Limping Child
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Synovial Fluidfluid 11
LWBK461-c11_p253-262.qxd 11/18/09 6:04 PM Page 253 Aptara Inc CHAPTER SynovialSynovial FluidFluid 11 Key Terms ANTINUCLEAR ANTIBODY ARTHROCENTESIS BULGE TEST CRYSTAL-INDUCED ARTHRITIS GROUND PEPPER HYALURONATE MUCIN OCHRONOTIC SHARDS RHEUMATOID ARTHRITIS (RA) RHEUMATOID FACTOR (RF) RICE BODIES ROPE’S TEST SEPTIC ARTHRITIS Learning Objectives SYNOVIAL SYSTEMIC LUPUS ERYTHEMATOSUS 1. Define synovial. VISCOSITY 2. Describe the formation and function of synovial fluid. 3. Explain the collection and handling of synovial fluid. 4. Describe the appearance of normal and abnormal synovial fluids. 5. Correlate the appearance of synovial fluid with possible cause. 6. Interpret laboratory tests on synovial fluid. 7. Suggest further testing for synovial fluid, based on preliminary results. 8. List the four classes or categories of joint disease. 9. Correlate synovial fluid analyses with their representative disease classification. 253 LWBK461-c11_p253-262.qxd 11/18/09 6:04 PM Page 254 Aptara Inc 254 Graff’s Textbook of Routine Urinalysis and Body Fluids oint fluid is called synovial fluid because of its resem- blance to egg white. It is a viscous, mucinous substance Jthat lubricates most joints. Analysis of synovial fluid is important in the diagnosis of joint disease. Aspiration of joint fluid is indicated for any patient with a joint effusion or inflamed joints. Aspiration of asymptomatic joints is beneficial for patients with gout and pseudogout as these fluids may still contain crystals.1 Evaluation of physical, chemical, and microscopic characteristics of synovial fluid comprise routine analysis. This chapter includes an overview of the composition and function of synovial fluid, and laboratory procedures and their interpretations. -
Upper Extremity
Upper Extremity Shoulder Elbow Wrist/Hand Diagnosis Left Right Diagnosis Left Right Diagnosis Left Right Adhesive capsulitis M75.02 M75.01 Anterior dislocation of radial head S53.015 [7] S53.014 [7] Boutonniere deformity of fingers M20.022 M20.021 Anterior dislocation of humerus S43.015 [7] S43.014 [7] Anterior dislocation of ulnohumeral joint S53.115 [7] S53.114 [7] Carpal Tunnel Syndrome, upper limb G56.02 G56.01 Anterior dislocation of SC joint S43.215 [7] S43.214 [7] Anterior subluxation of radial head S53.012 [7] S53.011 [7] DeQuervain tenosynovitis M65.42 M65.41 Anterior subluxation of humerus S43.012 [7] S43.011 [7] Anterior subluxation of ulnohumeral joint S53.112 [7] S53.111 [7] Dislocation of MCP joint IF S63.261 [7] S63.260 [7] Anterior subluxation of SC joint S43.212 [7] S43.211 [7] Contracture of muscle in forearm M62.432 M62.431 Dislocation of MCP joint of LF S63.267 [7] S63.266 [7] Bicipital tendinitis M75.22 M75.21 Contusion of elbow S50.02X [7] S50.01X [7] Dislocation of MCP joint of MF S63.263 [7] S63.262 [7] Bursitis M75.52 M75.51 Elbow, (recurrent) dislocation M24.422 M24.421 Dislocation of MCP joint of RF S63.265 [7] S63.264 [7] Calcific Tendinitis M75.32 M75.31 Lateral epicondylitis M77.12 M77.11 Dupuytrens M72.0 Contracture of muscle in shoulder M62.412 M62.411 Lesion of ulnar nerve, upper limb G56.22 G56.21 Mallet finger M20.012 M20.011 Contracture of muscle in upper arm M62.422 M62.421 Long head of bicep tendon strain S46.112 [7] S46.111 [7] Osteochondritis dissecans of wrist M93.232 M93.231 Primary, unilateral -
Transient Synovitis Or Septic Arthritis in Early Stage?
