Transcript

Pediatric musculoskeletal disorders: Pathology review

From Osmosis from Elsevier · Episode page · Watch on YouTube

· 24 min · 3,756 words · 31 timestamped sections

This is the full, timestamped transcript of "Pediatric musculoskeletal disorders: Pathology review", an episode of Osmosis from Elsevier published December 9, 2025 (24 min, about 3,756 words). It mentions 9 people, works and ideas, including radial head subluxation, Osgood Schlatter disease, developmental dysplasia of the hip, greenstick fracture, Legg-Calvé-Perthes disease.

What is discussed, and when

  1. – 5:00: developmental dysplasia of the hip, Osgood Schlatter disease, radial head subluxation
  2. – 15:00: Osgood Schlatter disease
  3. – 20:00: radial head subluxation, Boeing fracture, Taurus fracture
  4. – 24:29: radial head subluxation, developmental dysplasia of the hip, Osgood Schlatter disease

Notable quotes from "Pediatric musculoskeletal disorders: Pathology review"

  • Femoral epiphosis, osgood schlatter disease, patellofhemeral syndrome, radial head subluxation, and a variety of bone fractures.
    about radial head subluxation · at
  • For diagnosis, on an X-ray, a Taurus fracture can often be seen as a small bulge on one side of the bone.
    about Taurus fracture · at
  • Finally, we have Boeing fracture, also known as plastic deformity. This occurs when the bone shaft is exposed to a longitudinal force that exceeds the bone's ability to return to its normal.
    about Boeing fracture · at

Who and what is mentioned in this episode?

Concepts & topics

Full transcript with timestamps

A 13-year-old boy named Lucas comes to the clinic for right knee pain, which gets worse when he is running, jumping, or climbing stairs. Upon further questioning, Lucas mentions that he plays basketball for his school team. And recently, he started training more intensely for an upcoming tournament. On physical examination, you were able to move his hip in all directions with no resistance or pain, but you notice that his right knee has a more prominent tibial tubacle, which is also tender to the touch. Some days later, a 4-year-old girl named Sophia is brought to the clinic by her parent. Earlier that day, Sophia's older sibling was swinging her by the arms.

Since then, Sophia has been experiencing pain in her right arm when she tries to move it. On physical examination, you notice that Sophia is holding her arm by her body and cries when you try to move it. You decide to quickly hyperronate her arm, after which Sophia becomes able to use her arm again without pain. Okay. Both Lucas and Sophia seem to have some form of a pediatric muscularkeeletal condition, meaning a condition that commonly affects the muscles, bones, or cartilage of individuals younger than 18 years. for your tests. The most high yield pediatric muscularkeeletal disorders include developmental dysplasia of the hip, leg calvees disease, slipped cap femoral epiphosis, osgood schlatter disease, patellofhemeral syndrome, radial head subluxation, and a variety of bone fractures.

Enjoying our osmosis videos? Unlock your full potential with an Osmosis subscription. Get unlimited access to every Osmosis feature and resource with a free 7-day trial. Okay, let's start with developmental dysplasia of the hip or DDH, which is also known as congenital hip dysplasia. In DDH, the femoral head dislocates out of the acetabulum during development in uterero. For your exams, it's important to keep in mind that this is more common in twin or multiple pregnancies where the fetuses have to share the space within the uterus, which may put a lot of pressure on them, as well as in firstborns because the mother's uterus is not as stretched out or when the fetus is lying in a breach position within the mother's uterus with its buttock near the cervix at the time of delivery. Another situation that can lead to DDH is oligo hydramnio where there's not enough amniotic fluid to expand the uterine cavity. so the fetus

can have enough room. In any case, over time, as the femoral head spends a lot of time outside of the acetabulum, the acetabular ligaments and fatty tissue start expanding to fill the space that would normally be occupied by the femoral head. At the same time, remember that during the development, the femoral head functions as a template around which the acetabulum is formed. So without it in DDH the acetabulum turns out shallow making it a poor fit for the femoral head. Another thing to note is that this misalignment of the hip may eventually wear down the articular cartilage leading to the development of osteoarthritis in early adulthood.

