MS in Paeds Flashcards
Variants in skeletal development
Upto 12 months - bowleg
3-4 yrs - genu valgum
7-adulthood - straightens
females have > valgus throughout adulthood
What is normal alignment at birth
Kyphosis from Cx to sacrum
Hips flexion+ER
Varus feet
IR tibia
- this lengthens out over time
MS assessment of the infant
Symmetry
Skull shape
Mm bulk
Joint range
Lower back:
tufts of hair
spinal alignment
ROM of hips/knees/feet
Describe what positional plagiocephaly is and the different types
-misshapen head; balances out within 6 weeks; nothing wrong with brain development
Lateral deformational plagiocephaly
- ipsilateral temporal skull growth
- ipsilat ear anteriorly displaced
- flattening posterolateral of skull only
Posterior plagiocephaly
- central posterior
- widening of posterior
- temporal bossing
Plagiocephaly - treatment/prevention
- Education
- Counter positioning
- Environmental set up
- Active positioning
- Helmet (only good before sutures close 10-12 months)
- Treat causative factors (eg. if increased extensor tone causing baby to push head back then treat that)
Congenital muscle toricollis
- named for the SCM affected
- earlier treatment starts (6 weeks to 2 months) the better; consider implications for plagiocephaly
- 3 types:
Positional
Muscular
SCM mass
Neonatal brachial plexus palsy
- traction to BP during birth - C5-6 most common
- large baby, shoulder getting stuck behind pubis (dystocia)
Will show:
- waiters tip posture (wrist flexion/pronation, elbow extension, shoulder IR)
- no response to stimulation
- 70-80% get better spontaneously
- nerve recovery complete in a few months
BP Assessment+Treatment
Assessment: History Look Move - PROM/AROM Test - developmental/functional assessment
Treatment:
- maintain PROM
- faciliate active movements
- strengthening/surgery/splinting (casting, night splints, orthotics, stretching)
Development dysplasia of the hip
- d/t mm imbalance over time/shallow acetabulum/lig laxity
RFs: - females - 1st born - family history ALSO - breech position, excessive swaddling, neuro conditoins, neuro conditions
Signs of DDH/Tests for DDH/Treatment
Galeazzi sign
Asymmetrical knee creases
Limited/aysmmetrical hip ABD
Tests:
Ortolani (prying open)/Barlow (pushing down and out)
US
Treatment: paediatric orthopod Pavlik harness Surgery Education/proper handling
Metatarsus Adductus
- flexible or rigid; cosmetic condition only - its overtreated!
- use heel bisector line to Dx
Talipes calcaneovalgus
- forefoot curved laterally
- hindfoot valgus
- excessive DF
- resolves spontenously if postural
- might need splinting if very stiff
Postural Talipes equinovarus (TEV) and Congenital Talipes Equinovarus (CTEV)
TEV - normal foot position can be reached passively
CTEV - structural; changes occur 6-8 weeks in utero; needs a lot of management; Ponsetti method used to treat
- cavus, adductus, varus of heel, equinus
- if not treated - you’ll walk on outside of foot - will ruin the foot by teens!
- Ponsetti = series of casts to change foot structure
> going from inv/add to ev/abd
> sets them up for surgery - when 45º abd/lateral head of talus no longer bulging out
>surgery = achilles tenotomy; then casted -ABD(60º)+DF (10º) - 3 months 23 hrs/day; then 12 hrs/night till age 4
What does pGALS include?
Obs Gait (heel/toe) Hands to ceiling Hands behind head MSF Hip IR
What is the prognosis of fractures dependent on?
Age
Site of fracture
Type of fracture
Blood supply
Rx for #?
- position + immobilise
- ensure proper circulation
- plaster care and post cast management
Osteomyelitis vs Septic Arthritis
Osteomyelitis
- infection of the bone spread from infection or puncture wound
- subacute/NWB/wont use limb
- pain on movement
- painful, red+tender+swelling
- Rx = curetting of bone/ABs/PKs/immob
Septic arthritis
- bacterial infection of synovial joint entering into bloodstream from puncture wound or infection in surrounding bone
- acute
- pain on movement and rest
- other just like above - except aspiration of fluid
Describe Perthes
- AVN of the capital femoral epiphysis
- destroys articular cortex - mushroom deformity
- limp towards the end of the day
- limited ABD+IR
- shorter leg on affected side
- quads wasting
What is the treatment for Perthes?
Younger kids:
- just monitor
- avoid WB until the joint has recovered
- give kids another way to burn energy
Adults:
- rest period needed; crutches or wheelchari might be needed upto 1 yr
- bracing or plaster casting?
- surgery
Describe SCFE
- OBESE kids - 90% of cases; assoc with females + long limbs
- femoral neck slips superior+anterior
- d/t weakness of growth plate
What are the findings for SCFE?
- overweight
- limp
- foot+knee ER
- shorter leg on affected side
- pain in groin/medial thigh/knee
- reduced ABD+IR
What is Rx for SCFE?
- minimize displacement + degeneration
Surgery:
- OR + realignment + fixation
- important to maintain blood supply - or else perthes!
Post op: Broomstick plaster (stick between feet) bed rest 1 week NWB 6 weeks; PWB 20% increase each week Hydrotherapy week 3
JIA + S/Sx?
- inflammation of 1+ joints for 6 or more weeks
- F>M
- > 80% have daily pain
- 85% affects ADLs
S/Sx:
- swelling
- pain/irritable
- limp
- weight loss
- mm wasting
- AM stiffness
- fever
- unexplained rash
What are the subgroups of JIA?
Oligoarticular:
- upto 4 joints affected
- dismissed as growing pains
Polyarticular:
- 5+ joints affected
- aggressive
- LT disability
Systemic:
- unwell/fever/rash
- cardiac/liver/lymph involved as well
Others:
Enthesitis related arthritis
Psoriatic arthritis
What does an assessment of JIA involve? Management?
Px scale pGALS+REMS AROM/PROM 6MWT QOL measure
Management:
- MDT
- drugs
- PT/OT
Treatment of JIA?
Hydroptherapy
Ex
Ice/heat
Splinting/serial casting
