11/13 - Pediatric Orthopedics Lisa's peds questions for final

Question 1

Which pediatric conditions may respond best to aquatic therapy?

Answer 1

I haven’t found specifics on this one. Assumed any pathology where the pool would be calming, it would help increase/maintain ROM (those with contractures), increase/maintain strength, and/or be psychologically beneficial for the pt.
1) Juvenile rheumatoid arthritis
2) Gait abnormalities (encourage symmetry of UE and LE)
3) Contracture
4) Scheuermann’s disease (stiffness in thoracic spine) or any disorder that has limited spine motion - swimming will allow fractionation of UE and LE movements hopefully resulting in movement in the thoracic spine
5) Neural mobilization with movements
? 6) Hip dysplasia - Hip ROM limitations; encourages movement, strengthening, helps with contractors; risk of subluxation or dislocation of joint
7) LBP - strengthening of core
8) Spinal instability - strengthening of core
9) Degenerative disc disease
10) Overuse injuries (recovery without impact)
11) Pediatric patients that love the pool and will benefit psychologically getting them into a “normal” environment for them.

Question 2

Treatment for an adult with arthrogryposis in an outpatient orthopedic clinic.

Answer 2

I haven’t found specifics on this one. Treatment depends on the joint(s) impacted. Its often associated with clubfoot. Children born with 1+ joint contractures=abnormal fibrosis of the muscle tissue causing muscle shortening, & therefore are unable to do passive extension & flexion in the affected joint or joints.

The key interventions include:

1) Splinting to extend or flex the joint(s) impacted.
2) Increase/maintain ROM
3) Increase/maintain strength
4) Refer to orthopedic surgeon (via referring doctor) for surgery

Question 3

Factors that may affect prognosis (related to curve progression) for a teen-age girl newly diagnosed with idiopathic scoliosis.

Answer 3

Positive:

1) Determine pt. goals and activities to educate how scoliosis progression could impact them
2) Posture education and breathing - lifelong benefits
3) Goal is to avoid/delay surgery
4) Girls are more compliant than boys in wearing their brace; if compliant with bracing - studies show no or minimal progression in scoliosis

Negative:

1) Social pressure if brace is needed since often 23 hours per day
2) Higher rate of progression with younger patients
3) If bracing is needed, it often results in decreased ROM, strength, small treatment window to initiate bracing, MUST have a good orthotist

Other:

1) Important to educate how weight impacts scoliosis (BMI >85%=2.5x risk of failure and double surgical rate)
2) Is curve flexible? Bracing is best for flexible curves

Question 4

What would you do to treat a 2 month old with torticollis and plagiocephaly?

Answer 4

Torticollis:
At 2 months, the infant is still developing neck musculature and articulation restrictions are not in place, so treatment should be relatively gentle and passive. Encourage baby to activate contralateral SCM/scalenes. The infant does not have ability to muscle guard at 2 mos.
1) Sustained stretching of the involved SCM/scalenes and manual passive stretching
2) Strengthen by encouraging activation of contralateral SCM/scalenes. Example: Hold baby so he/she has to rotate head or lift head towards unaffected side
3) Gentle STM of contracted SCM/scalenes
4) Craniosacral therapy
5) Myofascial release

Plagiocephaly and torticollis:
1) Encourage parents to lie the baby on different sides for different amounts of time to encourage rounding of the skull

Question 5

What pediatric conditions would make picking up a young infant under the arms dangerous?

Answer 5

I haven’t found specifics on this one.

1) OSTEOGENESIS IMPERFECTA (brittle bone)
2) Damage to brachial plexus (most often due to MVA)
3) Shoulder deformity is the most common MSK problem following brachial plexus injury
4) Dislocation of shoulder?