L8: Pediatric Eval Lab (Important Info***) Flashcards
Tests/Measures
Hip measures
- IR/ER
- Ryders
- Hip Dysplasia testing
Tests/Measures
Knee/Ankle measures
- Mod’d Tardieu (R1/R2)
- Popliteal angle
- Ankle R1/R2
- Tone vs mm length limitations
Tests/Measures
LLD Measures
via…
Cusick method
Other tests/measures
Torsion
Tibial Torsion
Tests/Measures
Metatarsal bones turned towards midline of body
Metatarsus Adductus
*another test/measure to observe
Rotation
motion occurs about an axis; complete turn
Version
Act or process of turning or changing pos.
A twist w/in the bone structure
Torsion
Version + Torsion NOT synonymous!!!
!!!!!!!!
Antetorsion
State of twist about the longitudinal axis of femur
Anterversion
A turning of the bone in the forward direction
Hip Development:
Normal Newborn
- 40* ANTETORSION
- 20* ANTEVERSION (due to Hip ER)
- ==> Total of 60*
ER:IR ratio @ Birth (Lat rot:Med rot)
AND what should it be by age 3?
- 3:1 @ birth
- 1:1 by age 3 w/ 90* total ROM
Ex. 45*IR + 45*ER = 90* total hip motion
Untwisting the femur
In a nutshell… what does it?
Gluteals
Untwisting the femur cont’s for how long
Years
Untwisting the femur
Explain how this is done
- Capsular restraint on prox femur→ Base for gluteals to apply torsional-reducing force across growth plates
W/ dev. infants activate ____ and ______ to assist in untwisting femur
Glutes and rotators
As infants develop→ activate glutes and rotators to assist untwisting bone
How?
Creeping, climbing, stairs, ambulation
*Place torque forces on femur
*continues for years until normal alignment achieved
By age _____ femur should be in normal mature adult pos.
Age 8****
By age 8, mature hip pos. should be achieved
Mature hip position?
15-20* anteversion***
*aka anteversion DECREASES W/ AGE but some still present
How do we measure hip rotation?
Prone w/ knees flexed to 90*
*Bring both legs thru arc of motion and measure @ end range
Measuring hip rotation
*IF ER:IR ratio is NOT 1:1 AND child is >3yo======
Ryders Test
*reqd bc something is “off” @ the hip
ex. bony blockage
Ryders Test
What is it?
Estimation of femoral torsion to see how much safe play there is in femur and if we can strap them, and to what degree****
Ryders Test typically done on children w/ what?
IN-TOEING POSTURE***
How do you perform Ryder’s Test?
- Child in prone→ bisect thigh to find position of femur→ palpate greater troch→ bring hands up to prox thigh and place fingers apart around loc. of greater troch
- Rotate hip med and lat until greater troch sits bw fingers→ RECORD THIS AS RYDER’S TEST VALUE
-
Next, add 15-20* to this value to acct for normal anteversion
- Ryders Value + 15-20*== __* internal femoral torsion
- Ex. Ryders test value of 20* of med. rot + 15-20* of built in anteversion== 35-40* medial femoral torsion or MFT***
- Ryders Value + 15-20*== __* internal femoral torsion
IF Ryders is an ER value, subtract 15-20*, but this is rare
******
Interpretation of Ryders Findings:
- COMMON in children and typ resolves on its own 99% of time
- IF OVER 8yo→ PT is ineffective
-
IF UNDER 8yo→ strengthen glutes and ERs
- assists in untwisting to better align hip and DEC torsion, and/or lateral strapping***
Be careful w/ Lateral Strapping****
Why?
This can change how head of femur sits in acetabulum→ if pt has too much internal femoral torsion and strap is rotating and strap is rotating them laterally→ could pull them right out of acetabulum **** NOT ENOUGH SAFE PLAY
Anteversion clinical presentation
In order to keep head of femur in the acetabulum, children need to medially rotate the limb===IN-TOEING POSTURE
Easy to pop femoral head out of acetabulum if…
we only laterally rotate the limb
Take home Message: Lateral Strapping for MFT
- Undserstand that after the age of 8, PT typ does not change bone structure and those w/ incd MFT may req sx intervention known as Varus Derotational Osteotomy or VDRO to correct hip alignment deficits
- Do not assume that lateral rotation strapping is safe when a child presents w/ In-Toeing gait or appears to have femoral anteversion
Hip Dysplasia
Cond. in young babies where the hip has not developed properly and the hip can be easily dislocated and relocated into the acetabulum
Hip Dysplasia Test
Barlow
-
Flex and ABDuct hip→ THEN ADDuct w/ posterior pressure
- Disloc. of femoral head over Post. acetabulum==> Instability
Hip Dysplasia Test
Ortalani
Whats diff about this one?
HIP IS ALREADY DISLOCATED IN POS. OF FLEX AND ADDUCTION
Hip Dysplasia Test
Ortalani
- Hip already disloc’d in pos. of FLEX and ADDuction
- Gentle flexion, ABDuction and slight traction to reduce hip → clunk may be felt
- (+) Ortalani == MORE unstable hip vs. (+) Barlow****
Hip Dysplasia Test
Asymmetry of skin folds===>
Need for further testing bc one hip may be displaced
HS Length or Popliteal Angle
Purpose
Assess spasticity of HSs and avail. mm length
HS Length or Popliteal Angle
- Pt SUPINE w/ hip flexed to 90* using Mod. Tardieu Method
-
Pts knee brought DOWN into FLEX and quickly brought UP into knee EXT
- R1= first catch of resistance
- R2= full avail. PROM
- Documentation: R1/R2 (-50*/-30*) for example
-
Pts knee brought DOWN into FLEX and quickly brought UP into knee EXT
NOTE:** this is NOT a measure jt ROM, but rather **mm extensibility & spasticity**
Ankle R1/R2
- Pt in prone w/ knee EXTd and then Flexed
- EXTd→ Gastroc is elongated
- FLEXED→ Gastroc is on slack (looking mostly @ Soleus)
- Expect to see MORE range w/ knee FLEXED→ Soleus sometimes overlengthened in Peds.
Interpreting R-values
R1/R2 FAR APART
EX. -70/-30
Limiting factor?
TONE is limting factor
Interpreting R-values
R1/R2 CLOSE TOGETHER
Indicates what ?
- BOTH tone and mm length are likely contributing to deficit→ Unable to decipher which contributing more
R1=R2
Says what?
CONTRACTURE present
*cause uncertain
R1/R2
Documenting
Always document as R1/R2
LLD
- Tape measure method not accurate
- Pos. child Prone w/ LEs EXTd→ observe skin folds @ glutes, popliteal fossa, malleoli, heel pads w/ ankles in DF OR flex knees to see if heel pads lvl
- **IF LLD observed-→ Gently tug on limbs to flatten pelvis and measure diff bw heel pads
LLD:
Galeazzi Sign
Quick screening method for LLD
*Does NOT provide any estimate of value of diff.
