Lecture 16 - MSK conditions in Paediatrics Flashcards
When does growth start
first trimester
When is the matrix of the skeleton laid down
first 4 weeks of gestation
when do limb buds arise
during 4th week of gestation
what do the 2 genes homeobox and sonic hedgehog do
convey body plan, position information and limb developments
When do type 1 and type 2 muscle fibres form
type 1 by 12 weeks
type 2 by 30 weeks
When is skeletal growth most rapid
2-3 yrs (at 2 u will be half your adult height)
Define packaging conditions in an infant
rapid growth wight and height in 3rd trimester - 1st growth spurt –> greater force on cartilaginous foetal skeleton –> can lead to msk deformation
What is normal alignment at birth
kyphosis - from c-spine to sacrum
hip flexed and in ER
IR of tibia
varus feet
Define plagiocephaly, brachiocephaly
plagio = mishapen head, influenced by neck tone - pushing back against pillow
brachio = flattening at back
treatment = education, positioning, environmental set up
What is Congenital muscular torticollis (CMT)
shortened sternocleidomastoid
risk factors - first born, plagiocephaly, birth trauma
resolves 6w - 2m
stretching, put stimuli on other side
What is neonatal brachial plexus palsy
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
Define Developmental Hip Dysplasia
mismatch between femoral head and acetabulum
What are some risk factors for DDH
intrauterine restriction,
females,
first born,
neuro conditions
What do u watch for with DDH
limited hip abduction
shortened femoral length
aysmetrical skin creases
prominent greater trochanter
What are the tests and treatments you can do for DDH
Tests: Barlow, Ortolani, Hip US
Treatment: Pavlik harness, ortho surgery
what is metatarsus adductus
metatarsal bones deviated inward
flexible or rigid
What is Talipes Calcaneovalgus
forefoot curved laterally, hindfoot in valgu, full or excessive DF
usually resolves spontanously, casting or splinting
Describe Positional Talipes equinovarus
foot is inverted and pf
What is congenital talipes equinovarus
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
Describe congenital vertical talus (CVT)
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
describe the pGALS
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
Describe pREMS
look, feel, move
Beware of the 4 S’s when performing pGALS and pREMS. what are they
Symmetry
Symptoms
Stiffness
Systemic - inflammation
What is the common diagnosis for DDH for a toddler (1-4yr old), a child (4-10), and a adolescent (>10)
Toddler - DDH
Child - Transient synovitis of the hip
Adolescent - slipped capital femoral epiphysis
What are the 6 types of fracture
bowing buckle greenstick complete spiral complete transverse complete oblique
management of a fracture
position limb/immobilize
immobilize joints above and below
define osteomyelitis
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
Describe Perthes disease (leg-calve)
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
Slipped capital femoral epiphysis
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
What are 3 examples of traction apophysis
osgood schlatters
Sinding Larsen-johannsson
Sever’s disease
Describe JIA
autoimmune disease
inflammation in one or more of the joints for 6 weeks or longer
What are some clinical signs of JIA
swelling pain warmth fever limp decreased ROM morning stiffness fatigue
What are the 4 types of JIA. describe each
Oscar
Pistorius
Sucks
Everyones Rank Ass
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
What percentage of children with JIA are unable to participate in school and sports
85%
How do you assess JIA
pGALS, pREMS, AROM, PROM, MMT, 6m walk test, QoL measures, pain
What are the aims of management
decrease pain maintain rom improve function prevent/correct deformity improve exercise endurance
How do you treat JIA
ice/heat
casting
exercise
hydrotherapy