Symptoms of developmental dysplasia of the hip may vary according to age. In a test question, look for a newborn or infant with legs of unequal length or asymmetric skin folds along the thigh or glutial area. On the other hand, older kids may present with painless limping or hip pain that can radiate to the knee. Diagnosis of developmental dysplasia of the hip in babies starts with the physical examination. For your exams, you must remember two maneuvers. In the barlo maneuver, the baby's hip and knee are flexed to 90°. then adducted while applying a gentle posterior force to the femur. In a baby with hip dysplasia, this maneuver will cause the femoral head to pop out of the socket, which you'll feel as a distinct clunk, indicating a positive test. On the other hand, in the Ordolani maneuver, the baby's hip is flexed to 90°, then gently abducted while placing anterior pressure on the greater troanter. If the femoral

head is out of the socket, this maneuver will cause it to slip back into the acetabulum, which would feel and sometimes sound like a clunk. This indicates a positive ordalani test. In addition, imaging techniques like ultrasound can be used in children younger than 4 months of age so as to assess the position of the femoral head and the structure of the acetabulum. On the other hand, X-rays are recommended for children older than 4 months as the hip cartilage begins to oify and can become easily visible on X-ray. Now, the treatment of congenital hip dysplasia depends on the age of the child and extent of the deformity.

Before 6 months of age, abduction splints can be used for a period of 1 to two months, such as the Pavlic harness that holds the hip joint flexed and abducted. This helps to keep the femoral head within the socket to promote normal hip joint development. For those older than 6 months, closed manual reduction of the femoral head into the acetabulum can be performed under anesthesia. If this doesn't work, open surgical reduction might be necessary. All right, moving on to leg calvetes disease. This is a hip disorder that occurs when the blood supply to the head of the femur gets disrupted. Normally the head of the femur is supplied by three main arterial branches which are the medial and lateral circumflex arteries and the artery of ligamentum terries. In leg calvees disease the blood supply to the femur is disrupted and this causes the bone to stop growing and die off a process called avascular

necrosis. The reason why this happens is not exactly known which is why it's also called idiopathic avascular necrosis of the femoral head. However, the main risk factor to keep in mind is repeated minor trauma to the hip joint, which might be associated with a child's hyperactivity. In any case, over time, the femoral head becomes more fragile and prone to fractures. Over time, the weakened bone may lose its normal round shape and become flattened, so it can no longer smoothly rotate inside the acetabulum. Symptoms of leg calvees disease most commonly present in males between the age of 3 and 12 years and include a gradual onset limp with or without hip pain that typically gets worse with activity. One high yield fact to remember for your tests is that the hip pain in leg calve per disease can sometimes refer to the knee. So these kids might initially complain of knee pain. On physical examination, remember

that it's common to find a limited range of motion which is particularly evident for abduction as well as internal rotation of the hip. Diagnosis of leg calve per disease is based on imaging studies like x-ray of the hip which can show fragmentation or flattening of the femoral head. However, for your tests, keep in mind that early on in the disease, X-ray can be normal and in this case, MRI can be useful to confirm the diagnosis. Treatment of leg calvees disease is typically conservative and may include reduced weightbearing on the affected side, physical therapy, and pain management. In severe cases with extensive damage to the femoral head, surgery might be recommended.

Next up is slipped capital femoral epiphosis or skiffy for short. Now long bones such as the femur have a diaphosis or bone shaft, a metaphysis or neck portion on each side and an epiphosis at each end. And remember that the proximal one is the femoral head. Between each metaphysis and epiphosis there's the ficus or growth plate which is a cartilagynous structure that enables growth. Normally as an individual is growing the growth plate is relatively weak and vulnerable to shearing forces. Eventually around the age of 16 in females and 19 in males the growth plate oifies and fuses with the epiphosis.

In skiffy increased stress on the growth plate causes it to break and this leads the femoral head to slip away from the neck just like a scoop of ice cream slipping off a cone. Now keep in mind that the femoral head remains well held in the acetabulum by the joint capsule and the ligamentum terries. So the movement happens at the femoral neck which gets displaced antrolaterally and superiorly and this is actually high yield. Now the exact cause of skiffy is unknown but what's important to remember for your tests is that it is often associated with obesity. That's because the increased weight is thought to increase the mechanical force on the growth plate causing it to break. In addition, hormonal changes that normally occur during adolescence or with endocrine disorders like hypothyroidism can make the growth plate weaker.

