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7 Pediatrics > L11 MSK Impairments > Flashcards

L11 MSK Impairments Flashcards

1
Q

Connective tissue disorders

A

EDS
JIA
Hemophilia
Scleroderma
Dermatomyositis

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2
Q

Bony disorders

A
  • arthrogryposis multiplex congenital
  • osteogenesis imperfecta
  • Scurvy
  • Rickets
  • Fractures
  • Limb-length discrepancy
  • scoliosis
  • dysplasia
  • legg-calve perthes
  • SCFE
  • Clubfoot, pes planus
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3
Q

Ehlers Danlos Syndrome

A
  • heterogeneous group of connective disoders
  • affects 1/5,000 people
  • abnormal collagen synthesis, can leads to skin hyperextensibility, laxity, fragility, delayed wound healing, atrophic scarring, easy bruising, bleeding
  • 13 types of EDS
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4
Q

Classic Ehlers Danlos

A
  • abnormal colalgen type V
  • autosomal dominant inheritance
  • impairments include developmental delay, HE, atrophic scarring, slow wound healing, hernias, easy bruising, structural cardiac abnormalities
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5
Q

Hypermobility EDS

A
  • unknown etiology
  • impairments include skin laxity, velvet skin, joint HE, frequent dislocations
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6
Q

Vascular EDS

A
  • abnormal collagen type 3
  • unknown etiology or autosomal dominant inheritance
  • impairments include, arterial, intestinal fragility, varicose veins, easy bruising, unusual facial features
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7
Q

Kyphoscoliosis EDS

A
  • defiiciency of an enzyme that provides stability to collagen
  • autsomal recessive
  • impairments include joint laxity, scoliosis from birth, sclera fragility, hypotonia in infants
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8
Q

Arthroclasia EDS

A
  • abnormal collagen type 1
  • autosomal dominant
  • joint hypermobility, frequent dislocations, kyphoscoliosis, skin fragility, easy bruising, hypotonia
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9
Q

Dermatosparaxis EDS

A
  • abnormal collagen type 1
  • autosomal recessive
  • sagging, redundant skin with soft feeling, easy bruising, hernia, premature rupture of fetal membranes
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10
Q

Most common types of EDS

A
  • classic
  • hypermobility
  • vascular
  • kyphoscoliosis
  • arthroclasia
  • dermatosparaxis
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11
Q

Activity considerations for EDS

A
  • caution with PA putting bones, joints, skin at risk
  • social stigma
  • care or avoidance of strenuous weight bearing or contact sports
  • weight training (vEDS)
  • postural considerations (kEDS)
  • stress on skin or skin trauma (dEDS)
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12
Q

Juvenile Idiopathic Arthritis

A
  • exclusion classification for all types of arthritis of unknown origin affecting kids before 16
  • prevalence is 11-20/100,000
  • likely involves cytokines signaling proteins
  • 7 main categories
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13
Q

Categories of JIA

A
  • systemic
  • persistent and extended olgioarthritis
  • polyarthritis
  • enthesitis-related
  • psoriatic
  • undifferentiated
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14
Q

Systemic JIA

A
  • typically most painful, diagnosed in young kids from 5-15
  • onset preceded by fever and rash for 2 weeks
  • involvement of heart, inflammation lung, swollen glands, liver/spleen enlargement, abdominal pain, anemia, growth stunt
  • generally symmetrical and multiple joints
  • small % of kids present with macrophage activation, which results in inflammatory s/s, insufficient liver function, neuro changes. should see immediate care
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15
Q

Oligoarthritis

A
  • no fever, most common JIA subtype
  • persistent = asymmetrical, affecting ≤ 4 joints, onset is prior to 6 yo, less severe, mostly LE
  • extended = involvement of UE, more severe form, longer duration
  • 10-30% have eye inflammation
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16
Q

Polyarthritis

A
  • RA factor + –> ≥5 joints, + RA factors in 2 blood tests 2 months apart. Typically females, usually symmetrical, swelling. Prognosis not favorable
  • RA factor - –> ≥5 joints, presents similar to oligoarthritis, no significant joint swelling, contractures/stiffness
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17
Q

Therapeutic Considerations for JIA

A
  • education
  • pain management
  • deformity prevention
  • ROM interventions
  • strengthening
  • proprioceptive training
  • joint protection by avoiding end range, maintaining motion
  • functional abilities
  • physical fitness
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18
Q

Hemophilia

A
  • missing protein required for clotting
  • defect in gene on x chromosome
  • impairments present as joint destruction, premature arthritis, chronic pain, muscle atrophy, ROM limitations, nerve compression, severe bleeding
  • activities: pain and psychosocial limitations, limitations to activity and play
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19
Q

