Pediatric Orthopedics

Transcription

1 Pediatric Orthopedics

2 Jan Douwes Visser Pediatric Orthopedics Symptoms, Differential Diagnosis, Supplementary Assessment and Treatment

3 Jan Douwes Visser Groningen The Netherlands Word processing: Hendrika Schotanus and Yvonne Werink. Translation: Prof. Peter H. Robinson, MD., Ph.D. Drawings: Douwe Buiter ISBN DOI / ISBN (ebook) Library of Congress Control Number: Springer International Publishing 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

4 Preface In practice, we do not tend to think in terms of differential diagnosis. We often consider the most probable diagnosis based on the patient s complaints. Only when the most probable diagnosis is not supported by physical examination and/or supplementary tests, do we further consider the other possibilities. In this book, Pediatric Orthopedics: Symptoms, Differential Diagnosis, Supplementary Assessment and Treatment, we are working towards a system for differential diagnosis based on the principal complaints and findings. In some cases there are more than one different kinds of complaint. As an example, in Osgood-Schlatter, there are complaints of pain and swelling. In those cases we consider the most preveland complaint which in Osgood- Schlatter is pain. In other cases, for instance a meniscal tear, there may be several individual complaints or a combination of these such as pain medially or laterally combined with limited extension and/or swelling. A torn meniscus appears in several differential diagnoses. A system has been established for every diagnosis as described here: (a) explanatory notes, (b) advice on supplementary tests, (c) advice as to which problems can be treated in primary care, (d) when to refer for secondary care treatment, and (e) what the options are for secondary care treatment. Generalized neurological disorders and neuromuscular disorders such as in spasticity, spina bifida, and acute traumatic lesions have been left out. There are many diverse treatment possibilities available. However, many pediatric orthopedic treatments are not evidence based or sometimes have a low or extremely low value from the literature. The author, advisers, and the publisher are not responsible for faults, omissions, or other implications as a result of the information given in this book. Application of the information given in this publication remains the responsibility of the clinician involved. Groningen, The Netherlands Jan Douwes Visser v

5 Acknowledgments Advisory Board Minne Heeg, M.D., Ph.D. Pediatric orthopedic surgeon Wilhelmina Hospital Assen, The Netherlands Sjoerd K. Bulstra, M.D., Ph.D. Professor and chairman Department of Orthopedic Surgery University Medical Center Groningen, The Netherlands Peter H. Robinson, M.D., Ph.D. Emeritus Professor of Plastic, Hand and Reconstructive Surgery University Medical Center Groningen, The Netherlands vii

6 Abbreviations ANF Antinuclear factor C Cervical CRP C-reactive protein CT Computed tomography ESR Erythrocyte sedimentation rate Hb Hemoglobin HLA Human leukocyte antigen Ht Hematocrit L Lumbar MRA Magnetic resonance arthrography MRI Magnetic resonance imaging n. Nerve NSAID Non-steroidal anti-inflammatory drugs S Sacral T Thoracal WBC count White blood cell count ix

7 Contents 1 Chest Wall Chest Wall Deformity Chest Wall Pain Neck Neck Deformity Neck Flexion Deformity Short Neck Wry Neck Neck Pain Acute Onset of a Painful Stiff and Possibly Wry Neck Slow Onset Painful Stiff and Possibly Wry Neck Painful Stiff and Possibly Wry Neck with Neurological Symptoms Back Back Misalignment Lateral Curvature(s) of the Back Abnormal Rounded Back Abnormal Hollow Back Combined Curvatures Back Pain Back Pain Back Pain Accompanied by Noctural Sweating Back Pain with Neurological Symptoms Pelvis Pelvic Pain Shoulder Shoulder Anomalies Absent Collarbone Elevated Shoulder Blade Repeated Non Traumatic Shoulder Subluxation/ Dislocation Repeated Traumatic Shoulder Subluxation/Dislocation xi

8 xii Contents Shoulder Swelling Collarbone Swelling in Newborns Swelling of the Shoulder Blade or Collarbone or Upper Arm Shoulder Movement Limitations in Newborns Paralysis of the Arm at Birth Shoulder Pain Vague Shoulder Pain Shoulder Pain After a Trivial Trauma Shoulder Pain in Overhead Athletes Painful Shoulder Movement Trajectory Extremely Painful Immobile Shoulder Elbow and Forearm Elbow Misalignment Crooked Elbow After a Fracture Repeated Elbow Subluxation/Dislocation Elbow Swelling Elbow Swelling on the Back or Front or Outer Side Elbow and Forearm Movement Limitations Limited Extension and/or Flexion in the Elbow After a Fracture Forearm Movement Limitation Elbow Pain Pain in the Outer Side of the Elbow After Arm Traction Pain in the Outer Side of the Elbow Pain in the Inner Side of the Elbow Extremely Painful Immobile Elbow Wrist Wrist Misalignment Crooked Wrist Wrist Swelling Hard Swelling on the Back of the Wrist Soft Swelling on the Back or Front of the Wrist Wrist Pain Pain on the Back of the Wrist Wrist Pain After a Trauma Severely Painful Immobile Wrist Hand Thumb and Finger Abnormalities Extra Thumb or Finger(s) Gigant Growth of Thumb and/or Finger(s) Finger Misalignment Short Finger Fused Fingers and/or Thumb Thumb Misalignment Long Thumb Short Thumb Hand Swelling