Symptoms of slipped cap femoral epiphosis typically present between the ages of 10 and 16 years and include hip pain that becomes worse with activity and may sometimes refer to the thigh or knee. This can also result in limping. On physical examination, remember that these individuals often also have reduced range of motion, especially with hip movements that involve abduction and internal rotation. Diagnosis of slipped cap femoral epiphosis includes imaging studies like a hip x-ray. To better visualize both hip joints, the x-ray should be obtained in both an anterior view as well as a lateral view with the individual sitting in a froglike position. Some characteristic x-ray findings of skiffy include widening of the growth plate as well as antrolateral and superior displacement of the femoral neck relative to the head.

Treatment of skiffy generally involves decreasing weight bearing on the affected side in addition to surgery to realign the femoral head and neck using a screw. Moving on to Osgood Schlatter disease. This refers to inflammation of the tibial tubacle which is a small bony prominence at the proximal tibia. What's important to know is that the tibial tubacle serves as an apothesis or attachment site for the patellar tendon which arises from the patella. In this way, contraction of the quadriceps muscles can pull the patella and tibial tubacle causing extension of the knee joint and this allows you to walk, climb stairs, run and jump. And what you need to remember for your exams is that at birth the tibial tubacle consists of cartilage but between the ages of 9 and 15 it begins to oify and at around the age of 18 becomes a bony tuberosity and that's a high yield fact.

The cause of Osgood Schlatter disease is not exactly understood, but it's thought that intense physical activity that involves repeated sprinting and jumping like when playing basketball and volleyball can expose the tibial tubacle to constant strain and traction. This results in inflammation, partial avulsion or tearing and fragmentation of the tibial tubrical which is called traction apocitis. When this happens over a long period of time, the chronic inflammation is followed by a healing process which occurs by laying down new bone at the tibial tubacle causing it to be more prominent.

Symptoms of Osgood Schlatter disease typically present between the age of 10 and 14 years after the growth spurt and include progressive anterior knee pain. For your exams, what's important to remember is that this pain gets worse when going up or down stairs, as well as with physical activities like running, jumping, and squatting. On physical examination, what you'll often see is swelling or a prominent enlargement of the tibial tubacle. Now, for the diagnosis of Osgood Schlatter disease, no imaging is needed if the clinical picture fits. If an X-ray is done, it might show fragmentation of the tibial tuberosity.

For treatment of osgood schlatter disease, all that's typically needed is nonopiate pain medication, temporarily reducing physical activity, and applying ice to the tuberosity to reduce the swelling. That's because the disease is usually self-resolving once the individual stops growing. In the meantime, wearing a knee pad to protect the tubercal can be helpful, as can physical therapy. Next is patellofhemeral syndrome which affects the patellofhemeral joint. Normally this joint is formed by the patella that sits onto the trolear groove on the distal part of the femur and is covered by a slippery articular cartilage that allows for smooth movement when flexing or extending the knee. In patellofhemeral syndrome, there's inflammation that results from mechanical stress between the patella and the tlear groove which is often linked to overuse of the patellofhemeral joint which is common in runners. That's

why patellofhemeral syndrome is also called runner's knee. And this is a high yield fact. And for your exams, remember that patellofhemeral syndrome affects females more than males. So in a test question, look for a female athlete. Another less frequent cause of patellofhemeral syndrome is malignment of the patella with the tlear groove, which could be due to knee trauma or weakness of the quadriceps muscles and results in uneven distribution of the mechanical load. Symptoms of patellofhemeral syndrome typically begin during adolescence and include anterior knee pain that's often described as being around or behind the patella. The pain typically gets worse with knee flexion as in running, squatting, climbing stairs, and prolonged sitting. On physical exam, one high yield test to remember is the patellofhemeral compression test in which pressing on the patella into the tlear groove reproduces the pain.