edicine: O M p y e c n n A e c g c r e e s s m E Emergency Medicine: Open Access Sekouris et al., Emergency Med 2014, 4:4 ISSN: 2165-7548 DOI: 10.4172/2165-7548.1000195 Short Communication Open Access Hip Pain in Children, a Diagnostic Challenge: Transient Synovitis or Septic Arthritis in Early Stage? Nick Sekouris*, Antonios Angoules, Dionysios Koukoulas and Eleni C Boutsikari Asssistant Director Orthopaedic, 'Metropolitan' Hospital, Athens, Greece *Corresponding author: Nick Sekouris, Asssistant Director Orthopaedic, 'Metropolitan' Hospital, Athens, Greece, Tel: +30 (210) 864 2202; E-mail: [email protected] Received date: April 27, 2014; Accepted date: June 13, 2014; Published date: June 17, 2014 Copyright: © 2014 Sekouris, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Short Communication symptoms, in case of SA, a destruction or dislocation of the femoral head or a widespread destruction of the femoral head and neck may be Hip pain in children is a diagnostic challenge for every practitioner visible radiographically. in emergency medicine and for any other doctor or health professional, facing this common symptom. Diagnosis may vary from Bone scintigraphy is neither sensitive nor specific enough in innocent conditions such as Transient Synovitis (TS), also mentioned distinguishing TS from SA and is not routinely used. Nevertheless, it as “irritable hip”, to hazardous for the child health diseases like Septic can diagnose multiple musculoskeletal lesions [7]. Arthritis (SA). -
Acetabular Labral Tears and Femoroacetabular Impingement
Michael J. Sileo, MD, FAAOS Sports Medicine Injuries Arthroscopic Shoulder, Knee & Hip Surgery December 7, 2018 NONE Groin and hip pain is common in athletes Especially hockey, soccer, and football 5% of all soccer injuries Renstrom et al: Br J Sports Med 1980. Complex anatomy and wide differential diagnoses that span multiple medical specialties make diagnosis difficult • Extra-articular causes: Muscle strain Snapping hip Adductor Trochanteric bursitis Iliopsoas Abductor tears Gluteus medius Compression neuropathies Hamstrings LFCN (meralgia paresthetica) Gracilis Sciatic nerve (Piriformis Avulsion injuries syndrome) Sports Hernia Ilioinguinal, Osteitis Pubis iliohypogastric, or genitofemoral nerve Intra-articular causes: Labral pathology Capsular laxity Femoroacetabular impingement Stress fracture Chondral pathology Septic arthritis Ligamentum teres injury Adhesive capsulitis Loose bodies Osteonecrosis Benign Intra-articular tumors SCFE PVNS Transient synovitis Synovial chondromatosis Soft-tissue injuries such as muscle strains and contusions are the most common causes of hip pain in the athlete It is important to be aware and suspicious of intra- articular causes of hip pain Up to 60% of athletes undergoing arthroscopy are initially misdiagnosed Delay to diagnosis is typically 7 months Labral pathology may not be diagnosed for up to 21 months Byrd et al: Clin Sports Med 2001. Burnett et al: JBJS 2006. Nature of discomfort Mechanical symptoms Stiffness Weakness Instability Location of discomfort -
Differential Diagnosis of Juvenile Idiopathic Arthritis
pISSN: 2093-940X, eISSN: 2233-4718 Journal of Rheumatic Diseases Vol. 24, No. 3, June, 2017 https://doi.org/10.4078/jrd.2017.24.3.131 Review Article Differential Diagnosis of Juvenile Idiopathic Arthritis Young Dae Kim1, Alan V Job2, Woojin Cho2,3 1Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea, 2Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 3Department of Orthopaedic Surgery, Montefiore Medical Center, New York, USA Juvenile idiopathic arthritis (JIA) is a broad spectrum of disease defined by the presence of arthritis of unknown etiology, lasting more than six weeks duration, and occurring in children less than 16 years of age. JIA encompasses several disease categories, each with distinct clinical manifestations, laboratory findings, genetic backgrounds, and pathogenesis. JIA is classified into sev- en subtypes by the International League of Associations for Rheumatology: systemic, oligoarticular, polyarticular with and with- out rheumatoid factor, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Diagnosis of the precise sub- type is an important requirement for management and research. JIA is a common chronic rheumatic disease in children and is an important cause of acute and chronic disability. Arthritis or arthritis-like symptoms may be present in many other conditions. Therefore, it is important to consider differential diagnoses for JIA that include infections, other connective tissue diseases, and malignancies. Leukemia and septic arthritis are the most important diseases that can be mistaken for JIA. The aim of this review is to provide a summary of the subtypes and differential diagnoses of JIA. (J Rheum Dis 2017;24:131-137) Key Words. -
