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OPP 4 FINAL TEST EVER > Lower extremity problems in kids > Flashcards

Lower extremity problems in kids Flashcards

1
Q

What are the growth centers and when do they appear? (6)

A
  • Iliac crest- 11-14 years
  • Ischial tuberosity- 13-15 years
  • Femoral head- 4 months
  • Greater trochanter- 4-6 years
  • Femoral condyle- 39 weeks
  • Tibial plateau- birth
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2
Q

When do the growth centers close? (6)

A

All between 16-20 years

  • Iliac crest- 20 years
  • Ischial tuberosity- 16 years
  • Femoral head- 16-18 years
  • Greater trochanter- 16-17 years
  • Femoral condyle- 16-19 years
  • Tibial plateau- 16-19 years
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3
Q

What must be integrated for gait to evolve?

A

Integration of the visual, vestibular, and somatosensory (proprioceptive) systems

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4
Q

At what age to children develop an adult gait?

A

5-6 years

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5
Q

Evolution of childhood gait

A

high-guard gait –> low-guard gait –> adult gait

- Persistence of high or low guard gait is a sign of pathology that needs to be followed up.

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6
Q

Static visual inspection of the lower extremity

A
  • Line and shape of legs: genu valgum/varus, muscular tone and power
  • Symmetry and shape of joints and folds: gluteal and popliteal
  • The weight bearing foot: flat feel normal in kids until 3
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7
Q

What do you look for in gait evaluation?

A
  • In-toeing
  • Out-toeing
  • Arm swing
  • Range of motion- global active and passive
  • Joint evaluation
  • Muscles
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8
Q

What are you looking for in X-ray evaluation of lower extremity?

A
  • Presence and shape of 3 innominate bones
  • Growth centers: b/l presence according to age
  • Special tests according to site
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9
Q

Signs and symptoms of Developmental dysplasia of the hip (DDH)

A
  • Asymptomatic

- Decreased ROM hip, difficulty with diaper change, delayed crawling, standing, walking

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10
Q

When is the best time time to detect DDH

A

Early detection before 6 months gives best outcome

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11
Q

Exam for DDH

A

Ortalani and Barlow

- Requires XR if positive or high suspicion

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12
Q

What happens if you don’t diagnose DDH as a child?

A

The adult will have a misshapen acetabulum.

This sets the joint up for mechanical and orthopedic problems- arthritis

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13
Q

Legg-Calve-Perthes Disease characteristics and demographic

A

A form of aseptic necrosis of the femoral head in 2-12 year olds

  • Boys > girls
  • Aching groin or proximal thigh
  • Pain worse at the end of the day
  • Antalgic gait
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14
Q

XR of Legg-Calve-Perthes

A

Narrowed and irregular epiphysis

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15
Q

Slipped Capital Femoral Epiphysis characteristics and demographic

A

Orientation of physis changes in adolescence- horizontal to more oblique

  • Increased body size is a risk factor
  • Ages 10-16
  • Pain and antalgic gait- sudden onset or insidious
  • Decreased physical activity
  • B/L in 40-50% of pts
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16
Q

Osgood-Schlatter disease

A

Effects the knee
- Caused by repetitive, tensile forces on developing tibial tubercle

  • Most common pediatric overuse syndrome
  • May be benign, self-limit
  • May occur after getting kicked in soccer
  • 20% of all young athletes
  • 20% b/l
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17
Q

Presentation of osgood-schlatter and types

A

Pain over tibial tubercle with activity, especially eccentric contraction of quadriceps
- Tenderness and swelling over tubercle

Type I: soft tissue swelling only
Type II: xray evidence of fragmentation

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18
Q

Metatarsus adductus

A

Intoeing- medial deviation of the forefoot on the hindfoot.

Important to determine the location of the internally rotated lower extremity- can occur at hip, knee, ankle, or foot

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19
Q

Rigid vs functional flat foot

A
  • Functional: when great toe is passively extended, the median arch will lift up. Normal in the child until age 2-3 years.
  • Rigid: flat foot will remain when great toe is extended. Never normal
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20
Q

What could flat foot indicate?

A

Weakness in the associated muscles, talar, or sub-talar joints

21
Q

Goal of OMT

A

Balance musculoskeletal tensions across all joints to:

  • optimize function
  • decrease biomechanical pressures across the joint and minimize damage
22
Q

What do anterior hip muscles effect?

A

Lumbar sacral joint
sacral iliac joint
acetabular function

indirectly- knee and ankle function

23
Q

What dysfunctions can osgood-schlatter cause in the innominate?

A
  • Posterior rotations
  • Lateral flares
    may increase tensile forces across the patella
  • Anterior rotations alter tone in knee flexors and may influence knee rotation
24
Q

How does the tibia move with knee extension and what happens if it can’t move?

A

Rotates laterally
- The medial femoral condyle is larger than the lateral

If it can’t move, tensile forces are increased

25
Q

How can knee flexors cause somatic dysfunction?

