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Apophyseal Injury

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41. Acutely Limping Child Up To Age 5

of acute limping in children is a minor traumatic injury [8]. Unfortunately, particularly in younger children, it is common that the pain cannot be accurately localized to one focal area. When there is no concern for infection and pain cannot be localized through history or physical examination, an imaging strategy designed to first localize the source of the pain and subsequently better characterize the cause is typically pursued. Radiography Lower Extremities In children <4 years of age, it is common (...) case it is important to exclude an underlying fracture. Clinical examination and history may allow localization of the pain or injury to a specific area, which allows a more focused imaging evaluation [26]. Radiography Lower Extremity Targeted radiographs of the areas of concern have a role in evaluating for possible fracture [12,26-29]. Negative radiographs do not completely exclude the possibility of a nondisplaced fracture. Dunbar et al [30] first described ACR Appropriateness Criteria ® 6

2018 American College of Radiology

42. CRACKCast E176 – Pediatric Musculoskeletal Disorders

spondylolisthesis: Grade 1 with no neuro deficits = rest for 60-90 days. [31] List 4 common apophyseal injuries in children. The apophysis is a cartilaginous structure that serves as a site for insertion of tendons on the growing bone. It has its own growth plate, with a slower rate of growth than the nearby epiphyseal plate. Apophysitis is unique to patients with skeletal immaturity and involves inflammation of this actively growing bone prominence, which is under great tensile stress. Little leaguer’s elbow (...) ] The growth plate is the weakest part of the bone and is more likely to separate before the adjacent tendon or ligament tears, thereby making sprains uncommon. Of supracondylar fractures, 95% are of the extension type. Displaced fractures are at risk for neurovascular injury and compartment syndrome; the anterior interosseous branch of the median nerve (“A-OK sign”) and the brachial artery are most commonly involved. Developmental dysplasia of the hip affects 1% of children ; all children who are not yet

2018 CandiEM

43. CRACKCast E057 – Knee and Lower Leg

CRACKCast E057 – Knee and Lower Leg CRACKCast E057 – Knee and Lower Leg - CanadiEM CRACKCast E057 – Knee and Lower Leg In , by Adam Thomas January 9, 2017 This episode of CRACKCast covers Chapter 57 of Rosen’s Emergency Medicine, Knee and Lower Leg. Continuing on with the orthopaedic chapters and objectives, this episode reviews the relevant approaches to knee and lower leg injuries that are actionable in the emergency department setting. Shownotes – Also check out the EM Cases Rapid Review (...) videos on Occult Knee Injuries and Rosen’s in Perspective “Most complex joint in the body” Flexion, extension, rotation, gliding, rolling Joins the two longest levers in the body (tibia and femur) Main ER goals: Identify repairable vascular injuries Reducing dislocations Stabilizing fractures Giving antibiotics when needed Has two joints: Tibio-femoral Femur = two condyles These articulate with the tibia, cushioned with the medial and lateral menisci Four strong ligaments anchor the tibia

2017 CandiEM

44. Back Pain ? Child

and has been positively associated with clinical symptomatology [23,24]. Resolution of signal abnormalities suggests a response to therapy and potential prevention of progression to fracture [22,37]. It remains uncertain whether MRI or bone scan with SPECT is preferred in the evaluation of suspected spondylolysis [38]. Abnormalities on MRI such as apophyseal injuries, spondylolysis, and disc disease have been shown to be associated with back pain in the pediatric athlete [39]. MRI can evaluate (...) radiculopathy elicited by both spondylolytic and nonspondylolytic causes and may demonstrate additional etiologies, including apophyseal fractures, intraspinous ligamentous injury, discogenic injury, Scheuermann disease, and compartment syndromes [8,31,40]. If contrast is administered, precontrast images are needed to assess enhancement. MRI of the spine in the clinical setting of back pain should always be performed with fat-saturated imaging techniques. There is little use for performing an MRI

2016 American College of Radiology

45. Developmental rheumatology in children. Scenario: Out-toeing

problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral (...) , acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

