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PAL > Lecture 16 - MSK conditions in Paediatrics > Flashcards

Lecture 16 - MSK conditions in Paediatrics Flashcards

1
Q

When does growth start

A

first trimester

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2
Q

When is the matrix of the skeleton laid down

A

first 4 weeks of gestation

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3
Q

when do limb buds arise

A

during 4th week of gestation

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4
Q

what do the 2 genes homeobox and sonic hedgehog do

A

convey body plan, position information and limb developments

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5
Q

When do type 1 and type 2 muscle fibres form

A

type 1 by 12 weeks

type 2 by 30 weeks

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6
Q

When is skeletal growth most rapid

A

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

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7
Q

Define packaging conditions in an infant

A

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

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8
Q

What is normal alignment at birth

A

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

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9
Q

Define plagiocephaly, brachiocephaly

A

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

brachio = flattening at back

treatment = education, positioning, environmental set up

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10
Q

What is Congenital muscular torticollis (CMT)

A

shortened sternocleidomastoid

risk factors - first born, plagiocephaly, birth trauma

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

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11
Q

What is neonatal brachial plexus palsy

A

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

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12
Q

Define Developmental Hip Dysplasia

A

mismatch between femoral head and acetabulum

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13
Q

What are some risk factors for DDH

A

intrauterine restriction,
females,
first born,
neuro conditions

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14
Q

What do u watch for with DDH

A

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

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15
Q

What are the tests and treatments you can do for DDH

A

Tests: Barlow, Ortolani, Hip US

Treatment: Pavlik harness, ortho surgery

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16
Q

what is metatarsus adductus

A

metatarsal bones deviated inward

flexible or rigid

17
Q

What is Talipes Calcaneovalgus

A

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

usually resolves spontanously, casting or splinting

18
Q

Describe Positional Talipes equinovarus

A

foot is inverted and pf

19
Q

What is congenital talipes equinovarus

A

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

20
Q

Describe congenital vertical talus (CVT)

A

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

21
Q

describe the pGALS

A

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
22
Q

Describe pREMS

A

look, feel, move

23
Q

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

A

Symmetry
Symptoms
Stiffness
Systemic - inflammation

24
Q

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

A

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

25
Q

What are the 6 types of fracture

A 
bowing
buckle
greenstick
complete spiral
complete transverse
complete oblique
26
Q

management of a fracture

A

position limb/immobilize

immobilize joints above and below

27
Q

define osteomyelitis

A

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

28
Q

Describe Perthes disease (leg-calve)

A

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

29
Q

Slipped capital femoral epiphysis

A

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

30
Q

What are 3 examples of traction apophysis

A

osgood schlatters
Sinding Larsen-johannsson
Sever’s disease

31
Q

Describe JIA

A

autoimmune disease

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

32
Q

What are some clinical signs of JIA

A 
swelling
pain
warmth 
fever
limp
decreased ROM
morning stiffness
fatigue
33
Q

What are the 4 types of JIA. describe each

Oscar
Pistorius
Sucks
Everyones Rank Ass

A

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

34
Q

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

A

85%

35
Q

How do you assess JIA

A

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

36
Q

What are the aims of management

A 
decrease pain
maintain rom 
improve function 
prevent/correct deformity 
improve exercise endurance
37
Q

How do you treat JIA

A

ice/heat
casting
exercise
hydrotherapy

PAL (14 decks)

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