MORNING REPORTMarch 22, 2011

Septic Arthritis

Most common organism? Staph Aureus

Presentation? Acute Monoarthritis Erythema Warmth Swelling Intense pain on movement Fever – 70%

Septic Arthritis

Definitive Diagnostic Test? Joint fluid analysis and culture

Other labs or studies? CBC ESR/CRP US CT/MRI

Septic Arthritis

Emergency? Outcome depends of

timing of diagnosis, initiation of antibiotics, adequacy of drainage, virulence and host factors

Osteomyelitis

Presentation Fever Localized pain Erythema Swelling Pinpoint tenderness Decreased ROM

Osteomyelitis

Diagnosis? Bone scan MRI Bone Culture

Other labs? WBC ESR/CRP Blood culture – 60% Bone culture – 80% Plain films

Transient or Toxic Synovitis

Emergency? Benign, self-limited

Causes? Acute or post infection Trauma

30% of all nontraumatic limps

Transient Synovitis

Presentation? Limp Painful hip Afebrile or low-grade Otherwise appears well Mild restriction of ROM

Transient Synovitis

Diagnosis? Exclude septic arthritis and osteo Four predictors associated with septic arthritis

History of fever Inability to bear weight ESR >40 WBC >12

Transient Synovitis

Treatment? Rest Anti-inflammatory

Most children do very well

JIA

Definition of arthritis Joint effusion + 2 of the

following Stress pain Limited ROM Increased warmth

JIA One joint for at least 6

weeks Cause

Host Enviromental

JIA

Oligo Most common Girls 1-3y Large joints

Knee, ankle, wrist elbow

Morning stiffness ANA +

Anterior uveitis

JIA

Poly Symmetric involvement

Small and large joints Most RF –

RF+ are typically adolescent females and behave like adult RA

Systemic Fevers Evanescent rash

Salmon pink macules Other

HSM, pericarditis, serositis, LAD

JIA

Psoriatic Knees and small joints of hands

and feet Look for the rash Other

Nail changes or dactylitis Enthesitis

More common in boys Asymmetric lower limbs

Tendons of heel, plantar fascia or patella

May develop ankylosing spondylitis or other HLA-B27 diseases

JIA

Diagnosis? History and exam

Testing? CBC ESR/CRP ANA RF Radiographs

JIA

Treatment Anti-inflammatories Rheumatologist

Intra-articular corticosteroids Disease modifying agents

MTX Sulfasalazine Biologics

PT

Lyme Disease

Name of infective agent Borrelia burgdorferi

Transmission Ticks

Presentation Erythema migrans Arthritis

May occur months to years after infection

Other Meningitis, cranial nerve palsies,

carditis, ocular involvement

Lyme Disease

Diagnosis History and PE Lab testing

Culture Stain PCR

Blood, synovial fluid or synovial tissue

Serologic testing IgG may remain positive

for years

Lyme Disease

Treatment Antibiotics

Ceftriaxone or Amoxicillin or Doxycycline

Anti-inflammatories Prognosis for children

Good

Growing Pains

Definition Intermittent Nonarticular

Diagnosis History and normal PE

Benign Age range

3-10y

Growing Pains

Pain At night Limited to calf, thigh or shin Short-lived

Alleviated by Heat Massage Mild analgesics

SCFE

Definition Femoral head is

displaced from the femoral neck

Typical patient Overweight Boy 10-14y

SCFE

History and PE Trauma Acute

Pain Inability to walk

Subacute or Chronic Pain Limb held flexed and externally rotated Passive internal rotation is painful

SCFE

Diagnosis Radiographs

Bilateral 30% Treatment

Referral to ortho for repair No weight bearing Close follow up

Legg-Calve-Perthes

Definition Avascular necrosis of

the capital femoral epiphysis

Typical patient Boy 4-10y

Legg-Calve-Perthes

Presentation Limp Pain Reduced hip ROM

Diagnosis Radiographs MRI

Early disease Treatment

Refer to ortho Splints Casts surgery