4: Peds Ortho Flashcards
· What is DDH
Developmental dysplasia of the hip (Congenital)
o Abnormal formation of the hip joint
o Femoral head unstable in the acetabulum
o Head of the femur may be loosely in the acetabulum/completely dislocated
o Can lead to pain and osteoarthritis by early adulthood
Tests for DDH
Barlow’s test- flex and adduct the hips= positive sign= femoral head dislocates posteriorly to the acetabulum
ortolani’s Test- hip is abducted back into the acetabulum, should hear an audible clunk as it returns into place
Pavlik: Soft splint
· Helps keep the hips and knees bent and the thighs spread apart
· Positions head of the femur deeper into the acetabulum
· Commonly used in infants up to the age of six months
Hip Abduction Brace:
· May be used if DDH is diagnosed after age 6 months.
· Allows a child to walk or cruise.
· Same positioning purpose as Pavlik Harness
closed reduction: DDH
· May be used after 6 months, as the child is often too mobile for the Plavik harness
· Hip is put back into place under anesthetic
· Then child wears a hip spica cast to keep pressure on the joint
What is· LCPD
Legg-Calve-Perthe’s Disease
· Rare disease of the hip
· Affects boys 4 -5x more often than girls
· Involves degeneration of the head of the femur
· Disturbance in blood flow, followed by subsequent regeneration
· Diagnosis usually between 2-12 years old
· Average age of 6
· About 5% bilateral
Clinical Signs & Symptoms: LCPD
· Limp and/or Trandelenburg gait
· Mild pain in the groin, medial thigh or knee
· Decreased ROM, especially hip abduction and internal rotation
· Atrophy of the thigh, calf and gluteal muscles
· Possible leg length discrepancy
Prognosis:LCPD
4 year progression
· Considered a “self-limiting” condition
Treatment: LCPD
o Mild cases: close monitoring
o Moderate cases: abduction braces and exercises
o Severe cases: possible surgery
Torticollis
· Occurs at birth or up to 2 months of age
· Child’s head is tilted towards, and rotated away from, a tight sternocleidomastoid muscle
Torticollis Treatment (just the stretch & positioning)
· Gentle ROM
· Strengthening head and trunk muscles as infant gains control of upright postures
· Manual stretching most common form of treatment
· Stretching exercises
· 4 to 6 times a day
What is · Plagiocephaly
o Refers to asymmetrical head shapes
o Caused by deformation of the skull
o Also known as positional plagiocephaly
o Produced by extrinsic forces acting on a normal skull
3 patterns of Plagiocephaly
o right occiput- right is flat
o left occiput
o central occiput
Importance of tummy time
Takes pressure off of the back of their skull, strengthens neck muscles
Why babies sleep on their backs
SIDS
· Clubfoot- 3 types
o Talipes Equinovarus- foot is plantar flexed and inverted
o Calcaneovalus- Foot is sharply dorsiflexed and everted
o Metatarsus Adductus- front part of the foot is adducted
Clubfoot TX
o Stretching
o Serial casting
o Most common treatment
o Foot is manipulated as far as it can go without pain and a plaster cast applied
o Repeated every 1-2 months
· Leg Length Discrepancy
2.5 cm (or greater) difference in length
o Due to overgrowth or shortening of the limb
Associated Impairments of clubfoot
o Functional scoliosis
o Gait abnormalities
o Abnormal loading of the lower extremity joints
Physiotherapy Treatment of clubfoot
· Stretching and strengthing exercises in preparation for surgery
· Crutch fitting and instruction in restricted weight bearing activities
· ROM and isometric exercises
· Post operative care
What is JRA
· Characterized by chronic joint inflammation
· Most prevalent form of juvenile arthritis
· Autoimmune disorder (ie, immune system begins to attack
JRA: Pauciarticular:
Pauciarticular: Four or fewer joints are affected
Most common form Typically affects large joints (ex: knees)
About half of all children with JRA have this type
JRA: Polyarticular:
Five or more joints are affected,
Small joints (ex: hands and feet) are most commonly involved
disease may also affect large joints
Effects are often symmetrical
~30% of all children with JRA have this type
JRA: Systemic: AKA Still’s disease
· Characterized by fever and light skin rash
· May also affect internal organs (ie, heart, liver, spleen, and lymph nodes)
· Still also involves joint swelling
· ~20% percent children with JRA have this type
Symptoms of JRA
o joint pain, stiffness, and swelling
o loss of joint function
o Limping
o joint deformity
o eye irritation
o Rash
o weight loss
o growth problems
Physiotherapy treatment: JRA
· Help maintain joint mobility, muscle strength & function
· Activities such as biking and swimming -no weight bearing, low impact, open chain
o Help promote joint mobility with less stress
· Maintaining muscle strength support & protect joints
· Safe cardiovascular activity
· Encourage family involvement to increase fun & desire to participate
· Osteogenesis Imperfecta
· Brittle Bone Disease
Inheritance pattern of OI
Autosomal Dominant
Pathology of OI
Caused by a genetic defect that affects the body’s production of type 1 collagen
o Forms main protein of extracellular matrix of skin, bones, tendons, etc.
