Transcript Limb Pain in Children

APPROACH TO LIMB PAIN IN
CHILDREN/OSTEOMYELITIS
MR 7/17/09
J.Chen
Approach to Limb Pain in Children
Approach to Child with Limb Pain
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History
History
History
PE
Labs/Imaging
History
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Important aspects:
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Area involved
# of joints involved
Nature of the pain
Presence of systemic symptoms (fever, rash, weight loss, fatigue)
Presence of limp
Weight bearing status
Morning stiffness
History of past medical illneses
Travel
Family History (Arthritis, Bleeding Disorders, Sickle Cell Disease,
IBD)
Physical Exam
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Important Aspects
 Joint
Exam
 Swelling
 Erythema
 Warmth
 Tenderness
 Deformity
 ROM
Physical Exam Continue
 Adjacent
Structures
 Bones
 Tendons
 Muscles
 Skin
 Gait
 Leg
length discrepancy
 Full Neurologic Examination
Basic Screening
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CBC with Diff
Blood Smear
ESR
CRP
Radiographs
Imaging
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Plain Radiograph and Bone Scan (Technetium-99 scan)
have long been the mainstay for joint and bone
problems
CT useful in diagnosing:
Osseus Tumors
 Pelvic and acetabular fractures
 Intraarticular Extension of Femoral Fractures
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US:
Joint effusions
 Developmental dysplasia of the hip
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Imaging Continued
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MRI-useful in evaluating
 Soft
tissue
 Joint spaces
 Suspected joint infection
 Soft tissue tumors
 Muscle injuries
 Early avasular necrosis
Approach to Limb Pain in Children
Osteomyelitis
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Cause:
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Most commonly results from Hematogenous spread
May be from direct invasion of Pathogens into the bone.
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May be precipitated by trauma
Pathogens:
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Staph aureus: 90%
Non-group A beta-hemolytic streptococci
Hib now less prevalent
Salmonella-Sickle Cell Anemia
Pseudomonas aeruginosa-puncture wound
Neisseria gonorrhacae-sexually active
GBS-neonates
Clinical Presentation
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Sudden onset
Localized pain
Swelling
Fever
+/- trauma
Limp/refusal to bear weight
Previous infection
Physical Exam
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Erythema
Swelling
Point tenderness
Decreased ROM
Most commonly involves
femur>tibia>humerous>fibula>radius>calcaneus>il
ium
Imaging
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X-Ray-not helpful in early diagnosis
 Findings
appear after 7 days
 Soft
tissue swelling
 Subperiosteal changes
 Bone destruction
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Bone Scan-85-100% sensitive
MRI-equal sensitivity, better specificity
Treatment