9 Contents xiii 9 Hip Hip Movement Limitations in Babies and Infants Hip Movement Limitation Away from the Midline of the Body The Legs Can Not Be Approximated or with Pelvic Obliquity Waddling Gait Snapping Hip Hip Pain Vague Pain Around Groin or Pelvis or Upper Leg Hip Pain and Limited Internal Rotation Hip Pain and Movement Limitation in All Directions Hip Pain After a Trivial Trauma Extremely Painful Immobile Hip Knee Knee Misalignment Bowleg Knock Knee Overstretched Knee Deformity Bent Knee Deformity Repeated Kneecap Subluxation/Dislocation Knee Swelling Swelling Just Above and/or Below the Knee Swelling at the Back of the Knee Knee Movement Limitations Knee Stretch Limitation Knee Bending Limitation Knee Effusion Knee Effusion Within a Few Hours After Trauma Knee Effusion Within 24 h After Trauma Knee Effusion Without a Preceding Trauma Knee Effusion Skipping to Other Joints Knee Effusion Accompanied by Nocturnal Sweating Knee Pain Vague Pain Just Above or Below the Knee Pain in the Inner or Outer Side of the Knee Pain at the Front of the Knee Thigh and Knee Pain Extremely Painful Immobile Knee Lower Leg Lower Leg Misalignment Forwards and Outwards Lower Leg Bowing Backwards and Inwards Lower Leg Bowing Lower Leg Pain Severe Lower Leg Pain Pain in the Outer Side of the Lower Leg Pain in the Inner Side of the Lower Leg

10 xiv Contents 12 Ankle Ankle Misalignment The Heel Progressively Deviates Outwards (Valgus Deformity) The Heel Progressively Deviates Inwards (Varus Deformity) Ankle Pain Pain at the Front of the Ankle Pain at the Back of the Ankle Extremely Painful Immobile Ankle Ankle Sprain Foot Foot Deformities Foot Deformities Present at Birth Toe Walking Flattened Longitudinal Medial Foot Arch Abnormal High Longitudinal Medial Foot Arch Foot Pain Pain in the Outer Side of the Hindfoot Heel Pain Pain in the Inner Side of the Midfoot Painful Swelling on the Upper Outer Side of the Heel Painful Swelling on the Inner Side of the Midfoot Painless Bilateral Swelling on the Medial Side of the Footsole Toes Abnormal Toe Extra Toe Giant Toe Growth Bent Toe Deformity Overlapping Toe Short Toes Fused Toes The Big Toe Deviates Medially The Big Toe Deviates Laterally The Little Toe Is Deviated Medially Painful Toes Painful Stiff Big Toe Pain at the Level of the Head of the Second Metatarsal (or Third or Fourth or Fifth) Toenail Pain Leg Length Inequality One Leg is Shorter or Longer than the Other One Leg is Shorter than the Other One Leg is Longer than the Other

11 Contents xv 16 Abnormal Gait Introduction Gait Disorders Limping Waddling Gait Toe Walking Out-Toeing Intoeing Unburdening Hip Gait Gaits with a Shortened Standing Phase Limb and Back Reduction Deficiency Present at Birth Limb General Classification Frequency Upper Limb Absence of the Whole or Part of the Arm Absence of the Whole Arm or Upper Arm or Forearm Between the Trunk and the Hand in Which Case the Elbow Joint Is Always Absent Abnormal Forearm and/or Hand Lower Limb Absence of the Whole or Part of the Leg Absence of the Whole Leg or Thigh or Lower Leg Between the Trunk and the Foot, in Which Case the Knee Joint Is Always Absent Short Upper Leg, the Knee Joint Is Always Present Abnormal Lower Leg and/or Foot Back Buddhist Posture Bone and Joint Infections Extremely Painful Immobile Extremity Incidence Pathogenesis of Acute Osteomyelitis Pathogenesis of Septic Arthritis Localization More Locations Pathogens Late Complications Caffey Disease Addendum Appendix Literature Index