Congenital and Neuromuscular Conditions in Children

Question 1

What is cerebral palsy?

Answer 1

= damage to the growing brain before the age of 3 y/o (can be intrauterine)
*loss of inhibition of LMN or loss of connections to LMN will be related to MSK conditions

MSK presentations like bony deformity are secondary/tertiary manifestations of the disease, and despite no cure for primary CNS conditions, can potentially be managed

Question 2

How does cerebral palsy present in MSK terms?

Answer 2

• Hip dislocation
• Spinal issues (eg. scoliosis - helical twist)
• Spasticity/Dystonia –> abnormal gait

Question 3

What is a scale to assess likelihood of hip dislocation of child affected by cerebral palsy?

Answer 3

GMFCS scale = Gross Motor Function Classification System (levels I - V)

Question 4

When is spinal fusion performed and what is the value of the operation?

Answer 4

Usually in adolescence when there is still some flexibility in spine
For curves > 45 degrees

Protect respiratory function
Carers report more comfortable seating

Question 5

What types of problems do we encounter with cerebral palsy?

Answer 5

Primary - Injury to CNS
Secondary - developed during growth
Tertiary - developed when coping with primary/secondary conditions

Question 6

What is clubfoot? (Congenital talipes equinovarus)

Answer 6

= a deformity during foetal period in which an infant’s foot is turned inward, often so severely that the bottom of the foot faces sideways or even upward

“CAVE”

Question 7

How to manage clubfoot?

Answer 7

Plastic casting (Ponsetti technique)

Question 8

Growing pains in legs

Answer 8

Are common
Females > males
Usually bilateral
Growing pains do not cause limp

Question 9

Leg pain red flags in children

Answer 9

Asymmetry
Good localisation
Short history
Persisting limp
Not thriving
Pain worsening

Question 10

What to do when having patients present with knee pain?

Answer 10

Examine hip joint! It could be referred pain

Question 11

What is osteochondritis dissecans?

Answer 11

a condition that usually presents in the teenage years and onwards, where a piece of bone and cartilage becomes detached from the joint surface

Question 12

What is HSMN? (Hereditary motor and sensory neuropathy)

Answer 12

autosomal dominant
Because it is a sensory neuropathy, deformed feet might not lead to pain in patients

Question 13

Take-away from the session

Answer 13

• CP is common and important
Walking and non walking – GMFCS
• CTEV - Ponseti
• Feet deformity? – check spine
• Neurology exam
• Knee pain – think hip!!!!
• Expose – or you will miss pathology