Chapter 29 & 30: Musculoskeletal and Neuromuscular Dysfunction Flashcards
What are some pediatric differences when compared to adults regarding musculoskeletal system?
4 differences
- epiphyseal plate still elongating
- ligaments and tendons are stronger than bones until puberty
- bones are more porous and pliable – “bounce” rather than break
- infant skull fontanels in process of closing
What are fractures?
4 aspects
- break in a bone
- common injury in children, but rare in infants except with MVA
- most common broken bone in childhood (< 10 y.o.) = clavicle
- may be caused by bicycle or sports injuries
What are the 4 types of fractures?
- compound/open: fractured bone protrudes through skin
- complicated: bone fragments have damaged other organs/tissues
- comminuted: small fragments of bone are broken from fractured shaft and lie in surrounding tissue
- greenstick: compressed side of bone bends but the tension side of the bone breaks, causing an incomplete fracture
What is a growth plate (epiphyseal/physeal) injury?
4 aspects
- injury to the cartilage growth plate (epiphyseal plate), weakest point of long bones
- frequent site of damage
- may affect future bone growth
- treatment:
– ORIF – open reduction, internal fixation – prevents growth disturbances
What are some s/s of fractures?
7 s/s
- swelling
- pain or tenderness
- deformity
- diminished functional use
- bruising
- muscular rigidity
- crepitus
What are general bone healing times for each stage of childhood?
- neonatal = 2 - 3 weeks
- early childhood = 4 weeks
- later childhood = 6 - 8 weeks
- adolescence = 8 - 12 weeks
– younger children have more osteoblasts –> faster healing times for fractures
How are fractures diagnosed? What are some interventions for fractures?
- confirmed diagnosis with X-rays
- treatments:
– pain meds
– PT & OT
– skin assessments
– neurovascular checks – CMS checks (circulation, movement, sensation)
– pulses in extremities distal to fracture
What are the 5 P’s for fracture assessment?
- pain
- pulse – distal to fracture
- pallor
- paresthesia – sensation distal to fracture
- paralysis – movement distal to fracture
What might be indicated by pain unrelieved by pain medication?
compartment syndrome
What are some education topics for families of casted pts?
5 education topics
- don’t get it wet
– use blow dryer on COOL setting if it gets wet
– if too wet, will need to have it changed - don’t stick anything down cast
– can cause skin breakdown or infection - supervise casted children to ensure nothing is stuck down cast
- parents can perform home CMS checks
- cast removal
– child can touch saw to see that it won’t hurt
– limb will look different when cast comes off (pale, smelly, smaller than other limb)
What is traction? What is it used for?
5 uses
- an extended pulling force using weights for injured extremities
- used to:
– rest an extremity
– position bones for healing
– immobilize a fracture until healing is sufficient for casting
– prevent contracture
– reduce muscle spasms
What is developmental dysplasia of the hip (DDH)?
3 aspects
- congenital hip dysplasia
- abnormality in the development of the proximal femoral head and acetabulum where they are improperly aligned – femur head lies outside acetabulum
- 2 types:
– idiopathic – infant is neurologically intact
– teratologic – neuromuscular defect
How is DDH diagnosed?
US or X-ray
What are some s/s of DDH?
5 s/s
- asymmetrical gluteal and thigh folds – most common s/s
- shortening of femur
- Ortolani click
- limited hip abduction
- positive Trendelendburg sign with lordosis
What are some interventions for DDH?
2 interventions
- swaddling
- Pavlik harness – skin assessments
What is congenital clubfoot? What are the 4 types?
- birth defect where one or both feet are twisted out of alignment
- 4 types:
– talipes varus: inversion
– talipes valgus: eversion
– talipes equinovarus: plantarflexsion with toes lower than heel
– talipes calcaneus: dorsiflexion with toes higher than heel
How is clubfoot treated?
serial casting
What is osteomyelitis?
- infection of bone and tissue around bone
- AKA septic joint
What are some s/s of osteomyelitis?
- pain in affected bone
- fever
- irritability
- guarding of affected limb
How is osteomyelitis diagnosed?
5 diagnostics
- based on s/s
- radiography
- bone scan
- blood cultures
- I&D, aspirate fluids – determine infection
What are some interventions for osteomyelitis?
