U01.11.026 Childhood musculoskeletal conditions

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Learning Objectives

  • Identify the mechanism of Radial Head Subluxation and the ligament involved.
  • Differentiate between Osgood-Schlatter and Patellofemoral Syndrome in active adolescents.
  • Compare and contrast the age, presentation, and pathophysiology of Legg-Calvé-Perthes vs. SCFE.
  • Recognize the physical exam maneuvers and imaging choice for Developmental Dysplasia of the Hip (DDH).

1. Elbow & Knee Overuse

Radial Head Subluxation (Nursemaid’s Elbow)

Common in children < 5 years old due to a sudden upward pull on the extended arm.

  • Mechanism: The immature annular ligament slips over the head of the radius and becomes trapped.
  • Presentation: The child holds the arm in a slightly flexed and pronated position, refusing to use it.

 

Osgood-Schlatter Disease

An overuse injury, technically known as traction apophysitis of the tibial tuberosity.

  • Pathophysiology: Repetitive strain and chronic avulsion of the secondary ossification center.
  • Presentation: Progressive anterior knee pain and a visible “bump” at the tibial tuberosity in jumping/running athletes.

Patellofemoral Syndrome

Anterior knee pain is caused by improper tracking of the patella over the femur.

  • Demographic: Classically young, female athletes.
  • Presentation: Pain exacerbated by prolonged sitting (the “theater sign”) or weight-bearing on a flexed knee.

2. Pediatric Hip Disorders

Condition Typical Patient Key Pathophysiology
DDH Newborn (Breech risk) Abnormal acetabular development; hip instability.
Legg-Calvé-Perthes Male, 5–7 years old Idiopathic avascular necrosis of the femoral head.
SCFE Obese Adolescent, ~12 years old Epiphysis displaces relative to the femoral neck (like “ice cream off a cone”).

3. Diagnostics & Physical Exam

Developmental Dysplasia of the Hip (DDH)

  • Screening: Barlow maneuver (dislocates the hip) and Ortolani maneuver (reduces the hip with a “clunk”).
  • Imaging: Ultrasound is used for infants < 4 months because the femoral head is not yet ossified (x-rays are useless here).

Slipped Capital Femoral Epiphysis (SCFE)

  • Presentation: Hip or referred knee pain with an altered, waddling gait.
  • Diagnosis: X-ray confirms the “slip.” This is an orthopedic emergency requiring surgical pinning.

Clinical Notes & Step 1 Pearls:

  • Nursemaid’s Reduction: Can be reduced by hyperpronation or supination of the forearm with flexion at the elbow.
  • Insidious Pain: In Legg-Calvé-Perthes, the pain starts slowly (insidious), and the initial x-ray is often normal, unlike the acute slip in SCFE.

Activity: Pediatric MSK 

Quick Mnemonics:

SCFE: Slip = Six (plus six = 12 years old).

Perthes: Perthes is for Preschool/Primary schoolers (younger).

Ortolani: Ortolani Opens the hip (reduction).

Activity: