4: Peds Ortho

Question 1

· What is DDH

Answer 1

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

Question 2

Tests for DDH

Answer 2

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

Question 3

Pavlik: Soft splint

Answer 3

· 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

Question 4

Hip Abduction Brace:

Answer 4

· May be used if DDH is diagnosed after age 6 months.
· Allows a child to walk or cruise.
· Same positioning purpose as Pavlik Harness

Question 5

closed reduction: DDH

Answer 5

· 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

Question 6

What is· LCPD

Answer 6

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

Question 7

Clinical Signs & Symptoms: LCPD

Answer 7

· 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

Question 8

Prognosis:LCPD

Answer 8

4 year progression
· Considered a “self-limiting” condition

Question 9

Treatment: LCPD

Answer 9

o Mild cases: close monitoring
o Moderate cases: abduction braces and exercises
o Severe cases: possible surgery

Question 10

Torticollis

Answer 10

· Occurs at birth or up to 2 months of age
· Child’s head is tilted towards, and rotated away from, a tight sternocleidomastoid muscle

Question 11

Torticollis Treatment (just the stretch & positioning)

Answer 11

· 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

Question 12

What is · Plagiocephaly

Answer 12

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

Question 13

3 patterns of Plagiocephaly

Answer 13

o right occiput- right is flat
o left occiput
o central occiput

Question 14

Importance of tummy time

Answer 14

Takes pressure off of the back of their skull, strengthens neck muscles

Question 15

Why babies sleep on their backs

Answer 15

SIDS

Question 16

· Clubfoot- 3 types

Answer 16

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

Question 17

Clubfoot TX

Answer 17

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

Question 18

· Leg Length Discrepancy

Answer 18

2.5 cm (or greater) difference in length
o Due to overgrowth or shortening of the limb

Question 19

Associated Impairments of clubfoot

Answer 19

o Functional scoliosis
o Gait abnormalities
o Abnormal loading of the lower extremity joints

Question 20

Physiotherapy Treatment of clubfoot

Answer 20

· Stretching and strengthing exercises in preparation for surgery
· Crutch fitting and instruction in restricted weight bearing activities
· ROM and isometric exercises
· Post operative care

Question 21

What is JRA

Answer 21

· Characterized by chronic joint inflammation
· Most prevalent form of juvenile arthritis
· Autoimmune disorder (ie, immune system begins to attack

Question 22

JRA: Pauciarticular:

Answer 22

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

Question 23

JRA: Polyarticular:

Answer 23

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

Question 24

JRA: Systemic: AKA Still’s disease

Answer 24

· 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

Question 25

Symptoms of JRA

Answer 25

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

Question 26

Physiotherapy treatment: JRA

Answer 26

· 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

Question 27

· Osteogenesis Imperfecta

Answer 27

· Brittle Bone Disease

Question 28

Inheritance pattern of OI

Answer 28

Autosomal Dominant

Question 29

Pathology of OI

Answer 29

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

Question 30

Symptoms of OI:

Answer 30

· 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

Question 31

Other complications of OI

medical

Answer 31

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

Question 32

Physio treatment focus of OI

Answer 32

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

Question 33

What is · Osgood-Schlatter’s

Answer 33

***Inflammation of the epiphysis where the patellar tendon attaches to the tibial tuber

Question 34

Symptoms of OS-

Answer 34

· 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

Question 35

Treatment: OS

Answer 35

· 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

Question 36

· Exercise OS

Answer 36

o Maintenance of quadriceps strength with pain-free exercise- isometric, gentle, closed chain

Question 37

· Scoliosis

Answer 37

excessive curvature of the spine
Happens later in childhood
o Diagnosed when other causes are ruled out

Question 38

Diagnosis-Scoliosis- Cobb angle

Answer 38

Cobb angle >10ᵒ (concave)=positive

Question 39

· Adam’s Forward Bend: Scoliosis

Answer 39

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.

Question 40

Symptoms: Scoliosis

Answer 40

-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

Question 41

• Progression: Scoliosis

howis it measured, what happens?

Answer 41

curve progression estimated by measuring the Cobb Angle
* As the curve progresses, there may be a rotation element, affecting the ribs

Question 42

• Treatment: Scoliosis

and why its done

Answer 42

-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

Question 43

· Patellofemoral Pain Syndrome

Answer 43

Umbrella term for pain arising from the patellofemoral joint or adjacent soft tissues

Question 44

o Q-angle

Answer 44

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

Question 45

o Etiology: PFPS

Answer 45

-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

Question 46

Muscular etiology PFPS

Answer 46

• Weak quads, Weak medial Quads, Tight IT band, Tight Hamstrings, Weak/Tight hip muscles, Tight calf muscles

Question 47

o Symptoms: PFPS

Answer 47

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

Question 48

o Treatment (non-surgical) PFPS

Answer 48

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