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Morning Report

Morning Report. March 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

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Morning Report

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  1. Morning Report March 22, 2011

  2. Septic Arthritis • Most common organism? • Staph Aureus • Presentation? • Acute • Monoarthritis • Erythema • Warmth • Swelling • Intense pain on movement • Fever – 70%

  3. Septic Arthritis • Definitive Diagnostic Test? • Joint fluid analysis and culture • Other labs or studies? • CBC • ESR/CRP • US • CT/MRI

  4. Septic Arthritis • Emergency? • Outcome depends of timing of diagnosis, initiation of antibiotics, adequacy of drainage, virulence and host factors

  5. Osteomyelitis • Presentation • Fever • Localized pain • Erythema • Swelling • Pinpoint tenderness • Decreased ROM

  6. Osteomyelitis • Diagnosis? • Bone scan • MRI • Bone Culture • Other labs? • WBC • ESR/CRP • Blood culture – 60% • Bone culture – 80% • Plain films

  7. Transient or Toxic Synovitis • Emergency? • Benign, self-limited • Causes? • Acute or post infection • Trauma • 30% of all nontraumatic limps

  8. Transient Synovitis • Presentation? • Limp • Painful hip • Afebrile or low-grade • Otherwise appears well • Mild restriction of ROM

  9. 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

  10. Transient Synovitis • Treatment? • Rest • Anti-inflammatory • Most children do very well

  11. 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

  12. JIA • Oligo • Most common • Girls 1-3y • Large joints • Knee, ankle, wrist elbow • Morning stiffness • ANA + • Anterior uveitis

  13. 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

  14. 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 ankylosingspondylitis or other HLA-B27 diseases

  15. JIA • Diagnosis? • History and exam • Testing? • CBC • ESR/CRP • ANA • RF • Radiographs

  16. JIA • Treatment • Anti-inflammatories • Rheumatologist • Intra-articular corticosteroids • Disease modifying agents • MTX • Sulfasalazine • Biologics • PT

  17. Lyme Disease • Name of infective agent • Borreliaburgdorferi • Transmission • Ticks • Presentation • Erythemamigrans • Arthritis • May occur months to years after infection • Other • Meningitis, cranial nerve palsies, carditis, ocular involvement

  18. 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

  19. Lyme Disease • Treatment • Antibiotics • Ceftriaxone or • Amoxicillin or • Doxycycline • Anti-inflammatories • Prognosis for children • Good

  20. Growing Pains • Definition • Intermittent • Nonarticular • Diagnosis • History and normal PE • Benign • Age range • 3-10y

  21. Growing Pains • Pain • At night • Limited to calf, thigh or shin • Short-lived • Alleviated by • Heat • Massage • Mild analgesics

  22. SCFE • Definition • Femoral head is displaced from the femoral neck • Typical patient • Overweight • Boy • 10-14y

  23. 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

  24. SCFE • Diagnosis • Radiographs • Bilateral 30% • Treatment • Referral to ortho for repair • No weight bearing • Close follow up

  25. Legg-Calve-Perthes • Definition • Avascular necrosis of the capital femoral epiphysis • Typical patient • Boy • 4-10y

  26. Legg-Calve-Perthes • Presentation • Limp • Pain • Reduced hip ROM • Diagnosis • Radiographs • MRI • Early disease • Treatment • Refer to ortho • Splints • Casts • surgery

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