Acute pain Flashcards
What are the multidimensional observational scales to measure pain in children?
Face, leg, activity, cry and consolability (FLACC) scale
Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS)
Developmental dysplasia of the hip
Spectrum of developmental abnormalities of hip joint that ranges from instability in dislocation
DDH - subluxable
Femoral head can be partially displaced to the rim of the acetabulum
DDH - dislocatable
Femoral head is in the socket but it can be displaced completely outside the acetabulum with manual pressure
DDH - dislocated
Femoral head lies completely outside the hip socket but can be reduced with manual pressure
DDH - teratologic
Femoral head lies completely outside the hip socket and cannot be reduced with manual pressure
DDH - assessment at birth
Unequal creases in the buttocks or thighs
Difficulty abducting legs
Inequality in leg length
DDH - assessment at 3 months
Red flags include hip abduction range of motion <60 degrees, asymmetry in lower limb crease, leg length differences and Trendelenburg
DDH management
Reduction
Splinting - restrict hip extension and adduction
Legg- Calve Perthes Disease
Process involves initial avascular necrosis of capital femoral epiphysis with subsequent re vacuolisation - a self limiting disorder
Perthes disease presentation
Presents with painful limp, limitation of IR/ABD hip
Perthes disease - monitoring
Non-operative containment of femoral head within acetabulum - maintenance of full ROM
Perthes disease - operative containment
Varus dérogation osteotomy of proximal femur
Perthes disease - post op Physio role
Review and address:
- weakness/stiffness in hip abductors
- gait retraining
- posture and balance strategies
Slipped capital femoral epiphysis
Displacement of femoral neck from CFE which remains in the acetabulum
SCFE - Physio role
Refer to hospital - missed or late diagnosis can result in avascular necrosis of hip/premature closure of physis
Post op - crutch walking instructions, increase in WB ambulations, buttock and LL strengthening
Osteosarcoma
Pain is presenting feature Severe joint pain/bone pain Pain at rest Swelling in bones/joints Reluctance to WB
Most common sites for osteosarcoma
Around metaphysics of distal femur, proximal tibia, proximal humerus and proximal femur
Physio assessment - limb reconstruction
Pain Extent of deficiency Active ROM of joints surrounding limb Passive ROM in remaining joints Muscle imbalance/control issues Impact on motor skills Monitor with growth
Osteosarcoma - Physio role pre/post op
Pre-op - baseline ROM - baseline muscle strength - functional mobility training Post-op - maintain ROM - muscle strengthening - functional mobility training - manage pain