Musculoskeletal Clinical Vignettes a Case Based Text
Leading the world to better health MUSCULOSKELETAL CLINICAL VIGNETTES A CASE BASED TEXT Department of Orthopaedic Surgery, RCSI Department of General Practice, RCSI Department of Rheumatology, Beaumont Hospital O’Byrne J, Downey R, Feeley R, Kelly M, Tiedt L, O’Byrne J, Murphy M, Stuart E, Kearns G. (2019) Musculoskeletal clinical vignettes: a case based text. Dublin, Ireland: RCSI. ISBN: 978-0-9926911-8-9 Image attribution: istock.com/mashuk CC Licence by NC-SA MUSCULOSKELETAL CLINICAL VIGNETTES Incorporating history, examination, investigations and management of commonly presenting musculoskeletal conditions 1131 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey Prof. John O'Byrne Mr. Iain Feeley Dr. Richie Downey Dr. Martin Kelly Mr. Iain Feeley Dr. Lauren Tiedt Dr. Martin Kelly Department of General Practice, RCSI Dr. Lauren Tiedt Dr. Mark Murphy Department of General Practice, RCSI Dr Ellen Stuart Dr. Mark Murphy Department of Rheumatology, Beaumont Hospital Dr Ellen Stuart Dr Grainne Kearns Department of Rheumatology, Beaumont Hospital Dr Grainne Kearns 2 2 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey TABLE OF CONTENTS Prof. John O'Byrne Mr. Iain Feeley Introduction ............................................................. 5 Dr. Richie Downey Dr. Martin Kelly General guidelines for musculoskeletal physical Mr. Iain Feeley examination of all joints .................................................. 6 Dr. Lauren Tiedt Dr. Martin Kelly Upper limb ............................................................. 10 Department of General Practice, RCSI Example of an upper limb joint examination ................. 11 Dr. Lauren Tiedt Shoulder osteoarthritis ................................................. 13 Dr. Mark Murphy Adhesive capsulitis (frozen shoulder) ............................ 16 Department of General Practice, RCSI Dr Ellen Stuart Shoulder rotator cuff pathology ................................... -
T Helper Cell Infiltration in Osteoarthritis-Related Knee Pain
Journal of Clinical Medicine Article T Helper Cell Infiltration in Osteoarthritis-Related Knee Pain and Disability 1, 1, 1 1 Timo Albert Nees y , Nils Rosshirt y , Jiji Alexander Zhang , Hadrian Platzer , Reza Sorbi 1, Elena Tripel 1, Tobias Reiner 1, Tilman Walker 1, Marcus Schiltenwolf 1 , 2 2 1, 1, , Hanns-Martin Lorenz , Theresa Tretter , Babak Moradi z and Sébastien Hagmann * z 1 Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany; [email protected] (T.A.N.); [email protected] (N.R.); [email protected] (J.A.Z.); [email protected] (H.P.); [email protected] (R.S.); [email protected] (E.T.); [email protected] (T.R.); [email protected] (T.W.); [email protected] (M.S.); [email protected] (B.M.) 2 Department of Internal Medicine V, Division of Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; [email protected] (H.-M.L.); [email protected] (T.T.) * Correspondence: [email protected]; Tel.: +49-622-1562-6289; Fax: +49-622-1562-6348 These authors contributed equally to this study. y These authors share senior authorship. z Received: 16 June 2020; Accepted: 23 July 2020; Published: 29 July 2020 Abstract: Despite the growing body of literature demonstrating a crucial role of T helper cell (Th) responses in the pathogenesis of osteoarthritis (OA), only few clinical studies have assessed interactions between Th cells and OA—related symptoms. -
Evaluation of the Limping Child
