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RB Y2 MSK 03 - Spine and Paediatric Orthopaedics > 2. Neuromuscular Disorders > Flashcards

2. Neuromuscular Disorders Flashcards

1
Q

cerebal palsy

A

chronic disorders of posture and movement caused by non progressive CNS lesions sustained before 2 years old

resulting in delayed motor development, evolving CNS signs, learning disability and epilepsy

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2
Q

cerebal palsy: causes

A

genetic problems

brain malformation

intrauterine infection

prematurity

intra cranial haemorrhage

hypoxia during birth

meningits

labour

idiopathic

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3
Q

cerebal palsy: most common expression

A

spastic - 80%

injury to motor cortex, upper motor neurones or corticospinal tract resulting in weakness and spasticity

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4
Q

cerebal palsy: ataxic

A

affects cerebellum

reduces coordination and balance

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5
Q

cerebal palsy: athetoid

A

affects extrapyramidal motor system, pyramidal tract and basal ganglia

causes uncontrolled writhing motion, sudden changes in tone and difficulties controlling speech

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6
Q

cerebal palsy: monogenic

A

affects one limb

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7
Q

cerebal palsy:hemiplegic

A

affecting one ipsilateral upper and lower limb - most common

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8
Q

cerebal palsy: diplegic

A

both legs only

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9
Q

cerebal palsy: quadriplegic

A

all 4 limbs usually with learning disabilities

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10
Q

cerebal palsy: developmental milestones

A
  • may be delayed in children
  • ATNR reflex persists past 6 months
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11
Q

cerebal palsy: MSK problems

A

joint contracture, scoliois and hip dislocations

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12
Q

cerebal palsy: non surgical treatment

A

physio

splintage to prevent contracture

baclofen and botox injection for spastic muscles

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13
Q

cerebal palsy: surgical treatment

A

hip excision or replacement

surgical release of joint contracture

correction of severe scoliosis

joint fusion

tendon transfer

selective dorsal rhizotomy can help some cases of spasticity

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14
Q

spasticity

A
  • muscle continuously contracted
  • spasticity is thought to be caused by an excessive increase of excitatory signals from sensory nerves without inhibition by GABA.
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15
Q

joint/muscle contracture

A

permanent shortening due to prolonged hypertonic spasticity

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16
Q

spina bifida:

A

congeital disorder where 2 halves of the pos vertebral arch fail to fuse

17
Q

mildest form of spina bifida

A

spina bifida occulta

18
Q

spina bifida occulta

A

may be no associated problems, but some can develop tethering of the spinal cord and roots which can cause a high arched foot (pes cavus) and clawing of the toes

neurological symptoms are not common but can occur at any age

19
Q

spina bifida occulta - tell tale sign

A

dimple/hair tuft overlying defect

20
Q

spina bifida: severe form

A

spina bifida cystica

21
Q

two types of spina bifida cystica

A

meningocele and myelomeningocele

22
Q

meningocele

A

contents of vertebral canal herniate through the defect with herniation of meninges alone

23
Q

myelomeningocele

A

contents of vertebral canal herniate through the defect with herniation of the spinal cord/cauda equina

neurological defect

24
Q

what is spina bifida cystica associated with in the brain

A

hydrocephalus -excess CSF around the brain raising intracranial pressure

25
Q

how may hydrocephalus be treated

A

shunt from the ventricles of the brain to either RA, pleural cavity or peritoneal cavity

26
Q

spina bifida - MSK features

A

spinal deformity and hip dislocation common

contracture can occur

27
Q

polio

what is it and where does the infection affect

A

(poliomyelitis)

viral infection that affects motor anterior horn cells resulting in lower motor neuron deficit

28
Q

how common is polio now

A

vaccination has eradicated new cases in modern healthcare systems however older patients with long term effects from childhood cases are sometimes encountered

29
Q

how does polio present

A

flu prodrome for 48h

pre-paralytic stage

<50% progress to paralytic stage - usually affecting muscles of one limb

joint deformities and growth defects can occur with shortening of the limb

30
Q

how are deformities (eg of foot and ankle) and flail joints treated in polio

A

arthrodesis - surgical immobilisation of the joints by fusion of the bones

31
Q

how is residual paralysis in polio treated

A

splintage - caliper, orthotics

32
Q
A

RB Y2 MSK 03 - Spine and Paediatric Orthopaedics (9 decks)

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