BONE AND CONNECTIVE TISSUE DISORDERS 1. (AB) Flashcards
What should be included in a comprehensive history for bone and connective tissue disorders?
Details about prenatal, perinatal, and postnatal periods, including gestational, maternal, and birth history.
What maternal health factors should be assessed in prenatal history?
Smoking, prenatal vitamins, illicit drug/narcotic use, alcohol, diabetes, immunization status (rubella vaccine), and STIs.
Why is prenatal history important in orthopedic assessment?
Certain maternal factors (e.g., rubella, diabetes) can contribute to congenital conditions like rubella syndrome.
What perinatal factors should be noted in a child’s history?
Pregnancy length, labor type, fetal presentation, fetal distress, need for oxygen, birth length/weight, Apgar score, and muscle tone.
Why is fetal presentation important in orthopedic assessment?
Certain limb deformities (e.g., breech position) may be due to intrauterine positioning rather than congenital abnormalities.
What neonatal factors should be documented in history taking?
Feeding history, hospital stay, and any resuscitation efforts.
Why is developmental history important in orthopedic assessment?
Delayed milestones (e.g., gross motor delay) may indicate syndromes like Trisomy 21 or neuromuscular disorders.
What conditions might be suspected in an infant presenting with foot swelling?
Trisomy 21, Trisomy 13, or congenital hypothyroidism.
What aspects of medical history are relevant to orthopedic complaints?
Past surgeries, history of burns, fractures, joint contractures, or chronic symptoms.
Why is family history important in musculoskeletal disorders?
It can suggest genetic conditions like muscular dystrophy or skeletal dysplasias and help with prognostication.
What are key aspects of pain characterization in orthopedic history?
Location, intensity, quality, onset, duration, progress, radiation, aggravating/alleviating factors.
What is the significance of localized pain in orthopedic assessment?
It suggests a specific issue with bones, joints, muscles, nerves, or nearby organs.
What is an important clue of tumor-related bone pain?
Pain that is progressive, unrelenting, and occurs at night.
What type of pain is usually continuous and associated with infection or inflammation?
Pain from cellulitis, abscesses, or post-fracture inflammation.
What are typical characteristics of acute orthopedic pain?
Sudden onset, often related to trauma, commonly associated with fractures.
What is the concern when pain persists for more than 3-4 weeks?
Possible serious underlying pathology such as infection, tumor, or inflammatory condition.
What does radiating pain in an orthopedic patient suggest?
Potential nerve involvement or radiculopathy, possibly requiring a neuro consult or MRI.
Why is it important to assess gait and posture in orthopedic evaluation?
Abnormalities can indicate musculoskeletal or neurologic conditions.
What does an orthopedic physical examination include?
Inspection, palpation, joint range of motion assessment, and functional assessment (e.g., gait).
What screening tool is adapted for pediatric musculoskeletal assessment?
The pediatric Gait, Arms, Legs, Spine (pGALS) test.
What are the three screening questions in the pGALS test?
1) Pain or stiffness in joints/muscles/back? 2) Difficulty dressing? 3) Difficulty climbing stairs?
What findings during inspection may suggest an underlying syndrome?
Skin rashes, café-au-lait spots, dimples, tufts of hair, or midline spinal defects.
What general body habitus findings should be noted in orthopedic exams?
Cachexia, pallor, or signs of nutritional deficiencies (e.g., vitamin D deficiency).
What is a key aspect of assessing joint deformities?
Determine whether the deformity is fixed or correctable and whether it is associated with muscle spasm or pain.
What are common deformity classifications?
Varus (away from midline), Valgus (toward midline), Recurvatum (hyperextension), and flexion deformity.
What conditions can cause gait abnormalities?
Muscle weakness (e.g., muscular dystrophy), spasticity (e.g., cerebral palsy), and contractures (e.g., arthrogryposis).
What non-musculoskeletal conditions can cause limping?
