Pediatric Orthopedics : Symptoms, Differential Diagnosis, Supplementary Assessment and Treatment

442 Pages·2017·41.67 MB·English

Jan Douwes Visser
Pediatric
Orthopedics
Symptoms, Diff erential
Diagnosis, Supplementary
Assessment and Treatment
123
Pediatric Orthopedics
Jan Douwes Visser
Pediatric Orthopedics
Symptoms, Differential Diagnosis,
Supplementary Assessment
and Treatment
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 978-3-319-40176-8 ISBN 978-3-319-40178-2 (eBook)
DOI 10.1007/978-3-319-40178-2
Library of Congress Control Number: 2016960534
© Springer International Publishing 2017
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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 exami-
nation and/or supplementary tests, do we further consider the other possibili-
ties. 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 menis-
cus 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 pri-
mary 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 pos-
sibilities 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
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
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
Contents
1 Chest Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chest Wall Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chest Wall Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Neck Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Neck Flexion Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Short Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Wry Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Neck Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Acute Onset of a Painful Stiff and Possibly Wry Neck . . . . . . . 12
Slow Onset Painful Stiff and Possibly Wry Neck . . . . . . . . . . . . 16
Painful Stiff and Possibly Wry Neck with Neurological
Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3 Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Back Misalignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Lateral Curvature(s) of the Back . . . . . . . . . . . . . . . . . . . . . . . . . 21
Abnormal Rounded Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Abnormal Hollow Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Combined Curvatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Back Pain Accompanied by Noctural Sweating . . . . . . . . . . . . . 51
Back Pain with Neurological Symptoms . . . . . . . . . . . . . . . . . . 52
4 Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Pelvic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
5 Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Shoulder Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Absent Collarbone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Elevated Shoulder Blade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Repeated Non Traumatic Shoulder Subluxation/
Dislocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Repeated Traumatic Shoulder Subluxation/Dislocation . . . . . . . 66
xi
xii Contents
Shoulder Swelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Collarbone Swelling in Newborns . . . . . . . . . . . . . . . . . . . . . . . 69
Swelling of the Shoulder Blade or Collarbone
or Upper Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Shoulder Movement Limitations in Newborns . . . . . . . . . . . . . . . . 71
Paralysis of the Arm at Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Shoulder Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Vague Shoulder Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Shoulder Pain After a Trivial Trauma . . . . . . . . . . . . . . . . . . . . . 75
Shoulder Pain in Overhead Athletes . . . . . . . . . . . . . . . . . . . . . . 76
Painful Shoulder Movement Trajectory . . . . . . . . . . . . . . . . . . . 76
Extremely Painful Immobile Shoulder . . . . . . . . . . . . . . . . . . . . 77
6 Elbow and Forearm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Elbow Misalignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Crooked Elbow After a Fracture . . . . . . . . . . . . . . . . . . . . . . . . . 79
Repeated Elbow Subluxation/Dislocation . . . . . . . . . . . . . . . . . 80
Elbow Swelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Elbow Swelling on the Back or Front or Outer Side . . . . . . . . . 81
Elbow and Forearm Movement Limitations . . . . . . . . . . . . . . . . . . 82
Limited Extension and/or Flexion in the Elbow
After a Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Forearm Movement Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Elbow Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Pain in the Outer Side of the Elbow After Arm Traction . . . . . . 84
Pain in the Outer Side of the Elbow . . . . . . . . . . . . . . . . . . . . . . 86
Pain in the Inner Side of the Elbow . . . . . . . . . . . . . . . . . . . . . . 87
Extremely Painful Immobile Elbow . . . . . . . . . . . . . . . . . . . . . . 87
7 Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Wrist Misalignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Crooked Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Wrist Swelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Hard Swelling on the Back of the Wrist . . . . . . . . . . . . . . . . . . . 92
Soft Swelling on the Back or Front of the Wrist . . . . . . . . . . . . . 93
Wrist Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Pain on the Back of the Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Wrist Pain After a Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Severely Painful Immobile Wrist . . . . . . . . . . . . . . . . . . . . . . . . 96
8 Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Thumb and Finger Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Extra Thumb or Finger(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Gigant Growth of Thumb and/or Finger(s) . . . . . . . . . . . . . . . . . 102
Finger Misalignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Short Finger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Fused Fingers and/or Thumb . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Thumb Misalignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Long Thumb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Short Thumb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Hand Swelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Contents xiii
9 Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Hip Movement Limitations in Babies and Infants . . . . . . . . . . . . . 117
Hip Movement Limitation Away from
the Midline of the Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
The Legs Can Not Be Approximated
or with Pelvic Obliquity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Waddling Gait . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Snapping Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Hip Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Vague Pain Around Groin or Pelvis or Upper Leg . . . . . . . . . . . 146
Hip Pain and Limited Internal Rotation . . . . . . . . . . . . . . . . . . . 147
Hip Pain and Movement Limitation in All Directions . . . . . . . . 163
Hip Pain After a Trivial Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Extremely Painful Immobile Hip . . . . . . . . . . . . . . . . . . . . . . . . 167
10 Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Knee Misalignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Bowleg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Knock Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Overstretched Knee Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Bent Knee Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Repeated Kneecap Subluxation/Dislocation . . . . . . . . . . . . . . . . 193
Knee Swelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Swelling Just Above and/or Below the Knee . . . . . . . . . . . . . . . 198
Swelling at the Back of the Knee . . . . . . . . . . . . . . . . . . . . . . . . 199
Knee Movement Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Knee Stretch Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
Knee Bending Limitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Knee Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Knee Effusion Within a Few Hours After Trauma . . . . . . . . . . . 206
Knee Effusion Within 24 h After Trauma . . . . . . . . . . . . . . . . . . 215
Knee Effusion Without a Preceding Trauma . . . . . . . . . . . . . . . . 216
Knee Effusion Skipping to Other Joints . . . . . . . . . . . . . . . . . . . 220
Knee Effusion Accompanied by Nocturnal Sweating . . . . . . . . . 221
Knee Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Vague Pain Just Above or Below the Knee . . . . . . . . . . . . . . . . . 223
Pain in the Inner or Outer Side of the Knee . . . . . . . . . . . . . . . . 229
Pain at the Front of the Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Thigh and Knee Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Extremely Painful Immobile Knee . . . . . . . . . . . . . . . . . . . . . . . 235
11 Lower Leg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Lower Leg Misalignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Forwards and Outwards Lower Leg Bowing . . . . . . . . . . . . . . . 237
Backwards and Inwards Lower Leg Bowing . . . . . . . . . . . . . . . 240
Lower Leg Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Severe Lower Leg Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Pain in the Outer Side of the Lower Leg . . . . . . . . . . . . . . . . . . . 244
Pain in the Inner Side of the Lower Leg . . . . . . . . . . . . . . . . . . . 246