A

Can limit tibial accommodation of femur

26
Q

What can hypertonicity of sartorius cause?

A

External tibial rotation

27
Q

How can shortened biceps femoris cause somatic dysfunction?

A

Medially- can limit external rotation of tibia during knee extension

Laterally- can limit internal rotation of tibia during knee flexion

28
Q

Foot mechanics of pes planus

A

Pes planus results in compensatory internal rotation of tibia during loading

29
Q

How does the foot arch act as a diaphragm?

A
  • Fibrous connective tissue arches
  • With normal gait mechanics is a the base of a pyramid
  • Alternating flattening/stretching and peaking/relaxing, creates pumping action
  • Navicular “keystone” of median arch- shock absorber and stabilizer
30
Q

What makes up the transverse arch and what is it’s purpose?

A
  • 3 cuneiforms and cuboid
    Relatively rigid, peak of the ‘tent’
  • Maintains osseus architectue of the foot and provides support for the plantar fascia, tibialis posterior, tibialis anterior, and peroneus longus
31
Q

10 y/o overweight male presents to the clinic with a cc of 4 months of dull, achy 4/10 left hip pain that began “all of the sudden” and has not gone away. Nothing alleviates or worsens. Associated sx include a left leg limp. Pt has never had these sx before.

A

Slipped capital femoral epiphysis

- Noninflammatory condition typically in overweight boys

32
Q

What endocrine disorders can be seen in slipped capital femoral epiphysis

A

Hypothyroidism or pituitary deficiencies

33
Q

What does the Frog leg pelvis x-ray lets you diagnose?

A

Slipped capital femoral epiphysis

34
Q

Slip angles of slipped capital femoral epiphysis

A

0-30: mild
30-60: moderate
60-90: severe

35
Q

Goal of treatment of slipped capital femoral epiphysis

A

Stabilization of the femoral to prevent vascular damage and further deformity
Tx- surgical fixations with central screw or bone graft epiphysiodesis

36
Q

What are the 2 risks of the post op slipped capital femoral epiphysis patient

A

Avascular necrosis and destruction of articular cartilage

37
Q

OMT in slipped capital femoral epiphysis

A

OMT is directed toward improving vascular and lymphatic circulation –> improve and balance muscular tone across the joint and in the areas above and below

From above- psoas, erector spinae, abdominals, innominates, sacrum, junctions

From below- quads, hams, adductors, abductors, knee, ankle, foot

38
Q

Tucker is a 12 year old Caucasian male presenting with his mother complaining of bilateral knee pain that began 3 months ago and has gotten progressively worse. Physical exam reveals tender and warm nodules over anterior superior aspect of the tibias bilaterally.

A

Osgood-Schlatter Disease

39
Q

OMT treatment of Osgood-Schlatter disease

A

OMT to address any contributing mechanical strains/stresses

  • Tibial rotation
  • Hip restriction

Maintain balance between quadriceps and hamstrings

Treat

  • pelvis –> innominates
  • hip rotators –> piriformis
  • Long restrictors –> quadriceps/hamstring
  • Tibial mechanics
  • Fibula
  • Foot mechanics
40
Q

An 18 month old female is brought in by parents for in-toeing. Parents report the right is worse than the left, but she is tripping more than their other children.

A

Metatarsus Adductus

41
Q

Common somatic dysfunctions metatarsus adductus

A
  • Tightness in the medial fascia and adductors of the foot
  • Torsion of the first and second metatarsals and innversion rotation of the first cuneiforms
  • Everted calcaneus
  • Lateral longitudinal arch flattened
  • Posterior fibular head
42
Q

what part of the foot does metatarsus adductus involve?

A

Forefoot

Hindfoot is relatively flexible

43
Q

Toddler’s fracture

A

Subtle undisplaced sprial fracture of the tibia usually seen in preschool children. Caused by a sudden twist, often after an unwitnessed fall

(from reading)

44
Q

Septic arthritis

A

An infection of the synovium and joint space.
Staph aureus is the most common organism.

(from reading)

45
Q

Perthes disease

A

Idiopathic avascular necrosis of a developing femoral head.
Typically in boys aged 4-8.
Affected children are usually shorter than their peers.
Xray shows sclerosis, fragmentation, and flattening of the proximal femoral epiphysis.

(from reading)

46
Q

What are children under 3 most vulnerable to?

A

Septic arthritis and non-accidental injury

from reading

47
Q

What are children 3-9 years most vulnerable to?

A

Transient synovitis

from reading

48
Q

What are children over 9 vulnerable to?

A

Slipped capital femoral epiphysis

from reading

49
Q

How can transient synovitis and septic arthritis be differentiated?

A

Gold standard: Aspirate the joint and identify the presence, or absence, of organisms.

(from reading)

OPP 4 FINAL TEST EVER (12 decks)

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