Module 8: Developing Spine & Extremities Flashcards
Three types of peripheral nerve injuries
- Neuropraxia = transient complete motor paralysis, MC 2ndary to mechanical pressure
- Axonotmesis = Motor, sensory & ANS complete paralysis. loss continuity of axon, maintain schwann sheath.
- Neurotmesis = complete loss continuity axon & schwann sheath.
What is most common hip pain in 3-8 yr old and often follows viral URTI?
- Transient synovitis
- Sudden onset hip pain
- Reduced ROM - esp IR
- Often self resolving in couple of days
What is the presentation of Erbs Palsy, what Nerve roots involved?
Erb palsy = MC brachial plexus injury
- C5, C6 Nerve roots involved
- IR of shoulder
- unable to abduct arm or bend elbow
- waiter tip deformity wrist
- may have atrophy of arm muscles
- May also have Horners syndrome = eyelid droop (ptosis) & smaller pupil size same side
- may be d/t clavicle fracture
which conditions can cause a limp in child and swelling/ heat over hip & fever?
- Septic arthritis - bacterial infection of synovial joints. Investigate MRI
- Osteomyelitis - Staph Aureus MC, Investigate MRI
- Transient synovitis
Painful vs Painless limp in child 1-3 yrs
Painful
- Septic arthritis/ osteomyelitis
- Transient synovitis
- Trauma
Painless;
- DDH
- JIA (juvenile idiopathic arthritis)
- Neuromuscular (CP)
Painful vs painless limp in child 3-10 yrs;
Painful
- Transient synovitis
- Septic arthritis/ osteomyelitis
- Trauma
- JIA
- Legg calve Perthes (acute)
- Malignant
Painless
- Perthes (Chronic)
- Neuromuscular (DMD)
- JIA
- DDH
Painful vs painless limp in child 11-18yrs?
Painful
- SUFE
- Perthes/ avascular necrosis
- JIA
- Trauma
- Septic arthritis/ myelitis
- Tumour
Painless:
- SUFE (chronic)
- JIA
Loss of internal hip rotation is common in which hip conditions?
- Transient synovitis
- Legg calve perthes
- SUFE
Presentation of SCFE?
- MC hip disorder in adolescents
- MC 8-15/16yrs
- Ass w obesity & metabolic disorders & growth hormone supplementation
- Limping
- poorly localised pain - hip px w ref to ant’ thigh & knee
- Dx imaging = Xray (Ap & frog leg)
- Reduced IR
- Can’t flex hip properly - on flexion roles into ER & ABD
Presentation/ pathophysiology of Leg calve Perthes?
- AVN of femoral head, often prior trauma
- M:F = 4:1
- good prognosis if dx before 6 yrs
- Pain - hip, can ref to ant thigh & knee
- limp, trendelenberg sign
- Pain relieved by rest
- LLD
- reduced IR & ABD
- Ref for XRAY
Pathophysiology & presentation of Transient synovitis:
- MC cause of limping in child - often due to URTI or gastro infection MC 3-4 yrs
- initiated by minor trauma
- inflammation of synovial membrane of hip resulting in synovial effusion w in joint capsule
- Groin & Ant thigh pain, limp, spasm hip muscle, reduced hip IR & ABD
- symptoms can last 1-2 weeks
significance of child not walking by 18 months
Red flag
But shuffling indicates?
Sign of poor central control, low tone.
often won’t have +ve support reflex
Homecare given for kids who are but shuffling;
- Ball rocking
- Opposites touch
- pre crawl rocking
- Deep pressure/ vibration to Bl feet and ankles
- supported crawl with parents doing cross pattern
Causes for asymmetrical crawl:
- Low tone = contributing factor
- DDH
- Plagio
- dural torque
How do you know if your adjustment is too much for Bub?
- wound up
- not seeing any change
- Pupil dialtion
- sympathetic response
What is an indicator that the child may have spina bifida?
- Hairy patch of skin or dimple on the baby’s back.
- Dx imaging = xray, MRI or CT
Which spinal motor tract modulates/ responsible for muscle tone & posture- where does it originate from?
- Reticulospinal tract
- Reticular formation (Originate pons & medulla)
- Travels Ipsilateral
Signs of UMN lesion?
- Hyper reflexia
- Increased Muscle tone hypertonia
- Weakness
- Loss of distal extremity strength/ dexterity
- Clasp knife
- +ve babinski
Signs of LMN lesion?
- Hypotonia
- Reduced MSR
- Weakness
- Muscle wasting/ atrophy
- Loss of strength
Spinothalamic tract carries what info;
- carry pain, temperature, crude touch
- decussate anterior white comminsure
Dorsal column carry what info?
- discriminative touch, joint position sense, vibration
- decussate to medial lemniscal system
What is considered part of the anterolateral system?
spinothalamic to thalamus
spinoreticular to reticular formation spinomesencephalic to PAG
What excites the pontomedullary reticular pathways and what does it cause?
- The ipsilateral cortex
- PMRF causes the following ipsilaterally:
• Inhibition of IML (sympathetic) output
• Inhibition of pain
• Inhibition of the inhibition of ventral horn cells (=facilitates muscle tone)
• Inhibition of anterior (flexor) muscles above T6 and posterior muscles below T6
