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CD3408 > Lecture 11-14 > Flashcards

Lecture 11-14 Flashcards

1
Q

At 7 weeks gestation what happens to the limbs

A

Upper limb bud rotates external
lower bud rotates int
(femurs ext, tibias int)

-Torsional deformities arise when these processes are arrested or accentuated

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2
Q

overall diagnostic approach to examining lower limb

A
  1. Evaluate for foot deformity
  2. evaluate gait and coordination
  3. evaluate lower limb oath
  4. Evaluate for rotational profile
  5. Evaluate angular profile
  6. Incidental issues
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3
Q

a fallen arch is normal up to what age

A

10yold`

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4
Q

flexible fallen longitudinal arch is made up of what

A

Talus rot medially

calcareous rotated outwards

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5
Q

What are common foot conditions leading to intoning

A

Metatarsus Adductus

Bilateral Metatarsus Adductusq

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6
Q

What is metatarsus adductus

A

Adduction and inversion of the metatarsal bones resulting in in toeing
(normally line drawn thru heel should intersect the second/third toe space of the foot)

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7
Q

What is bilateral metatarsus adductus

A

Medial deviation of the forefoot, rounded lateral foot border

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8
Q

Pathology of toein

A

Tarsometatarsal jts subluxate medially
adduction and inversion of all 5 metatarsals
-hindfoot in neutral or valgus

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9
Q

What is the v finger test and what does it mean

A

The lateral aspect of the foot is observed from a plantar side for medial or lateral deviation from middle finger
-medial deviation from the middle finger at the styloid process indicateds MTA

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10
Q

incidence of toe lining and associated risk factors

A

1/500

Congenital dislocation of hips in 2-10% of cases

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11
Q

What is metatarsus virus

A

A fixed deformity caused by in utero subluxation

does NOT correct spontaneously after birth

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12
Q

What is calcaneovalgus foot and how does it look

A

the forefoot is abducted and the ankle is dorsiflexed (up and out appearance)

(seen in 30%, 1/1000 severe)

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13
Q

What is searching toe and why does it happen

A

Big toe points medially during gait

contracture of abductors during stance

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14
Q

What is club foot And what is it associated w

A

forefoot varus, heel varus, ankle equines

associated w CP, polio, neuromm disease

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15
Q

Tx for club foot (2)

A

Stretching/casting

Ponseti method- seriel casting
French method- taping and stretching
also surgery

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16
Q

If you see tip toe gait after 2 years what could it indicae

A

idiopathic toe walking

Neuro (CP, spinal dysgraphia, myopathy, neuropathy)

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17
Q

if u see out toeing what could it mean

A

External femoral tosion

External tibial torsion

18
Q

IF you see in toeing what could it mean (3)

A

Metatarsus adductus
medial tibial torsion
internal femoral torsion

19
Q

What is medial tibial torsion associated q

A

COngenital metatarsus adductus
Genu valgum
femoral anteversion

20
Q

Torsion is diagnosed if

A

The rotation is >2 standard deviations from the mean

21
Q

how to measure rotational profile according to staheli

A
  1. foot progession angle
  2. Int rot of the hip
  3. Ext rot of the hip
  4. Thigh foot angle
  5. Transmalleolar angle
22
Q

Other ways to evaluate tibial torsion

A 
Malleolar palpation
(if at the same lvl then 20-30degrees int rot, normal is lat post)
23
Q

Internal tibial torsion management

A

spontaneous resolution in 95% of children by 8
stretching
moderate/fixed should be surgical

24
Q

causes of external tibial rot

A

Extremely rare

  • -sleeping prone with the legs externaly rot
  • my be secondary to femoral antevertion or IT band contracture
25
Q

Symptoms of femoral antiversion

A

In toeing of gait bilaterally, clumsiness, cosmetic cancer, sitting in W pos

26
Q

What is the craigs test for femoral ante version

A

pt prone and int rot hip

Degree of rot at which trochanter is most prominent (degree of femoral anteversion)

27
Q

most accurate imaging method to see ante version

A

CT

28
Q

tx of ante version

A

Usually corrects by 8

29
Q

notable hip conditions in children

A

Congenital hip dysplasia
Transient hip synovitis
SCFE
Legg Calve PErthes

30
Q

Angular changes of knees in 0-2. 3-4, 5-7, adult

A

0-2– bow legs
3-4– Knock knees
5-7– straight
adult- slight knock

31
Q

lower limb growing pains featrues

A

-no evidence they are truly related to growth

  • age 3-12
  • normal growth
  • leg pain, worse at night, poorly localized
  • pain in mm not joints
  • absense of jt pain, limp, disability, inflammation
32
Q

What things should u check for the brighten score

A
  1. Palms on ground 1 pt
  2. each knee that bends back 1 pt
  3. each elbow that bends back 1pt
  4. thumb that touches forearm 1pt
  5. 5th digit bend back >90 1 pt
33
Q

benign paroxysmal torticolis signs/characteristics

A
  • attacks that last hours to days (but < 1w)
  • reoccurs every few days to every few m
  • Imprves over 2 years, ends by 3
  • fam hx of migraine
  • severe GERD
34
Q

What is craniosynososis and what does it cause

A

early closure of suture of the skull (normally close aroundd 12-18m)

infants have

  • Increased intracranial pressure
  • vision hearing and breathing problems
  • head shaped like a trapezoid
  • ear pos post
35
Q

What is neurogenic torticollis

A

An acute episode of torticollis that usually occurs in older children w neuro annomolies

36
Q

what is osseous torticollis and what is it caused by

A

congenital cervical spine malformations (klippel-feil)

-passive ROM limited (without tightness/thickening of SCM)

37
Q

What is KISS/KIDD

A

biedermann proposed that birth trauma induced upper cervical dysfunction has immediate consequences (KISS) and if left untx could lead to KIDD

38
Q

Acquired postural torticolis features

A

SCM tightness and thickening

no palpable mass

39
Q

COngenital mm torticolis features

A

w or w/o SCM tumor
palpable mass in SCM
often seen w breech presentations and difficult deliveries

40
Q

what side are most congenital mm torticolis

A

75% on R

41
Q

What is congenital torticolis

A

mm damage during labor

observe/palpate mm lump

CD3408 (10 decks)

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