A disjointed effort: paediatric musculoskeletal examination

Gill, Irwin; Sharif, Farhana

doi:10.1136/archdischild.2011.301180

Cited by 11 publications

(5 citation statements)

References 6 publications

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“…Several authors have cited a lack of confidence in musculoskeletal diagnostic skills amongst primary care physicians as a reason for the high rate of unnecessary referrals [21][22][23][24][25][26][27][28], and have called for improved musculoskeletal education as part of entry-level medical education. The American Academy of Paediatrics in 2002 published guidelines for primary care physicians on referral for specialist opinion [29], but subsequent studies found that this publication has had no effect on referral patterns [1,30].…”

Section: Discussionmentioning

confidence: 99%

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics

Mir

Cooney

O’Sullivan

et al. 2016

Journal of Children's Orthopaedics

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BackgroundThe demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady’s Children’s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.PurposeTo evaluate the efficacy of the service over the 3-year period from January 2011 to December 2013.MethodsA review of the prospectively gathered database was performed in order to establish the demographic profile of patients, investigate clinic outcomes, and evaluate the reduction in patient waiting times.Results2650 patients were managed by the clinic over the 3-year period. A total of 77 % of patients were managed without consultant intervention. Fifty-three percent of patients were diagnosed as having a normal presentation. The mean waiting time reduced from 101.9 weeks pre-2010 to 15.4 weeks in 2013 for those patients managed by the POTC.ConclusionSince its inception, the clinic has significantly reduced waiting times for routine elective paediatric orthopaedic patients while managing the majority of patients independent of surgical opinion. This study shows that the APP can deliver high-quality care in the paediatric orthopaedic setting, benefitting both patients and service.

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Section: Discussionmentioning

confidence: 99%

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics

Mir

Cooney

O’Sullivan

et al. 2016

Journal of Children's Orthopaedics

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“…Despite the frequency of these complaints, a significant number of pediatricians are not confident in their skills to examine the musculoskeletal system properly [6], and musculoskeletal examination is not routinely performed during pediatric admissions [7,8].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of musculoskeletal pain in a pediatric emergency department

et al. 2015

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The objectives of this study were (1) to determine the percentage of emergency department (ED) visits due to musculoskeletal pain (MSP) by children 3-14 years of age during a period of 1 year; (2) to determine the most frequent presenting complaints; and (3) to characterize their etiology. A cross-sectional study was performed on children aged 3-14(11/12) years attended at the ED of a tertiary hospital due to MSP. The demographic and clinical characteristics of the patients were reviewed 5 days each month for 12 consecutive months. Study days were selected by computer-generated simple random sampling. Out of 4,531 visits to the ED, 826 were due to MSP (18.2 %; 95 % CI 17.1-19.4 %). When compared with children with no skeletal complaints, children with MSP had a similar sex distribution but were older (mean ± SD 7 ± 3.5 years vs 9.9 ± 3.1 years; p < 0.0001). The most common complaints were pain at the wrist (19 %), ankle (19 %) and finger (15 %). The most common etiology was trauma (88.4 %), including contusions (38 %), fractures (21 %) and sprains (18 %). Children with hip (6.7 ± 3 years; p < 0.0001) and elbow (7.8 ± 3.5 years; p < 0.0001) complaints were younger than children with pain in other locations, whereas children with wrist pain (10.5 ± 2.6 years; p < 0.002) and joint sprains (10.7 ± 2.7 years; p < 0.0001) were older. Fractures were more frequent in boys (64 vs 36 %, p = 0.008; OR 1.6; CI 1.1-2.2). Visits to the ED due to MSP increased with age. Pain at three locations represented 50 % of the presenting complaints. Trauma was the principal etiology, but fractures only represented one-fifth of the total.

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“…Initial suspicion in these cases was traumatic origin (painful pronation predominantly). As we mentioned before, there is a lack of awareness in relation to musculoskeletal examination in formative programs in pediatrics, 5 that could explain this phenomenon. On the other hand, we would like to emphasize how important a correct anamnesis is to know the causal mechanism of the traumatic lesion.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the lack of knowledge about musculoeskeletical physical examination might also be a contributing factor. 5 Delay in starting treatment could increase the risk of complications and sequels.…”

mentioning

confidence: 99%

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Characteristics of Upper Limb Osteoarticular Infections at the Emergency Department of a Tertiary University Hospital in Spain

Espín¹,

Loza

Plasin³

et al. 2020

Pediatr Emer Care

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Objectives: Osteoarticular infections are infrequent in pediatric patients, although their incidence seems to be increasing. They usually affect children younger than 5 years and tend to localize in the lower limbs. Because of their nonspecific symptoms, especially at onset, a timely diagnosis is difficult to achieve, with the subsequent risk of a delay in treatment. We hereby report the management of osteoarticular infections in our pediatric emergency department.Methods: This is a retrospective descriptive study of patients diagnosed with osteoarticular upper limb infection in the pediatric emergency department of a tertiary hospital from January 2011 to December 2016.Results: From an initial global sample of 170 patients diagnosed with osteomyelitis or septic arthritis at any location at the pediatric emergency department, 32 children (18.82%) with upper limb involvement were included in the study. Of them, 22 were male and the mean age at diagnosis was 14.5 months (interquartile range, 2-106). Eighteen patients (56%) were diagnosed with septic arthritis, and 14 (44%) had a diagnosis of osteomyelitis.The most frequent symptom was pain (50%). More than one third of patients (11) had received a different diagnosis in a previous hospital visit. A traumatic etiology was suspected in 7 cases (21%).Regarding acute phase reactants, the mean value for C-reactive protein was 21.3 mg/L, and erythrocyte sedimentation rate was elevated in 27 cases (84%). In 28 patients, blood cultures were obtained, 24 of which came back negative. All children received antibiotic treatment and achieved a full recovery.Conclusions: One third of patients were misdiagnosed at the first consultation, which stresses the importance of a high clinical suspicion to avoid delays in diagnosis and treatment of osteoarticular infections. This study also shows a lower mean age of children with upper limb infection as compared with those with lower limb infection. All patients recovered fully with oral antibiotics.

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A disjointed effort: paediatric musculoskeletal examination

Abstract: MSK examination is not performed routinely during paediatric admissions in contrast to the examination of other symptoms regardless of the presenting complaint. This may need to be addressed by local audit and increased undergraduate teaching.

Cited by 11 publications

References 6 publications

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics

Epidemiology of musculoskeletal pain in a pediatric emergency department

Characteristics of Upper Limb Osteoarticular Infections at the Emergency Department of a Tertiary University Hospital in Spain

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