Common Pediatric MSK Concerns


1. A six-year old girl is assessed for abnormal gait. Her parents are concerned that she tends to trip more than other children her age. She is a first-born child with no known health problems. Her parents have not noted any complaints of pain or limp. Physical exam reveals that both feet tend to point medially ("negative" foot-progression angle) when she walks. When she lies face down (prone exam) she has 90 degrees of internal rotation and 45 degrees of external rotation at the hips bilaterally. The lateral border of her foot is straight. Based on the information above, which of the following explains this child's presenting complaint?
  1. Parental anxiety
  2. Internal tibial torsion
  3. Bilateral developmental dysplasia of hips
  4. Femoral anteversion
  5. Forefoot adductus
2. This is a photograph of the patient described above. Describe the direction of her tibial torsion:


  1. Internal
  2. Neutral
  3. External

3. Which of the following descriptions is typical of the usual presentation of adolescent idiopathic scoliosis?
  1. Upper back pain
  2. Lower back pain
  3. Deformity noticed by patient
  4. Deformity noted by others
4. What is the significance of a 15o scoliosis in a pre-menarchal 10-year old girl?

Check answer

5. You evaluate a 16 year old girl because of a newly noted spinal deformity. She has a 20 degree thoracolumbar curve that appears to be idiopathic by history, physical and review of radiographs. Her bone age is equal to her chronological age. She reports that she had her first period at age 11If untreated, what is the most likely outcome from this patient's scoliosis?
  1. No problems
  2. Mild back pain
  3. Severe back pain
  4. Cardiopulmonary complications in midlife