Now the diagnosis of patellofhemeral syndrome is mainly based on history and physical examination. However, X-ray of the knee can sometimes be done to rule out other causes of knee pain such as osteoarthritis and fractures. Treatment of patellofhemeral syndrome is mainly conservative which involves rest from physical activities like running and pain management by using anti-inflammatory medications like NSAIDs. Physical therapy might also help to strengthen the quadriceps muscles which helps stabilize the patellofhemeral joint.

All right. Another pediatric muscularkeletal disorder that you need to know for your tests is radial head subluxation. Normally the head of the radius is attached to the radial notch on the ulna by the annular ligament. This allows the joint to remain stable and rotate during supination or when the forearm is turned outward as well as during pronation which is when the forearm is turned inward. Radial head subluxation typically occurs in children younger than 5 years when the annular ligament has not fully developed yet. In a test question, look for a case of a sudden forceful pull on the child's forearm. This causes the annular ligament to slip over the head of the radius, preventing the radial head from spontaneously relocating into its normal place.

Symptoms of radial head subluxation typically include an inability to move the affected limb due to elbow pain that aggravates with movement. What's especially high yield is that the child will typically hold the affected forearm in a pronated and extended or slightly flexed position. Diagnosis of radial head subluxation is mainly based on history and physical examination. Imaging studies like X-ray can be done to rule out other causes of elbow pain like fractures if needed. Treatment of radial head subluxation aims at returning the radial head into its normal place. To do this, you should remember two maneuvers. The first one involves supenating the forearm while fully flexing the elbow and the other one involves hyper pronation of the forearm which is more effective and less painful.

Okay, moving on to pediatric bone fractures. What's important to remember is that pediatric bones are not merely smaller versions of adult bones. In fact, they have unique characteristics such as a thicker and stronger perryostium. Now, pediatric fractures can be classified as complete, where high energy forces cause the bone to break from side to side, or incomplete, where the bone doesn't break completely, and usually only one side of the bone is involved. For your exams, keep in mind that incomplete fractures are particularly common in children due to the presence of the stronger perryostium, which can better resist forces applied to bones. Treatment of bone fractures generally involves immobilization of the affected limb in addition to the use of removable splints or casts to allow the bone to heal. Some severe or displaced fractures may require surgery.

Now the four high yield types of pediatric fractures include Taurus fractures, green stick fractures, Boeing fractures, and physial fractures. All right, let's start with Taurus or buckle fracture, which usually occurs following a fall on outstretched hands, also known as a foo injury. for your exams. Remember that this type of fracture commonly affects the metaphysis of long bones because it's where the bone is most porous and thus the weakest spot. Taurus fractures typically occur following an axial or longitudinal force that compresses one side of the bone called the compression or concave side.

This leads the bone's perryostium and cortex on that side to buckle and produce a bulge, hence the name Taurus, which is a Latin word that means a bulge or protuberance. In contrast, the other side of the bone, called the tension or convex side, remains intact. For diagnosis, on an X-ray, a Taurus fracture can often be seen as a small bulge on one side of the bone. Next, there's the green stick fracture, which typically occurs due to a bending force that creates more stress on the convex side of the bone, called the tension side, than the concave side, called the compression side. So in contrast with Taurus fractures with green stick fractures the force can cause the cortex and perryostium on the tension side to break while the compression side will remain intact just like when you try to break a green stick or twig.

Diagnosis of green stick fracture can be confirmed with an X-ray which would clearly show an incomplete fracture with a breach on one side of the bone while the other side would be intact. Finally, we have Boeing fracture, also known as plastic deformity. This occurs when the bone shaft is exposed to a longitudinal force that exceeds the bone's ability to return to its normal shape, but is not strong enough to break it. This causes the bone to bend and assume a more curved or bode shape. So, for your exams, remember that this is actually a shape deformity and not a true fracture. However, it's often associated with microscopic fractures in the perryioium of the bone.

To diagnose a Boeing fracture, an X-ray would show bowing or increased curvature of the bone. Now, fractures can also affect the growth plate, also known as the ficis. The main problem is that physial fractures can impair bone growth and lengthening, sometimes leading to growth arrest and asymmetrical length of the limbs. The Sultter Harris system is used to grade growth plate injuries from 1 to 5, where fractures with lower numbers can usually be treated without surgery and are less likely to cause growth arrest, and fractures graded with a higher number often need surgery and can lead to long-term damage. Physial fractures are not ones to sit around and wait on.

