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Approach to Limb Pain in Children/ Osteomyelitis

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. History History History PE Labs/Imaging. History. Important aspects: Area involved # of joints involved Nature of the pain

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Approach to Limb Pain in Children/ Osteomyelitis

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  1. Approach to Limb Pain in Children/Osteomyelitis MR 7/17/09 J.Chen

  2. Approach to Limb Pain in Children

  3. Approach to Child with Limb Pain • History • History • History • PE • Labs/Imaging

  4. History • Important aspects: • 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)

  5. Physical Exam • Important Aspects • Joint Exam • Swelling • Erythema • Warmth • Tenderness • Deformity • ROM

  6. Physical Exam Continue • Adjacent Structures • Bones • Tendons • Muscles • Skin • Gait • Leg length discrepancy • Full Neurologic Examination

  7. Basic Screening • CBC with Diff • Blood Smear • ESR • CRP • Radiographs

  8. Imaging • 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 • US: • Joint effusions • Developmental dysplasia of the hip

  9. Imaging Continued • MRI-useful in evaluating • Soft tissue • Joint spaces • Suspected joint infection • Soft tissue tumors • Muscle injuries • Early avasular necrosis

  10. Approach to Limb Pain in Children

  11. Osteomyelitis • Cause: • Most commonly results from Hematogenous spread • May be from direct invasion of Pathogens into the bone. • May be precipitated by trauma • Pathogens: • Staphaureus: 90% • Non-group A beta-hemolytic streptococci • Hib now less prevalent • Salmonella-Sickle Cell Anemia • Pseudomonas aeruginosa-puncture wound • Neisseriagonorrhacae-sexually active • GBS-neonates

  12. Clinical Presentation • Sudden onset • Localized pain • Swelling • Fever • +/- trauma • Limp/refusal to bear weight • Previous infection

  13. Physical Exam • Erythema • Swelling • Point tenderness • Decreased ROM • Most commonly involves femur>tibia>humerous>fibula>radius>calcaneus>ilium

  14. Imaging • X-Ray-not helpful in early diagnosis • Findings appear after 7 days • Soft tissue swelling • Subperiosteal changes • Bone destruction • Bone Scan-85-100% sensitive • MRI-equal sensitivity, better specificity

  15. Treatment

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