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Pediatrics > L8: Pediatric Eval Lab (Important Info***) > Flashcards

L8: Pediatric Eval Lab (Important Info***) Flashcards

1
Q

Tests/Measures

Hip measures

A
  • IR/ER
  • Ryders
  • Hip Dysplasia testing
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2
Q

Tests/Measures

Knee/Ankle measures

A
  • Mod’d Tardieu (R1/R2)
    • Popliteal angle
    • Ankle R1/R2
    • Tone vs mm length limitations
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3
Q

Tests/Measures

LLD Measures

via…

A

Cusick method

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4
Q

Other tests/measures

Torsion

A

Tibial Torsion

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5
Q

Tests/Measures

Metatarsal bones turned towards midline of body

A

Metatarsus Adductus

*another test/measure to observe

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6
Q

Rotation

A

motion occurs about an axis; complete turn

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7
Q

Version

A

Act or process of turning or changing pos.

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8
Q

A twist w/in the bone structure

A

Torsion

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9
Q

Version + Torsion NOT synonymous!!!

A

!!!!!!!!

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10
Q

Antetorsion

A

State of twist about the longitudinal axis of femur

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11
Q

Anterversion

A

A turning of the bone in the forward direction

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12
Q

Hip Development:

Normal Newborn

A
  • 40* ANTETORSION
  • 20* ANTEVERSION (due to Hip ER)
  • ==> Total of 60*
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13
Q

ER:IR ratio @ Birth (Lat rot:Med rot)

AND what should it be by age 3?

A
  • 3:1 @ birth
  • 1:1 by age 3 w/ 90* total ROM

Ex. 45*IR + 45*ER = 90* total hip motion

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14
Q

Untwisting the femur

In a nutshell… what does it?

A

Gluteals

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15
Q

Untwisting the femur cont’s for how long

A

Years

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16
Q

Untwisting the femur

Explain how this is done

A
  • Capsular restraint on prox femur→ Base for gluteals to apply torsional-reducing force across growth plates
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17
Q

W/ dev. infants activate ____ and ______ to assist in untwisting femur

A

Glutes and rotators

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18
Q

As infants develop→ activate glutes and rotators to assist untwisting bone

How?

A

Creeping, climbing, stairs, ambulation

*Place torque forces on femur

*continues for years until normal alignment achieved

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19
Q

By age _____ femur should be in normal mature adult pos.

A

Age 8****

20
Q

By age 8, mature hip pos. should be achieved

Mature hip position?

A

15-20* anteversion***

*aka anteversion DECREASES W/ AGE but some still present

21
Q

How do we measure hip rotation?

A

Prone w/ knees flexed to 90*

*Bring both legs thru arc of motion and measure @ end range

22
Q

Measuring hip rotation

*IF ER:IR ratio is NOT 1:1 AND child is >3yo======

A

Ryders Test

*reqd bc something is “off” @ the hip

ex. bony blockage

23
Q

Ryders Test

What is it?

A

Estimation of femoral torsion to see how much safe play there is in femur and if we can strap them, and to what degree****

24
Q

Ryders Test typically done on children w/ what?

A

IN-TOEING POSTURE***

25
Q

How do you perform Ryder’s Test?

A
  • 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***
26
Q

IF Ryders is an ER value, subtract 15-20*, but this is rare

A

******

27
Q

Interpretation of Ryders Findings:

A
  • 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***
28
Q

Be careful w/ Lateral Strapping****

Why?

A

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

29
Q

Anteversion clinical presentation

A

In order to keep head of femur in the acetabulum, children need to medially rotate the limb===IN-TOEING POSTURE

30
Q

Easy to pop femoral head out of acetabulum if…

A

we only laterally rotate the limb

31
Q

Take home Message: Lateral Strapping for MFT

A
  • 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
32
Q

Hip Dysplasia

A

Cond. in young babies where the hip has not developed properly and the hip can be easily dislocated and relocated into the acetabulum

33
Q

Hip Dysplasia Test

Barlow

A
  • Flex and ABDuct hip→ THEN ADDuct w/ posterior pressure
    • Disloc. of femoral head over Post. acetabulum==> Instability
34
Q

Hip Dysplasia Test

Ortalani

Whats diff about this one?

A

HIP IS ALREADY DISLOCATED IN POS. OF FLEX AND ADDUCTION

35
Q

Hip Dysplasia Test

Ortalani

A
  • 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****
36
Q

Hip Dysplasia Test

Asymmetry of skin folds===>

A

Need for further testing bc one hip may be displaced

37
Q

HS Length or Popliteal Angle

Purpose

A

Assess spasticity of HSs and avail. mm length

38
Q

HS Length or Popliteal Angle

A
  • 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

NOTE:** this is NOT a measure jt ROM, but rather **mm extensibility & spasticity**

39
Q

Ankle R1/R2

A
  • 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.
40
Q

Interpreting R-values

R1/R2 FAR APART

EX. -70/-30

Limiting factor?

A

TONE is limting factor

41
Q

Interpreting R-values

R1/R2 CLOSE TOGETHER

Indicates what ?

A
  • BOTH tone and mm length are likely contributing to deficit→ Unable to decipher which contributing more
42
Q

R1=R2

Says what?

A

CONTRACTURE present

*cause uncertain

43
Q

R1/R2

Documenting

A

Always document as R1/R2

44
Q

LLD

A
  • 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
45
Q

LLD:

Galeazzi Sign

A

Quick screening method for LLD

*Does NOT provide any estimate of value of diff.

Pediatrics (27 decks)

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