The faster an injury is recognized and evaluated by a specialist, the better the chances of a good outcome. All right, as a quick recap, pediatric muscularkeletal disorders include developmental dysplasia of the hip, which can occur when the femoral head dislocates out of its acetabulum in uterro. This is more common with multiple pregnancies, firstborns and breach presentation and presents with leg length discrepancy, asymmetric skin folds along the thigh or buttocks, painless limping or hip pain. Leg calvetes disease occurs when the blood supply to the head of the femur gets disrupted leading to avascular necrosis.

This can occur due to repeated minor trauma and presents with hip pain that may refer to the knee as well as limited hip abduction and internal rotation. Next is slipped capital femoral epiphosis where the femoral head and neck slip away from each other. This most commonly occurs in adolescence with obesity being a major risk factor and causes hip pain that can refer to the thigh or knee limping and limited hip abduction and internal rotation. Osgood schlatter disease or traction apositis refers to inflammation and fragmentation of the tibial tubrical which often occurs with sports that include running and jumping and causes anterior knee pain and tubal enlargement.

Patellofmeral syndrome results from inflammation of the patellofhemeral joint. This is associated with malalignment of the patella with the trolear groove or overuse of the joint as in running and presents with anterior knee pain that gets worse with knee flexion. Radial head subluxation occurs when the annular ligament slips over the head of the radius, preventing the radial head from spontaneously relocating into its normal place, which could result from a fall or a pull on the child's forearms when it's pronated and extended and causes the child to hold the affected forearm pronated and extended or slightly flexed.

Finally, pediatric fractures include Taurus or buckle fractures due to an axial or longitudinal force that breaks the compression side. Green stick fractures due to a bending force that breaks the tension. Boeing fractures, also known as plastic deformity due to a longitudinal force to the bone shaft that causes the bone to bend. And growth plate or physial fractures which can impair bone growth and lengthening resulting in asymmetrical growth of the limbs and angular deformity. Okay, back to our cases. Lucas is a 13-year-old boy who presents with right knee pain that gets worse with running and jumping. This should make you think of a muscularkeeletal disorder of the knee itself, or a disorder that affects the hip joint, where the pain could refer to the knee. The fact that Lucas's hip joint shows full range of motion and no pain should help you exclude hip joint pathologies.

Now, a big clue is his intense basketball training, which is a risk factor for traction. and apophositis. And the key here is the presence of a prominent and tender tibial tubacle, which indicates that Lucas has Ozgood Schlatter disease. On the other hand, Sophia is a 4-year-old girl who presents with right arm pain after her sibling was swinging her by the arms. This combined with the fact that Sophia holds her arm extended and pronated by her body and that her arm pain was relieved after hyper pronation makes this a straightforward case of radial head subluxation.

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Questions about this episode

What is discussed in "Pediatric musculoskeletal disorders: Pathology review"?

In order: 0:00 developmental dysplasia of the hip, Osgood Schlatter disease, radial head subluxation; 10:00 Osgood Schlatter disease; 15:00 radial head subluxation, Boeing fracture, Taurus fracture; 20:00 radial head subluxation, developmental dysplasia of the hip, Osgood Schlatter disease.

What is mentioned in this Osmosis from Elsevier episode?

9 people, works and ideas are mentioned, including radial head subluxation, Osgood Schlatter disease, developmental dysplasia of the hip, greenstick fracture, Legg-Calvé-Perthes disease, patellofemoral syndrome. Each one on this page links to its own page with every episode that mentions it.

How long is "Pediatric musculoskeletal disorders: Pathology review"?

The episode runs 24 min; the transcript is about 3,756 words in 31 timestamped sections.

More from Osmosis from Elsevier

About this transcript: the episode's spoken words as captioned on YouTube, split into timestamped sections. Reclip.Me locates every person, work and idea in the text, keeps the time it is first named, and quotes the words around it verbatim. Last updated January 24, 2026.