainage if unresponsive to Abx defined cause + lasts > 3 months
Presentation
Gelling- stiffness after a period of rest, such as long car rides)
Morning joint stiffness + pain
Juvenile Intermittent limp
Trauma History is usually diagnostic idiopathic Complications anterior uveitis, growth failure, flexion
arthritis contracture of joint
Mx NSAIDs, joint aspiration, methotrexate, systemic
corticosteroids
Limping child Spectrum of disorders ranging from
Dysplasia sublaxation frank dislocation
RF Female, Breech presentation, oligohydramnios, BW >5kg
DDH most common in the L. hip (20% bilateral)
Detected in neonates
Ix USS
Condition Features Developmental
Barlow test: attempts to dislocate an articulated femoral
dysplasia of the
head (posteriorly)
Most common cause of acute hip pain hip
Ortolani test: attempts to relocate a dislocated femoral
Common in boys, aged 2-12 years head on abduction
Often follows or is accompanied by a viral infection Mx Most unstable hips will stabilise by 3-6 weeks of age
Presentation Pavlik harness (dynamic flexion-abduction orthosis (children <
Transient
Sudden onset of pain, no pain at rest, decreased ROM, 4-5 months)
synovitis Older children may require surgery
particularly internal rotation
Pain may be referred to the knee Avascular necrosis of the capital femoral epiphysis of the
Afebrile/mild fever and does not appear ill femoral head- interruption of the blood supply followed by
Mx Rest, analgesia revascularisation + reossification over 18 -36 months
Serious infection of joint space bone destruction Mainly affects boys of 5-10 years
Most common <2 years old Presentation
Increased density in the femoral head (XR)
Haematogenous spread Perthes disease
Mx
Usually one joint affected- hip is of concern
Early bed rest and traction
S. aureus Late femoral head needs to be covered by the
Septic arthritis Presentation acetabulum to act as a mould for the re-ossifying
Erythematous, warm, acutely tender, reduced ROM, febrile epiphysis- maintain hip in abduction with plaster or
child calipers/ pelvic osteotomy
Hold the limb still and cry if it is moved Displacement of the epiphysis of the femoral head postero-
Mx Joint aspiration, under USS guidance inferiorly ?avascular necrosis (if untreated)
Prolonged Abx, rest + analgesia Common in 10-15 year olds during adolescent growth spurt,
Slipped upper
Infection of metaphysis of long bones: distal femur + particularly obese boys and is bilateral in 20%
femoral
proximal tibia Presentation
epiphysis
Haematogenous spread Limp/hip pain that may refer to the knee
Presentation Restricted abduction + internal rotation of the hip O/E
Osteomyelitis Mx Surgical, usually with pin fixation in situ
Painful, immobile limb, acutely febrile illness
Mx Parenteral Abx to prevent bone necrosis Commonest chronic inflammatory joint disease
Rested initially in splint then mobilised Persistent joint swelling < 16 years old w/o infection/any
Surgical drainage if unresponsive to Abx defined cause + lasts > 3 months
Presentation
Gelling- stiffness after a period of rest, such as long car rides)
Morning joint stiffness + pain
Juvenile Intermittent limp
Trauma History is usually diagnostic idiopathic Complications anterior uveitis, growth failure, flexion
arthritis contracture of joint
Mx NSAIDs, joint aspiration, methotrexate, systemic
corticosteroids