Current Concept Review Evaluation of the Limping Child Jessica Burns, MD, MPH; Scott Mubarak, MD Rady Children’s Hospital, San Diego, CA Abstract: Prompt evaluation of a younger child (age <5) with gait disturbance or refusal to walk is necessary to distinguish orthopedic urgency (trauma or infection) from relatively benign processes and chronic problems such as arthritis. Physical examination should include evaluation of gait, supine and simulated prone hip examination (on the parent’s lap to keep the child comfortable), and the crawl test. There are six radiographic views of the lower extremities that can assist in the diagnosis. In conjunction with the detailed history, a thorough physical exam, and radiographs from the orthopedic provider can determine the need for laboratory tests and other imaging. Key Concepts: • Evaluation of the limping child begins with a thorough history. • Physical examination of the limping child can be optimized by utilizing the parent to hold the child while the examiner moves the extremities and checks the back. • Six screening radiographs can be obtained to assist in making the correct diagnosis. • Laboratory analysis and magnetic resonance imaging can be obtained if the diagnosis remains elusive. Introduction Evaluation of gait disturbance in the younger child is an symptoms. Utilizing the parent in the physical important skill for the pediatric orthopedic surgeon. examination can help elicit a more detailed examination Although the true incidence is unknown, it is estimated of the child. Focused radiographs can then be utilized to that there are 1.8 per thousand children that will present support a suspected diagnosis. From there, the need for to the pediatric emergency department with complaint of laboratory analysis and further advanced imaging can be gait disturbance. -
Joint Pains UHL Childrens Hospital Guideline
LRI Children’s Hospital Joint Pains in Children Staff relevant to: Children’s Medical and Nursing Staff working within UHL Children’s Hospital Team approval date: March 2019 Version: 2 Revision due: March 2022 Written by: Dr A Sridhar, Consultant Paediatrician/Paediatric Rheumatology Trust Ref: C89/2016 1. Introduction and Who Guideline applies to THIS IS AN AREA WHERE CLINICAL ASSESSMENT IS USUALLY MUCH MORE IMPORTANT THAN “ROUTINE INVESTIGATIONS” SINGLE PAINFUL JOINT The most important diagnosis to consider is SEPTIC ARTHRITIS Can occur: In Any Joint All Age Groups May be co-existing osteomyelitis (particularly in very young) Related documents: Management of the limping child UHL - C13/2016 Septic Arthritis UHL – B47/2017 Differential diagnosis: 1. History of Injury: Traumatic, Acute Joint bleed (May be the first presentation of Haemophilia or other bleeding disorder) - Haemarthroses 2. Significant Fever and Pain: Septic arthritis or Osteomyelitis 3. Recent Viral illness, diarrhoea, Tonsillitis: Reactive Arthritis- 7-14 days after the illness, Fever may not be present 4. History of IBD: Usually monoarthritis of large joints reflects activity 5. Vascultic Rash: HSP or other forms of vasculitis Page 1 of 6 Title: Joint Pains in Children V:2 Approved by Children’s Clinical Practice Group: March 2019 Trust Ref: C89/2016 Next Review: March 2022 NB: Paper copies of this document may not be most recent version. The definitive version is held in the Trust Policy and Guideline Library. 6. Recent Drug ingestion: Serum sickness often associated with Urticarial rash 7. Bone pain, Lymphadenopathy, Hepato-splenomegaly: Leukemia, Lymphoma, Neuroblastoma, bone tumour (h/o nocturnal bone pain) 8. -
Hip Osteoarthritis Information
Bòrd SSN nan Eilean Siar NHS Western Isles Physiotherapy Department Hip Osteoarthritis An Information Guide for Patients and Carers Page 1 Contents Section 1: What is osteoarthritis? 