5 interventions
- blood cultures
- broad-spectrum antibiotics, then targeted antibiotics
- monitor labs
- treat symptoms – antipyretics, pain meds, rest, fluids, nutrition
- education on antibiotic compliance – takes a long time for this to heal; must remain compliant throughout treatment
What is scoliosis?
2 aspects
- complex spinal deformity in 3 planes:
– lateral curvature
– spinal rotation causing rib asymmetry
– thoracic hypokyphosis - may be congenital or develop during childhood
What are some s/s of scoliosis?
7 s/s
- lateral curvature of spine
- uneven waistline
- unequal shoulders
- unequal scapula
- unequal hips
- rib prominence
- pain is not a normal finding – may indicate spinal mass
What are some interventions for scoliosis?
2 interventions
- bracing
- spinal fusion if severe
What is juvenile idiopathic arthritis (JIA)?
3 aspects
- AKA juvenile rheumatoid arthritis
- unknown cause
- peak age = 1 - 3 y.o. & 8 - 10 y.o.
What are some s/s of JIA?
9 s/s
- stiffness
- swelling
- loss of mobility in affected joints
- warm to touch, usually without erythema
- tender to touch
- symptoms increase with stress
- growth retardation
- iridocyclitis – inflammation of vascular layer of eye (iris and ciliary body)
- uveitis – inflammation of uvea (middle layer of eye)
What are the 4 diagnostic criteria for JIA?
- age of onset = < 16 y.o.
- 1+ affected joints
- duration of arthritis longer than 6 weeks
- exclusion of other forms of arthritis
What are some interventions for JIA?
7 interventions
- no specific cure
- goals = preserve function, prevent deformities, relieve symptoms
- ophthalmologist to treat iridocyclitis and uveitis
- meds:
– NSAIDs
– SAARDs – slow-acting antirheumatic drugs
– corticosteroids
– cytotoxic agents
– immunologic modulators - PT & OT
- nutrition
- exercise
What is cerebral palsy?
3 aspects
- group of permanent disorders of movement and posture
- caused by intrauterine hypoxia or asphyxia
- most common permanent physical disability in childhood
How is cerebal palsy diagnosed?
5 diagnostics
- assessment in first 2 years of life
- neuro exams
- history
- neuro imaging – CT, MRI
- metabolic and genetic testing
What are some s/s of cerebal palsy?
7 motor s/s; 5 behavorial s/s
– motor signs:
* persistent primitive reflexes
* poor head control after 3 months
* stiff/rigid limbs
* arching back
* floppy tone – hypotonia
* unable to sit without support at 8 months
* clenched fists after 3 months
– behavioral signs:
* excessive irritability
* no smiling by 3 months
* feeding difficulties d/t frequent gagging or choking
* persistent tongue thrusting
* no reactions to sounds/talking
What are some interventions for cerebal palsy?
5 interventions
- surgery for spinal fusions – scoliosis is common
- bracing
- meds:
– seizure meds – antispasmodics (Ativan), antiepileptics, Botox (relaxes muscles), Baclofen
– analgesics - school and social support
- PT
What is muscular dystrophy (MD)?
4 aspects
- largest group of muscular diseases in children
- genetic origin
- gradual muscule degeneration – progressive wasting and weakness
- marked by increasing disability and deformity
What is Duchenne muscular dystrophy (DMD)?
4 aspects
- most severe and most common type of childhood muscular dystrophies
- X-linked inheritance
- onset = 3 - 7 y.o.
- death usually occurs d/t respiratory or cardiac failure
What are some s/s of DMD?
6 s/s
- Gower sign – standing upright by first kneeling, then walking hands up straightened legs
- frequent falls
- lordosis – excessive inward curve of lower spine
- enlarged muscles in thighs and upper arms
- profound muscular atrophy
- mental deficiency – developmental of cognitive delays (from walkie-talkie to nonverbal)
How is DMD diagnosed?
5 diagnostics
- prenatal testing if positive family hx
- clinical appearance
- blood demonstrating gene mutation
- EMG (electromyography) and muscle biopsy
- serum CPK and AST – elevated in first 2 years of life
What are some interventions for DMD?
10 interventions
- no effective treatment
- goal = maintain function of unaffected muscles as long as possible
- keep child as active as possible
- ROM
- bracing
- ADLs
- prevent contracture
- promote mobility and independence
- promote growth and development
- prevent complications and isolation
What is osteogenesis imperfecta?
genetic disease in which bones fracture easily with no obvious cause or minimal injury
