Rib Osteomyelitis , Secondary to Actinomycosis in a Patient with Abdominal Pain
Approach to Limb Pain in Children/ Osteomyelitis
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Transcript of Approach to Limb Pain in Children/ Osteomyelitis
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APPROACH TO LIMB PAIN IN CHILDREN/OSTEOMYELITISMR 7/17/09J.Chen
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Approach to Limb Pain in Children
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Approach to Child with Limb Pain History History History PE Labs/Imaging
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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)
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Physical Exam Important Aspects
Joint Exam Swelling Erythema Warmth Tenderness Deformity ROM
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Physical Exam Continue Adjacent Structures
Bones Tendons Muscles Skin
Gait Leg length discrepancy Full Neurologic Examination
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Basic Screening CBC with Diff Blood Smear ESR CRP Radiographs
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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
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Imaging Continued MRI-useful in evaluating
Soft tissue Joint spaces Suspected joint infection Soft tissue tumors Muscle injuries Early avasular necrosis
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Approach to Limb Pain in Children
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Osteomyelitis Cause:
Most commonly results from Hematogenous spread May be from direct invasion of Pathogens into the
bone. May be precipitated by trauma
Pathogens: 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
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Clinical Presentation Sudden onset Localized pain Swelling Fever +/- trauma Limp/refusal to bear weight Previous infection
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Physical Exam Erythema Swelling Point tenderness Decreased ROM
Most commonly involves femur>tibia>humerous>fibula>radius>calcaneus>ilium
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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
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Treatment