Testicular torsion, inguinal hernia, and appendicitis.
What is a key distinguishing feature of an antalgic gait?
The patient avoids weight-bearing on the affected limb due to pain.
What are common causes of back pain in children?
Trauma, spondylolysis, spondylolisthesis, infection, tumors, and systemic conditions like leukemia.
What should be included in a pediatric neurologic evaluation?
Developmental milestones, muscle strength, sensory function, tone, reflexes, and spinal assessment.
What is the importance of assessing limb length in orthopedic exams?
Discrepancies can indicate underlying pathology such as dysplasia or neuromuscular disorders.
Why is gait assessment important in children?
Neurologic maturation affects gait, and deviations may indicate underlying pathology.
At what age do children typically develop a mature gait?
By around 7 years old, their gait resembles that of an adult.
What orthopedic conditions are common in early walkers (1-3 years old)?
Septic arthritis, transient synovitis, occult trauma, and developmental dysplasia of the hip.
What orthopedic conditions are common in children aged 3-10 years?
Legg-Calvé-Perthes disease, juvenile idiopathic arthritis, septic arthritis, and osteomyelitis.
What non-orthopedic conditions should be considered in pediatric back pain?
Urinary tract infections, nephrolithiasis, pneumonia, and malignancies.
What is the significance of persistent back pain in children?
It warrants further evaluation as children often have an identifiable skeletal pathology.
What is the difference between spasticity and contractures?
Spasticity is increased muscle tone with hyperreflexia (e.g., cerebral palsy), while contractures are fixed joint stiffness due to fibrosis or muscle shortening.
What is the role of palpation in orthopedic exams?
Assess for warmth (infection/inflammation), tenderness, masses, tightness, and structural abnormalities.
How is range of motion assessed in joint examination?
Both active and passive movement should be compared bilaterally, ideally using a goniometer.
What are some key causes of limping in children?
Fractures, infections, inflammatory diseases, developmental dysplasia, and neuromuscular disorders.
What are common causes of knee pain in children?
Osteochondritis dissecans, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis.
What should be considered in a child presenting with toe-walking?
Cerebral palsy, muscular dystrophy, idiopathic habit, or tight Achilles tendons.
What are signs of a serious underlying cause in a child with musculoskeletal complaints?
Night pain, progressive symptoms, systemic signs (fever, weight loss), or neurologic deficits.
What conditions can present with genu varum (bowlegs) or genu valgum (knock-knees)?
Rickets, Blount disease, skeletal dysplasia, and physiologic variations.
What should be suspected in a child with scoliosis and café-au-lait spots?
Neurofibromatosis type 1.
Why is early identification of limping in children crucial?
It helps diagnose serious conditions like septic arthritis, tumors, or neuromuscular disorders early.
“What is metatarsus adductus?”
A condition where the forefoot is adducted relative to the hindfoot, often caused by intrauterine molding.
“What is metatarsus varus?”
A deformity where the forefoot is adducted and sometimes in supination.
“What percentage of metatarsus adductus cases are bilateral?”
0.5
“What are the key clinical features of metatarsus adductus?”
Forefoot adduction (sometimes supination), normal midfoot and hindfoot, convex lateral foot border, prominent base of the fifth metatarsal.
“What is the primary cause of calcaneovalgus feet?”
In utero positioning.
“What are the key clinical features of calcaneovalgus feet?”
Excessive dorsiflexion and eversion of the hindfoot, abducted forefoot, possible external tibial torsion.
“What is congenital talipes equinovarus (clubfoot)?”
A deformity involving malalignment of the calcaneo-talar-navicular complex.
“What is the mnemonic for the components of clubfoot?”
CAVE (Cavus: midfoot, Adductus: forefoot, Varus: heel, Equinus: hindfoot).
“What is congenital vertical talus?”
A condition where the midfoot is dorsally dislocated on the hindfoot and the ankle is in fixed equinus.