3 Contributing factors to osteoarthritis Section 2: Diagnosis and symptoms 5 Symptoms Diagnosis Flare up of symptoms Section 3: Gentle hip exercises for flare ups 7 Section 4: Living with osteoarthritis 8 How with osteoarthritis affect me? What you can do to help yourself Section 5: Range of movement exercises 9 Section 6: Strengthening exercises 10 Other forms of exercise Section 7: Other treatments 13 Living with osteoarthritis Surgery Section 8: Local groups and activities 14 Page 2 What is osteoarthritis? This booklet is designed to give you some useful information following your diagnosis of osteoarthritis. Osteoarthritis is a very common condition which can affect any joint causing pain, and stiffness. It’s most likely to affect the joints that bear most of our weight, such as the hips, as they have to take extreme stresses, twists and turns, therefore osteoarthritis of the hip is very common and can affect either one or both hips. A normal joint A joint with mild osteoarthritis In a healthy joint, a coating of smooth and slippery tissue, called cartilage, covers the surface of the bones and helps the bones to move freely against each other. When a joint develops osteoarthritis, the bones lose their smooth surfaces and they become rougher and the cartilage thins. The repair process of the cartilage is sometimes not sufficient as we age. Almost all of us will develop osteoarthritis in some of our joints as we get older, though we may not even be aware of it. -
Joint Pain and Sjögren’S Syndrome
Joint Pain and Sjögren’s Syndrome Alan N. Baer, MD, FACP Alan N. Baer, MD, FACP Associate Professor of Medicine Division of Rheumatology Johns Hopkins University School of Medicine Director, Jerome Greene Sjogren's Syndrome Clinic 5200 Eastern Avenue Mason F. Lord Bldg. Center Tower Suite 4100, Room 413 Baltimore MD 21224 Phone (410) 550-1887 Fax (410) 550-6255 In 1930, Henrik Sjögren, a Swedish ophthalmologist, examined a woman with rheumatoid arthritis who had extreme dryness of her eyes and mouth and filamentary keratitis, an eye condition related to her lack of tears (1). He became fascinated by this unusual debilitating condition and subsequently evaluated 18 additional women with the same combination of findings. He described this new syndrome as “keratoconjunctivitis sicca” in his postdoctoral thesis. Thirteen of the 19 women had chronic inflammatory arthritis. We would now classify these 13 women as having secondary Sjögren’s syndrome (SS), occurring in the context of rheumatoid arthritis. However, joint pain constitutes one of the most common symptoms of the primary form of SS, defined as SS occurring in the absence of an underlying rheumatic disease. In a recent survey of SS patients belonging to the French Sjögren’s Syndrome Society (Association Française du Gougerot-Sjögren et des Syndromes Secs), 81% reported significant joint and muscle pain (2). In this article, the joint manifestations of primary SS will be reviewed. A few definitions are needed for the reader. Although the term “arthritis” was originally applied to conditions causing joint inflammation, it now includes disorders in which the joint has become damaged by degenerative, metabolic, or traumatic processes. -
Musculoskeletal Infections V1.1: ED Evaluation
Musculoskeletal Infections v1.1: ED Evaluation Approval & Citation Summary of Version Changes Explanation of Evidence Ratings PHASE I (E.D.) Abbreviations: Inclusion Criteria · Suspected septic arthritis and/or Septic Arthritis (SA) osteomyelitis in children > 3 months old Osteomyelitis (OM) Musculoskeletal (MSK) Exclusion Criteria · Permanent implanted orthopedic hardware ! · Symptoms at site contiguous with pressure ulcer/chronic wound For patients who · Suspected necrotizing soft tissue infection · Suspected axial skeletal involvement (i.e. are hemodynamically skull, spine, ribs, sternum) Kocher Criteria unstable or with sepsis · Chronic recurrent multifocal osteomyelitis physiology, also refer to · Immunocompromised patient (e.g. BMT, Predictors for SA of the hip: Septic Shock Pathway oncology, transplant) · Non-weight-bearing · Temp > 38.5C · ESR ≥ 40 mm/hr · WBC > 12,000 cells/mm3 Caird et al. introduced a fifth ED Team Assessment predictor for SA of the hip: · CRP > 2.0 mg/dL Evaluate for signs/symptoms suggestive of a primary MSK Infection ! Initial Workup Delayed diagnosis Labs: Order CBC with diff, CRP, ESR of hip SA can lead to avascular necrosis Microbiology: Consider aerobic + anaerobic blood cultures of the femoral head Imaging: Order x-ray of the involved bone/joint Low Clinical Suspicion Moderate/High Clinical Suspicion Alternative for SA and/or OM: for SA and/or OM: Unifying Diagnosis · Consider hip US if hip SA remains · Consult Orthopedics on the differential · Order hip US if hip SA is suspected · Consider alternative