o Type 1
o Affects connective tissue and bone
Symptoms of OI:
· Osteoporosis
o Leads to fractures and bone deformities
· Discoloration of sclera (white of the eye)
o Blue or gray
· Discolouration and weakness of teeth
o Blue/gray or yellow/brown in colour
o Affects baby and adult teeth
· Hearing impairments
Other complications of OI
medical
o Respiratory infections
o Cardiac issues
o Kidney stones
o Tumour (osteogenic sarcoma)
o Joint conditions
o Basilar invagination
o Eye conditions and vision loss
o Malignant hyperthermia
Physio treatment focus of OI
o Developing optimal bone mass and muscle strength
o Independent mobility
· wheelchairs, braces, and other mobility aids – especially in more severe cases
· Low-impact exercises- swimming to help maintain strong bones
What is · Osgood-Schlatter’s
***Inflammation of the epiphysis where the patellar tendon attaches to the tibial tuber
Symptoms of OS-
· Anterior knee pain
o with/without swelling,
o Aggravated by physical activities-running, jumping, kneeling, stairs, etc.
· Tibial tuberosity (tender on palpation)
· Increased bony protuberance at the tibial tuberosity (rare)
· Tightness of Quadriceps (Ely’s Test)
· Painful resisted isometrics of Quadriceps
Treatment: OS
· Often self-limiting and goes away when the child stops growing
· Controlling pain & inflammation
o Ice
o Rest
o Modalities
o Patient education re: management of condition
o Splinting/taping
· Exercise OS
o Maintenance of quadriceps strength with pain-free exercise- isometric, gentle, closed chain
· Scoliosis
excessive curvature of the spine
Happens later in childhood
o Diagnosed when other causes are ruled out
Diagnosis-Scoliosis- Cobb angle
Cobb angle >10ᵒ (concave)=positive
· Adam’s Forward Bend: Scoliosis
patient bends over and examiner looks along the horizontal plane of the spine, searching for abnormalities of the spinal curve, like increased or decreased lordosis/ kyphosis, and an asymmetry of the trunk.
Symptoms: Scoliosis
-Sideways curvature of the spine
* Sideways body posture
* One shoulder raised higher than the other
* Clothes not hanging properly
* Muscular aches
* Decreasing pulmonary function in progressive curves
- Progression: Scoliosis
howis it measured, what happens?
curve progression estimated by measuring the Cobb Angle
* As the curve progresses, there may be a rotation element, affecting the ribs
- Treatment: Scoliosis
and why its done
-Exercise
* May be done in conjunction with bracing
* To maintain overall flexibility
* To maintain/increase mobility of the thoracic spine and ribs
* Overall cardiovascular fitness
· Patellofemoral Pain Syndrome
Umbrella term for pain arising from the patellofemoral joint or adjacent soft tissues
o Q-angle
Normal (with quads relaxed)
o < 15° in biological males
o < 20° in biological females
o An abnormally large Q-angle may result in knee problems
o Etiology: PFPS
-patellar trauma
o overuse and overload
o anatomical or biomechanical abnormalities
o muscular weakness, imbalance or dysfunction.
o Excessive overload and abnormal tracking of the patella
Muscular etiology PFPS
- Weak quads, Weak medial Quads, Tight IT band, Tight Hamstrings, Weak/Tight hip muscles, Tight calf muscles
o Symptoms: PFPS
Aggravated by activities that increase patellofemoral compressive forces
o Ascending/descending stairs
o Sitting with knees bent
o Kneeling
o Squatting
o Clinical Signs
o Pain on muscle contraction AND squatting
o 2 out of 3 of: pain on contraction, pain on squatting, pain on palpation
o 3 out of 3 of: pain on muscle contraction, pain on squatting, pain on kneeling
o Treatment (non-surgical) PFPS
o Correction of patellar alignment
o bracing / taping
o Stretching + strengthening exercises, particularly vastus medialis
o Informed by which muscles are causing issues
o Mobilization of the patellofemoral joint
o Muscle stim
o Can work on imbalance
o Foot orthoses
