Chapter 29 & 30: Musculoskeletal and Neuromuscular Dysfunction Flashcards
1
Q
What are some pediatric differences when compared to adults regarding musculoskeletal system?
4 differences
A
- 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
2
Q
What are fractures?
4 aspects
A
- 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
3
Q
What are the 4 types of fractures?
A
- 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
4
Q
What is a growth plate (epiphyseal/physeal) injury?
4 aspects
A
- 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
5
Q
What are some s/s of fractures?
7 s/s
A
- swelling
- pain or tenderness
- deformity
- diminished functional use
- bruising
- muscular rigidity
- crepitus
6
Q
What are general bone healing times for each stage of childhood?
A
- 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
7
Q
How are fractures diagnosed? What are some interventions for fractures?
A
- 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
8
Q
What are the 5 P’s for fracture assessment?
A
- pain
- pulse – distal to fracture
- pallor
- paresthesia – sensation distal to fracture
- paralysis – movement distal to fracture
9
Q
What might be indicated by pain unrelieved by pain medication?
A
compartment syndrome
10
Q
What are some education topics for families of casted pts?
5 education topics
A
- 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)
11
Q
What is traction? What is it used for?
5 uses
A
- 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
12
Q
What is developmental dysplasia of the hip (DDH)?
3 aspects
A
- 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
13
Q
How is DDH diagnosed?
A
US or X-ray
14
Q
What are some s/s of DDH?
5 s/s
A
- asymmetrical gluteal and thigh folds – most common s/s
- shortening of femur
- Ortolani click
- limited hip abduction
- positive Trendelendburg sign with lordosis
15
Q
What are some interventions for DDH?
2 interventions
A
- swaddling
- Pavlik harness – skin assessments
16
Q
What is congenital clubfoot? What are the 4 types?
A
- 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
17
Q
How is clubfoot treated?
A
serial casting
18
Q
What is osteomyelitis?
A
- infection of bone and tissue around bone
- AKA septic joint
19
Q
What are some s/s of osteomyelitis?
A
- pain in affected bone
- fever
- irritability
- guarding of affected limb
20
Q
How is osteomyelitis diagnosed?
5 diagnostics
A
- based on s/s
- radiography
- bone scan
- blood cultures
- I&D, aspirate fluids – determine infection
21
Q
What are some interventions for osteomyelitis?
5 interventions
A
- 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
22
Q
What is scoliosis?
2 aspects
A
- complex spinal deformity in 3 planes:
– lateral curvature
– spinal rotation causing rib asymmetry
– thoracic hypokyphosis - may be congenital or develop during childhood
23
Q
What are some s/s of scoliosis?
7 s/s
A
- lateral curvature of spine
- uneven waistline
- unequal shoulders
- unequal scapula
- unequal hips
- rib prominence
- pain is not a normal finding – may indicate spinal mass
24
Q
What are some interventions for scoliosis?
2 interventions
A
- bracing
- spinal fusion if severe
25
What is juvenile idiopathic arthritis (JIA)?
| 3 aspects
* AKA juvenile rheumatoid arthritis
* unknown cause
* peak age = 1 - 3 y.o. & 8 - 10 y.o.
26
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)
27
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
28
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
29
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
30
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
31
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
32
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
33
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
34
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
35
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)
36
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
37
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
38
What is osteogenesis imperfecta?
genetic disease in which bones fracture easily with no obvious cause or minimal injury