“What is pes cavus?”
A deformity involving plantar flexion of the forefoot or midfoot on the hindfoot, leading to elevation of the medial longitudinal arch.
“What are some common toe deformities?”
Juvenile hallux valgus, mallet toe, curly toes, claw toe, overlapping 5th toe, annular bands, polydactyly, macrodactyly, subungal exostosis, hammer toe, ingrown toenail.
“What are common causes of foot pain in children aged 0-6 years?”
Poorly fitting shoes, fractures, puncture wounds, foreign bodies, osteomyelitis, cellulitis, juvenile idiopathic arthritis, hair tourniquet, dactylitis, leukemia.
“What are common causes of foot pain in children aged 6-12 years?”
Poorly fitting shoes, trauma (fracture, sprain), juvenile idiopathic arthritis (enthesopathy), puncture wound, Sever disease, accessory tarsal navicular bone, hypermobile flatfoot, tarsal coalition, oncologic causes (Ewing sarcoma, leukemia).
“What are common causes of foot pain in adolescents aged 12-18 years?”
Poorly fitting shoes, stress fractures, trauma (fracture, sprain), foreign body, ingrown toenail, metatarsalgia, plantar fasciitis, Achilles tendinopathy, accessory ossicles, tarsal coalition, avascular necrosis (Freiberg infarction, Kohler disease), plantar warts.
“What is acetabular dysplasia?”
Abnormal morphology and development of the acetabulum.
“What is hip subluxation?”
A condition where the femoral head has only partial contact with the acetabulum.
“What is hip dislocation?”
A condition where there is no contact between the femoral head and acetabulum.
“What are the two major classifications of developmental dysplasia of the hip (DDH)?”
Typical and teratologic.
“What is the difference between typical and teratologic DDH?”
Typical DDH occurs in otherwise normal patients, while teratologic DDH is associated with syndromes or genetic conditions and occurs before birth.
“What is a hip click?”
A high-pitched sensation (or sound) felt at the end of abduction during DDH testing with Barlow and Ortolani maneuvers.
“What is the Barlow maneuver used for?”
To assess the potential for hip dislocation by adducting the hip and applying posterior pressure.
“What is the Ortolani test used for?”
To reduce a dislocated hip by abducting the hip while applying anterior pressure.
“What is the Galeazzi sign?”
A sign of DDH where one knee appears lower when both hips are flexed to 90 degrees.
“What is the Klisic test?”
A test where an imaginary line between the greater trochanter and anterior superior iliac spine should point to the umbilicus; deviation indicates hip dislocation.
“What is the primary goal in the management of DDH?”
To obtain and maintain a concentric reduction of the femoral head within the acetabulum for normal development.
“What is scoliosis?”
A complex, three-dimensional spinal deformity with a coronal plane curve of at least 10 degrees.
“What is the etymology of the term ‘scoliosis’?”
Derived from the Greek word ‘skolios,’ meaning bent or curved.
“What is the most common type of scoliosis?”
Idiopathic scoliosis.
“What percentage of scoliosis cases are idiopathic?”
0.8
“What is adolescent idiopathic scoliosis (AIS)?”
Idiopathic scoliosis occurring in patients aged 11 years and older.
“What are the three classifications of idiopathic scoliosis based on age?”
Infantile (0-3 years), Juvenile (3-10 years), Adolescent (≥11 years).
“What is the Adams forward bend test used for?”
To detect scoliosis by assessing rib hump prominence.
“What is the Cobb method used for?”
To measure the degree of spinal curvature in scoliosis.
“When is brace treatment used for scoliosis?”
For progressive curves in growing patients to reduce the risk of worsening.
“When is surgery indicated for scoliosis?”
For curves >45 degrees in growing patients or >50 degrees in skeletally mature patients.
“What is the goal of scoliosis surgery?”
To stop progression, improve cosmesis, and maintain spinal balance while preserving motion.
