Week 4: July 25 Peds MSK

During a preparticipation examination of a 5-year-old male for summer soccer camp, his mother states that he frequently awakens during the night with complaints of cramping pain in both legs, and that he seems to experience this after a day of heavy physical activity. She says that she has never noticed a definite limp. A physical examination of the hips, knees, ankles, and leg musculature is entirely normal. Which one of the following would be the most appropriate next step in the evaluation and management of this patient?

Which one of the following diagnoses is most likely in a 6-year-old boy who has been limping for one month, has associated hip stiffness and mild pain, has diminished internal rotation and abduction of the left hip compared with the right, and has increased radiodensity of the capital femoral epiphysis.

Which one of the following is the most accurate imaging study for assessing early osteomyelitis?

The anterolateral lower leg is quite tender but only slightly swollen, and there is exquisite pain in that area with passive plantar flexion of the great toe. Radiographs of the lower leg and ankle are negative. In addition to ice, elevation, and analgesia, which one of the following would be most appropriate?

When compared to a figure-of-eight dressing, which one of the following modalities of treatment has been shown to have similar fracture-healing outcomes and increased patient satisfaction for nondisplaced mid-shaft clavicular fractures?

An 11-year-old male is brought to your office for evaluation of bilateral posterior heel pain that has occurred for the past few months. He plays basketball and soccer several times a week and the pain begins several minutes into each of these activities. There is no pain at rest or with walking. The patient has not noticed any numbness, tingling, or weakness. On examination you find no swelling or tenderness of the heel or Achilles tendon. Reflexes, strength, and range of motion at the ankle are intact, but he does have bilateral posterior heel pain when you passively dorsiflex the ankles. Which one of the following is the most likely diagnosis?

A 13-year-old male presents with a 3-week history of left lower thigh and knee pain. There is no history of a specific injury, and his past medical history is negative. He has had no fevers, night sweats, or weight loss, and the pain does not awaken him at night. He tried out for his school’s basketball team but had to quit because of the pain, which was worse when he tried to run. Which one of the following physical examination findings would be pathognomonic for slipped capital femoral epiphysis?

A 16-year-old female presents for follow-up after a tibial stress fracture. The fracture was diagnosed 5 weeks ago by characteristic physical examination findings and radiographs showing a transverse fracture of the tibial diaphysis. She was placed on non–weight-bearing status for 2 weeks and after that was advised to limit activities that caused discomfort. In addition, she was placed on appropriate calcium and vitamin D supplementation based on results of her laboratory workup. The patient is a basketball player and would like to begin practicing with the team in 1 week. She says she is now able to walk without discomfort but has not tried running or jumping. Which one of the following is necessary for this patient to be able to return to basketball participation next week?

A 13-year-old baseball pitcher develops pain in the upper arm at the shoulder when throwing and is diagnosed with Little League shoulder. This entity is actually a?

A 4-year-old female slipped and fell off the edge of a dock but did not go underwater because her mother caught her by the hand and pulled her back. Since that time she has been upset and has not wanted to play, keeping her arm slightly bent and close to her side. The physical examination supports your initial diagnosis. Which one of the following would be the best management?