Bone changes with recurrent bleeds

A
  • deformity-valgus, subluxation, widening of bone
  • atrophy of heads of bones
  • loss of motion
  • osteophyte formation
  • bone cysts
  • changes in shape of bones
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20
Q

Juvenile Dermatomyositis

A
  • inflammation, vasculitis, proximal more than distal muscle weakness and rash, includes skin and GI
  • inflammatory cells predominantly B cells around blood vessels in septa between muscle
  • autoimmune disease, unknown etiology
  • focus on movement and function, avoid resistive exercises
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21
Q

Juvenile Scleroderma

A
  • localized or systemic, involves skin of face, upper trunk, hands, arms, internal organs
  • autoimmune disorder, unknown etiology
  • involves fibrous thickening and hardening of skin, can lead to severe joint and tissue contractures
  • may affect posture, rib cage mobility, limb length, muscle growth, skin changes
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22
Q

Arthrogryposis Multiplex Congenital

A
  • deficit in motor unit, leading to severe fetal weakness
  • fetal immobility, causes hypoplastic jt development and contractures
  • unclear cause, occurs in utero
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23
Q

Impairements in arthrogryposis multiplex congenital

A
  • contractures
  • hip subluxation
  • jaw, tongue ROM limitations
  • limbs appear tubular, lack of normal creases
  • diminished muscle mass, strength
  • mobility difficulties, difficulty w/ADLs
  • poor grasp, handwriting, feeding
  • speech difficulty
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24
Q

Typical contracture patterns

A
  • shoulder: adduction, IR
  • Elbow: extension
  • wrist: flexion and ulnar deviation
  • finger: flexion, thumb in pam
  • hip: flexion, abduction, ER
  • knee: flexion
  • clubfeet
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25
Q

Osteogenesis Imperfecta

A
  • defects in type 1 collagen
  • increased bone turnover
  • genetic cause
  • often short stature, poor tooth formation, hearing loss, blue sclera, translucent skin, triangle face
  • osteoporosis, ligamentous laxity, scoliosis, propensity for fractures
  • fragility limits play and ADL opportunities, mobility limitations
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26
Q

Scurvy

A
  • decreased thickening of bone cortex and epiphyseal plates
  • decreased bone available for calcification
  • caused by insufficiency of vitamin C
  • fragile bones, can fracture. Limits options for play
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27
Q

Rickets

A
  • deficiency interferes with bone calcification
  • caused by deficiency of vitamin D
  • long bones bend under body weight
  • may interfere with play, ADLs
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28
Q

Fractures

A
  • peak for typically developing, health children in early adolescence
  • bone turnover is high at this age
  • mineralization may lag behind height, weight growth
29
Q

Risk of subsequent fracture increases ____ after first fx

A
  • 2-3x
  • increases w/decreased calcium intake, first fx before 5 yo, and obesity
30
Q

Epiphyseal Fracture

A
  • fracture through growth plate
  • may cause growth arrest
  • about 20% of peds fractures
31
Q

Salter Harris Classification

A
  • determines extent of growth plate involvement
  • Type 2 is the most common
  • type 5 has poor prognosis
  • type 1-2 = does not completely cross epiphysis
  • type 3-4 = crosses epiphyseal border
  • type 5 = crushing injury
32
Q

Growth arrest

A
  • complete may lead to significant limb length inequality
  • asymmetrical may result in angular deformities if portion of bone keeps growing

usually happens in type 3-4

33
Q

Greenstick Fracture

A
  • occur in long bones when force breaks the cortex on side of impact and bends the other
  • causes angular deformity
  • refer to ortho physician
34
Q

Treatment of fracture depends on

A

extent of involvement

follow WB precautions, and advise/education with AD as necessary

35
Q

Nondisplaced/displaced treatment

A

Non = typically treated with cast
Displaced = closed or open reduction

36
Q

Limb Length Discrepancy

A
  • anatomical/osseous
  • functional (soft tissue, joint)
  • can assess with direct measurement (tape measure, imaging) or functional (postural, mechanical)
37
Q

Potential Cause for Limb Length Discrepancy

A
  • congenital
  • infection/inflammation
  • mechanical
  • neurological
  • trauma
  • tumors
  • others
38
Q

Congenital LLD

A

examples include hip dysplasia, club foot, giantism, hemophilia

39
Q

Infection/Inflammation LLD

A

examples include epiphyseal plate destruction, infection, JIA, increased blood flow

40
Q

Mechanical LLD

A

examples include long term immobilization, traumatic aneurysms

41
Q

Neurological LLD

A

examples include spina bifida, CP, polio

42
Q

Trauma LLD

A

examples include severe burns, damage to plate, femur/tibia fractures, operations, bone graft removal

