FRACS Orthopaedic Exams

iSAWEs

An eleven-year-old boy had neck pain for two weeks followed by the development of persistent torticollis. The neck pain gradually increased, and the symptoms did not improve after the administration of antipyretic drugs.
Four weeks after the onset of symptoms, the boy required walking aids because of severe neck pain and persistent torticollis; the neck was bent to the left side and slightly rotated to the right side. Physical examination revealed stiffness, pain upon motion of the cervical spine, and tenderness of the left upper cervical spine. There were no neurological deficits. Blood tests showed a slightly increased C-reactive protein level of 0.5 mg/dL (5 mg/L) (normal, 0.0 to 0.4 mg/dL [0 to 4 mg/L]) and alkaline phosphatase of 414 U/L (normal range for an adult, 90 to 340 U/L), while the white blood-cell counts were within the normal range.

A CT scan and an MRI were performed:

 

1. What is the diagnosis?
2. How will you treat this boy?

 

Webpage Last Modified: 17 July, 2011
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