46. Developmental rheumatology in children. Scenario: Clumsy child

problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral (...) , acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

47. Developmental rheumatology in children. Scenario: Bow legs in children

problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral (...) , acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

48. Developmental rheumatology in children. Scenario: Tip-toe walking

problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral (...) , acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

49. Developmental rheumatology in children. Scenario: Curly toes in children

is not suspected; back problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community (...) and strains, acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

50. Developmental rheumatology in children. Scenario: Flat feet in children

problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral (...) , acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

51. Developmental rheumatology in children. Scenario: Growing pains

problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral (...) , acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

52. Developmental rheumatology in children

(for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral of children (...) is a diagnosis of exclusion. The list of more serious conditions that need to be considered which can present similarly to growing pains is extensive and includes [ ; ]: Autoimmune and inflammatory conditions (for example juvenile dermatomyositis, juvenile idiopathic arthritis); infectious conditions (for example osteomyelitis, septic arthritis, cellulitis). Malignancy (for example leukaemia, Ewing sarcoma, metastatic lesions). Trauma (for example sprains and strains, acute or stress fracture, nerve injury

2019 NICE Clinical Knowledge Summaries

53. Developmental rheumatology in children. Scenario: Knock knees in children

is not suspected; back problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community (...) and strains, acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

54. Developmental rheumatology in children. Scenario: Hypermobility in children

is not suspected; back problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community (...) and strains, acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

55. Developmental rheumatology in children. Scenario: Delayed walking in children

is not suspected; back problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community (...) and strains, acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

56. Developmental rheumatology in children. Scenario: In-toeing gait in children

is not suspected; back problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community (...) and strains, acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

57. Developmental rheumatology in children. Scenario: Heel pain in children

problems (for example pain, scoliosis, neurological symptoms, systemic illness) — orthopaedics. Suspected neurological problem; possible cancer; milestone delay or regression; suspected non-accidental injury; bladder or bowel problems — paediatrics. Other features may also be present for which specialist assessment is necessary, but with less urgency. Have I got the right topic? Have I got the right topic? From birth to 16 years. This CKS topic covers when to consider community management or referral (...) , acute or stress fracture, nerve injury). Structural conditions (for example slipped capital femoral epiphysis, joint hypermobility syndrome, patellofemoral syndrome). Metabolic conditions (for example vitamin D deficiency). Non-inflammatory pain syndromes (for example fibromyalgia and restless leg syndrome). In contrast with these conditions, the physical examination in a child with growing pains is usually normal [ ]. Heel pain Heel pain Heel pain is commonly reported in young children

2019 NICE Clinical Knowledge Summaries

58. The effect of repetitive flexion and extension fatigue loading on the young porcine lumbar spine, a feasibility study of MRI and histological analyses (PubMed)

causes concurrent MRI and histological changes in the growth zones and endplates, which could be a first sign of fatigue and an explanation for the disc, apophyseal and growth zone injuries seen among adolescent athletes.

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2017 Journal of experimental orthopaedics

59. Knee pain - assessment

Knee pain - assessment Knee pain - assessment - NICE CKS Share Knee pain - assessment: Summary Knee pain is a common condition, particularly in older people. Possible causes include osteoarthritis of the knee, injuries (such as muscle strain and fractures), tumours, referred pain from the hip or lumbosacral spine, and bursitis. Risk factors for knee pain include increasing age, obesity, knee-straining work and participation in sport. A person presenting with knee pain should be: Asked about (...) a history of trauma. Asked to describe the history of the pain and/or injury (including, type and duration of pain, aggravating and relieving factors, history of swelling). An examination of the knee should be carried out. If there is a history of trauma, an assessment for injuries including fracture, tendon rupture, ligament tears, neurovascular damage, and septic arthritis is required. Red flags should be considered for: Infection (septic arthritis or osteomyelitis). Tumours (bone tumour, soft-tissue

2017 NICE Clinical Knowledge Summaries

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