module 21 peds MS Flashcards
Inspection
inspect skeleton and extremities and compare sides
- alignment
- contour and symmetry
- size
- gross deformity
inspection over muscles and joints
color
number of skin folds
swelling
masses
fetal development
skeletal system emerges from embryologic CT to form cartilage that calcifies to become bone
- Long bones: increase in diameter by growth of new bone tissue around bone shaft. Length results from proliferation of cartilage at growth plates.
- Small bones: cartilage ossifies
children ligaments
ligaments are stronger than bone till adolescence
- injuries to long bones and joints more likely to result in fractures than in sprains.
rapid growth in puberty leads to
dec. strength in epiphysis
- increased risk for injury
Bone growth complete
around age 20
- peak at age 35
Family Hx
congenital abnormalities of hip and foot scoliosis and back problems arthritis genetic disorders - osteogenesis imperfecta - skeletal dysplasia - rickets - hypophosphatemia - hypercalciuria
birth hx
presentation Large or small for gestation age birth injuries ( fx or nerve damage) type of delivery use of tools premature resuscitation ventilatior support
quality of movement
spasticity
flaccidity
cog wheel rigidity
back inspection on infants
hair tufts and dimples discolorations cysts or masses near spine curvature of spine Extremities - symmetry - movement - equality - deformity
infant palpation of bones
fractures of dislocations crepitus masses tenderness SPINE - shape - formation - splitting
infant palpation of muscles and joints
tone
mobility
subluxation or dislocation
Infants look for
motor development: fine and gross
ROM
muscle strength
tibial torsion
Barlow maneuver
detects hip dislocation or subluxation
- position yourself at supine infants feet, flex the hip and knee to 90 degrees
- thumb on inside of thigh, base of thumb on knee, fingers gripping outer thigh, finger tips on greater trochanter
- adduct the thigh and gently apply downward pressure on femur in attempt to disengage femoral head
- – Positive sign: clunk or sensation is felt as femoral head exits
Ortolani maneuver
detects hip dislocation of subluxation
- at supine infants feet, flex the hip and knee to 90 degrees
- thumb on inside of thigh, fingers on outer thigh, tips at the greater trochanter
- slowly abduct the thigh while maintaining axial pressure
- fingertips exert a lever movement in the opposite direction, press the head of the femur back toward the acetabulum
- if head of femur slips back into acetabulum with palpable clunk with pressure: suspect subluxation or dislocation
genu valgum
knock-knees
- common between 2-4 years of age
Genu varum
bowlegs
- common until 18 months of age
talipes equinovarus (club foot) 3 features
equinus or plantar flexion of the foot at the ankle joint
varus or inversion deformity of the heel
forefoot varus
tibial torsion
abnormal bowing (internal or external rotation) of tibia
- toeing appearance of child’s legs when walking/running
- not painful, trip and fall often
- can note internal rotation of affected leg, flat feet, increased lumbar lordosis
developmental dysplasia of the hip
abnormal development or dislocation of hips
- 1st born, breech, girl: risk factors
- oligohydramnios
Talipes equinovarus patho
fixed congenital defect of the ankle and foot
- genetic and external influences in the final trimester
- intrauterine compression
talipes equinovarus subjective
dx usually obvious at birth with classic deformity
talipes equinovarus objective
most common combo includes inversion of the foot at the ankle, plantar flexion, with the toes lower than the heel.
metatarsus adductus (metatarsus varus) patho
most common congenital foot deformity
- can be fixed or flexible
- caused by intrauterine positioning
- medial adduction of toes and forefoot results from angulation at the tarsometatarsal joint
metatarsus adductus subjective
dx is usually obvious at birth
heel and ankle uninvolved
metatarsus adductus objective
lateral border of the foot is convex
transverse crease is sometimes apparent on the medial border of the foot
- 10% of cases will also have hip dysplasia
legg-calve-perthes disease patho
avascular necrosis of the femoral head
legg-calve-perthes disease subjective
most common in boys between 3 and 11 years old
pain os often referred to the medial thigh, knee, or groin
bilateral involvement in 10% of cases
legg-calve-perthes disease objective
limp with or without pain
loss of internal rotation, abduction and decreased ROM
muscle weakness of the upper leg may be present if s/s have been present for a prolonged period
osgood-schlatter disease patho
traction apophysitis (inflammation of a bony outgrowth) of the anterior aspect of the tibial tubercle from repetitive stresses. (athletes)
- associated with inflammation of the anterior patellar tendon
- self limiting
- most common in boys between 9 and 15 years
- rapid growth spurts
osgood-schlatter disease subjective
walking with a limp
knee pain, especially with activity
osgood-schlatter disease objective
knee swelling that is aggravated by strenuous activity
pain especially prominent with activity involving the quad
pain with palpation over the tibial tuberosity
slipped capital femoral epiphysis patho
disorder in which the capital femoral epiphysis slips over the neck of the femur
- Spontaneous dislocation of femoral head both downward and backward secondary to disruption of epiphyseal plate
- most common between 8 and 16 years of age`
slipped capital femoral epiphysis subjective
child or adolescent with knee pain and limp
slipped capital femoral epiphysis objective
leg weakness and reduced internal hip rotation
XR: slippage of femoral head
muscular dystrophy patho
group of genetic disorders involving gradual degeneration of the muscle fibers
- progressive symmetric weakness and muscle atrophy or pseudohypertrophy from fatty infiltrates
muscular dystrophy subjective
clumsiness
difficulty climbing stairs
frequent falls
muscular dystrophy objective
muscle atrophy and weakness with a waddling gait
positive gower sign
progressive loss of function, including ability to walk
scoliosis patho
physical deformity of the spine
- curvature of the vertebral bodies: spine looks more like and S or C than a straight line from posterior view
scoliosis subjective
may lead to back discomfort and is often associated with a leg length discrepancy
scoliosis objective
lateral curvature of the spine, rib hump as the child flexes forward to touch toes
severe: uneven shoulder and hip levels, may have crease on one side at waist
Physiologic alterations occur in spine, chest, and pelvis
radial head subluxation (nursemaid elbow) patho
dislocation injury
- caused by jerking the arm upward while elbow is extended
radial head subluxation subjective
common in children 1-4 years old
pain in the elbow and wrist
refuses to move arm
Gower sign
child rises from a sitting position by placing hands on the legs and pushing the trunk up.
