Acute pain

Question 1

What are the multidimensional observational scales to measure pain in children?

Answer 1

Face, leg, activity, cry and consolability (FLACC) scale

Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS)

Question 2

Developmental dysplasia of the hip

Answer 2

Spectrum of developmental abnormalities of hip joint that ranges from instability in dislocation

Question 3

DDH - subluxable

Answer 3

Femoral head can be partially displaced to the rim of the acetabulum

Question 4

DDH - dislocatable

Answer 4

Femoral head is in the socket but it can be displaced completely outside the acetabulum with manual pressure

Question 5

DDH - dislocated

Answer 5

Femoral head lies completely outside the hip socket but can be reduced with manual pressure

Question 6

DDH - teratologic

Answer 6

Femoral head lies completely outside the hip socket and cannot be reduced with manual pressure

Question 7

DDH - assessment at birth

Answer 7

Unequal creases in the buttocks or thighs
Difficulty abducting legs
Inequality in leg length

Question 8

DDH - assessment at 3 months

Answer 8

Red flags include hip abduction range of motion <60 degrees, asymmetry in lower limb crease, leg length differences and Trendelenburg

Question 9

DDH management

Answer 9

Reduction

Splinting - restrict hip extension and adduction

Question 10

Legg- Calve Perthes Disease

Answer 10

Process involves initial avascular necrosis of capital femoral epiphysis with subsequent re vacuolisation - a self limiting disorder

Question 11

Perthes disease presentation

Answer 11

Presents with painful limp, limitation of IR/ABD hip

Question 12

Perthes disease - monitoring

Answer 12

Non-operative containment of femoral head within acetabulum - maintenance of full ROM

Question 13

Perthes disease - operative containment

Answer 13

Varus dérogation osteotomy of proximal femur

Question 14

Perthes disease - post op Physio role

Answer 14

Review and address:

• weakness/stiffness in hip abductors
• gait retraining
• posture and balance strategies

Question 15

Slipped capital femoral epiphysis

Answer 15

Displacement of femoral neck from CFE which remains in the acetabulum

Question 16

SCFE - Physio role

Answer 16

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

Question 17

Osteosarcoma

Answer 17

Pain is presenting feature
Severe joint pain/bone pain
Pain at rest
Swelling in bones/joints
Reluctance to WB

Question 18

Most common sites for osteosarcoma

Answer 18

Around metaphysics of distal femur, proximal tibia, proximal humerus and proximal femur

Question 19

Physio assessment - limb reconstruction

Answer 19

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

Question 20

Osteosarcoma - Physio role pre/post op

Answer 20

Pre-op
- baseline ROM
- baseline muscle strength
- functional mobility training 
Post-op
- maintain ROM
- muscle strengthening
- functional mobility training 
- manage pain