43
Q

Tumors LLD

A

examples include ones that involve growth plate, chemo can destroy bone, vascular malformations

44
Q

Scoliosis

A
  • curvature of spine, can be structural or nonstructural
  • infantile = < 3 yo
  • Juvenile = 3-10 yo
  • adolescent = 10 yo to skeletal maturity
45
Q

Adolescent Idiopathic Scoliosis

A
  • may have hereditary component
  • 2-3% incidence, prevalent in biological females with curves > 20°
  • feature includes rib hump
  • can measure with cobb method
46
Q

Rib hump

A
  • rotational component of scoliosis
  • identified by adams forward bend test
47
Q

Cobb Method

A
  • standard way to quantify curve size
  • uses a/p x ray
  • angle between the upper border of the upper vertebra and the lower borders of the lowest vertebra
48
Q

Treatment for AIS

A
  • <20° = exercise
  • 20-40° bracing w/exercise
  • > 35-40° surgery

schroth method helps to focus on de-rotation, lengthening, stabilization

49
Q

Developmental Dysplasia of Hip (DDH)

A
  • pathological hip instability
  • genetic predisposition, meningocele, mechanical
  • galaezzi sign, ortolani sign, barlow maneuver
50
Q

Mechanical DDH

A

breech position in utero
insufficient amniotic fluid

51
Q

Impairments and activity restrictions for DDH

A
  • unstable hip joint
  • limited hip abduction, LLD, poor acetabular development
  • pain
  • difficulty achieving motor milestones, ambulation, increased energy expenditure
52
Q

Galaezzi Sign

A

child supine, hip and knee flexion, asymmetrical knee heigh positive with shortened side

53
Q

Ortolani Sign

A

child supine, hips to 90°, gentle abduction and upward motion while stabilizing contralateral pelvis, positive with clunk indicating reduction into acetabulum

54
Q

Barlow Maneuver

A

same start position as ortolani, gentle adduction while feeling for posterior displacement at hip joint

55
Q

Pavlik Harness

A

maintains hip in flexion and abduction

56
Q

Legg-Calve Perthes Disease

A
  • AVN of femoral head
  • most common for kids 5-7 yo, may affects kids between 3-12 yo
  • unknown etiology
  • loss of blood supply results in shortened femoral neck, trochanteric overgrowth, asymmetrical repair of femoral head
  • modified waldenstrom classification
57
Q

Kids w/legg-calve-perthes disease present with

A
  • limp, tredenlenburg
  • pain in hip, knee, and/or thigh
  • pain is provoked by activity, relief with rest
  • reduced hip ROM, particularly hip abduction, IR
58
Q

Interventions for LCP Disease

A
  • pain management
  • ROM
  • strength
  • gait mechanics to promote hip congruency
  • hip abduction and IR
  • surgical (PTs are post)
59
Q

SCFE

A
  • post displacement of capital femoral epiphysis from femoral neck through weakened physis
  • typical onset in prepubescent, ages 10-15
  • unclear etiology, can be trauma, mechanical, inflammation, obesity, hormones, genetic
  • surgery, may include prophlactic pinning of univolved hip
60
Q

Impairments for SCFE

A
  • antalgic gait/limp
  • pain in grown
  • ER posturing
  • decreased hip flexion, abduction, IR
  • thigh moves into ER when flexed
  • pain, long term changes
61
Q

Slipped SCFE

A

mild to moderate pain with activity

62
Q

Unstable SCFE

A

severe hip pain, unable to walk

63
Q

Blount Disease

A
  • compression of medial portion of proximal tibia, most often associated with obesity
  • lateral bowing tibia, medial knee instability
  • pain, progressive joint degeneration
64
Q

Congenital Talipes Equinovarus

A
  • known as clubfoot
  • midfoot cavus/high arch, forefoot adductors, hindfoot varus, ankle equines deformity
  • classifications include postural, idiopathic, neurogenic, syndromic
  • surgery, serial casting, achilles surgery, bracing, taping, stretching
65
Q

Metatarsus Adductus

A

metatarsals adducted toward midline, assessed with straight line through calcaneus through long axis of foot

may or may not need intervention

66
Q

Pes Planus

A

flexible flat feet
may or may not need intervention

67
Q

Sports PT peds considerations

A
  • child physiology
  • repetitive loading
  • shear stress to articular cartilage
  • overuse injury
  • apophysis, often occur with excess compression or traction forces across joint during sport
68
Q

Osgood-Schlatter Disease/Sever’s Disease

A
  • excess stress on major tendon insertions
  • OS = tibia
  • sever = calcaneus

7 Pediatrics (10 decks)

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