Lecture 16 - MSK conditions in Paediatrics

Question 1

When does growth start

Answer 1

first trimester

Question 2

When is the matrix of the skeleton laid down

Answer 2

first 4 weeks of gestation

Question 3

when do limb buds arise

Answer 3

during 4th week of gestation

Question 4

what do the 2 genes homeobox and sonic hedgehog do

Answer 4

convey body plan, position information and limb developments

Question 5

When do type 1 and type 2 muscle fibres form

Answer 5

type 1 by 12 weeks

type 2 by 30 weeks

Question 6

When is skeletal growth most rapid

Answer 6

2-3 yrs (at 2 u will be half your adult height)

Question 7

Define packaging conditions in an infant

Answer 7

rapid growth wight and height in 3rd trimester - 1st growth spurt –> greater force on cartilaginous foetal skeleton –> can lead to msk deformation

Question 8

What is normal alignment at birth

Answer 8

kyphosis - from c-spine to sacrum
hip flexed and in ER
IR of tibia
varus feet

Question 9

Define plagiocephaly, brachiocephaly

Answer 9

plagio = mishapen head, influenced by neck tone - pushing back against pillow

brachio = flattening at back

treatment = education, positioning, environmental set up

Question 10

What is Congenital muscular torticollis (CMT)

Answer 10

shortened sternocleidomastoid

risk factors - first born, plagiocephaly, birth trauma

resolves 6w - 2m
stretching, put stimuli on other side

Question 11

What is neonatal brachial plexus palsy

Answer 11

traction injury to brachial plexus
factors: large baby, shoulder dystonia - prolonged labour , traumatic birth

70-80% get better spontaneously

tape, casting, stretching, facilitate active movements

Question 12

Define Developmental Hip Dysplasia

Answer 12

mismatch between femoral head and acetabulum

Question 13

What are some risk factors for DDH

Answer 13

intrauterine restriction,
females,
first born,
neuro conditions

Question 14

What do u watch for with DDH

Answer 14

limited hip abduction
shortened femoral length
aysmetrical skin creases
prominent greater trochanter

Question 15

What are the tests and treatments you can do for DDH

Answer 15

Tests: Barlow, Ortolani, Hip US

Treatment: Pavlik harness, ortho surgery

Question 16

what is metatarsus adductus

Answer 16

metatarsal bones deviated inward

flexible or rigid

Question 17

What is Talipes Calcaneovalgus

Answer 17

forefoot curved laterally, hindfoot in valgu, full or excessive DF

usually resolves spontanously, casting or splinting

Question 18

Describe Positional Talipes equinovarus

Answer 18

foot is inverted and pf

Question 19

What is congenital talipes equinovarus

Answer 19

congenital structural deformity - affects bones - ligs - muscles
uni or bilateral
inversion and adduction and PF
walk on outside of foot
casting - adduction and eversion –> 45 degrees –> surgery

Question 20

Describe congenital vertical talus (CVT)

Answer 20

sever foot deformity
dislocation of navicular onto head of talus
fixed hindfoot with DF ABD midfoot
head of talus can be felt on sole of foot

surgery/casting

Question 21

describe the pGALS

Answer 21

observe
Walk
Reach up touch the sky - look at the ceiling
out your hands behind your head

• looking for verbal/non-verbal clues of discomfort
• look for asymmetry

Question 22

Describe pREMS

Answer 22

look, feel, move

Question 23

Beware of the 4 S’s when performing pGALS and pREMS. what are they

Answer 23

Symmetry
Symptoms
Stiffness
Systemic - inflammation

Question 24

What is the common diagnosis for DDH for a toddler (1-4yr old), a child (4-10), and a adolescent (>10)

Answer 24

Toddler - DDH
Child - Transient synovitis of the hip
Adolescent - slipped capital femoral epiphysis

Question 25

What are the 6 types of fracture

Answer 25

``` bowing buckle greenstick complete spiral complete transverse complete oblique ```

Question 26

management of a fracture

Answer 26

position limb/immobilize | immobilize joints above and below

Question 27

define osteomyelitis

Answer 27

bacterial infection in a synovial joint entering through the blood stream after a puncture wound from an injection in the surrounding bone acute onset of limp pain on movement - limited ROM

Question 28

Describe Perthes disease (leg-calve)

Answer 28

blood supply to round head of femur is cut off - avascular necrosis limp limitation in ROM of abduction and IR of hip treatment - rest, monitor, avoid run/jump, rest from WB, surgery

Question 29

Slipped capital femoral epiphysis

Answer 29

caused by weakness of growth plate, femoral neck slips anteriorly/superiorly to femoral head - widening of growth plate >10yr old overweight limp foot and knee in ER treat - surgery, fixation/manage blood supply NWB for 6 weeks - hydrotherapy

Question 30

What are 3 examples of traction apophysis

Answer 30

osgood schlatters Sinding Larsen-johannsson Sever's disease

Question 31

Describe JIA

Answer 31

autoimmune disease | inflammation in one or more of the joints for 6 weeks or longer

Question 32

What are some clinical signs of JIA

Answer 32

``` swelling pain warmth fever limp decreased ROM morning stiffness fatigue ```

Question 33

What are the 4 types of JIA. describe each Oscar Pistorius Sucks Everyones Rank Ass

Answer 33

Oligoarticular - up to 4 jts involved Polyarticular - 5 or more joints Systemic - fever, rash, cardiac liver involvement/inflammation Enthesis related arthritis - inflammation of tendon and ligs - involves pine - ankolysing spondylitis

Question 34

What percentage of children with JIA are unable to participate in school and sports

Answer 34

85%

Question 35

How do you assess JIA

Answer 35

pGALS, pREMS, AROM, PROM, MMT, 6m walk test, QoL measures, pain

Question 36

What are the aims of management

Answer 36

``` decrease pain maintain rom improve function prevent/correct deformity improve exercise endurance ```

Question 37

How do you treat JIA

Answer 37

ice/heat casting exercise hydrotherapy