MSK & Articular Dysfunction Flashcards
what are some symptoms of MSK and articular dysfunction?
pain with weight bearing
decreased muscle tone
rigidity
developmental delays
not meeting milestones
decreased movement of affected limb
redness
swelling
what is the most difficult aspect of illness in children?
immobility
how does immobilization affect the MUSCULAR system?
decreased strength and endurance
atrophy
loss of joint mobility
how does immobilization affect the SKELETAL system?
bone demineralization
negative calcium balance (calcium leaves bone)
bone demineralization increases risk of ___________
fractures
how does immobilization affect METABOLISM?
decreased metabolism
how does immobilization affect calcium levels?
hypercalcemia
how does immobilization affect stress hormones?
decreased production
how does immobilization affect the CARDIOVASCULAR system?
altered blood volume distribution
venous stasis
decreased vasopressor effects
dependent edema
how does immobilization affect the RESPIRATORY system?
decreased oxygen consumption
decreased vital capacity
decreased resp muscle strength
crackles
aatelectasis
how does immobilization affect GASTROINTESTINAL system?
decreased muscle tone
distension
constipation
anorexia
how does immobilization affect the INTEGUMENTARY SYSTEM?
decreased circulation and pressure increases risk for pressure ulcers
how does immobilization affect the URINARY system?
difficult to pee in bed
urinary retention
what is a normal finding associated with immobilization, that we often have to educate parents about?
developmental regression
what are soft tissue injuries?
injuries to muscle, ligaments and tendons
how do most soft tissue injuries occur?
play
sports
what are some examples of soft tissue injuries?
dislocations
SCFE
sprains
strains
what is an SCFE?
slipped capital femoral epiphysis
femoral head displaces from growth plate
what is RICE?
rest
ice
compression
elevation
what is the most common injury in children?
fractures
how do children heal compared to adults? why?
faster
more osteogenic
fractures are rare in ____________ except when a result of ____________
rare in infants
except when caused by motor vehicle accidents
what is the most frequently broken bone?
clavicle
how do neonates end up with broken clavicles?
birth trauma
shoulder dystocia
what is the most concerning fracture?
spiral
why are spiral fractures so concerning?
sign of non-accidental injury
child abuse
what is an epiphyseal plate?
cartilage growth plate
weakest part of long bones
what is the risk associated with epiphyseal growth plate fractures?
growth abnormalities
how are epiphyseal injuries treated?
open reduction
internal fixation
what are the risks associated with open reduction and internal fixation surgeries?
vascular necrosis
infection
what are the 4 types of fractures?
simple/closed
compound/open
complicated
comminuted
what is a simple/closed fracture?
no break in skin
how are most simple/closed fractures treated?
casts
what is a compound/open fracture?
protrude through skin
what is a complicated fracture?
damage to other organs and tissues
what is a comminuted fracture?
bone fragments break away from fracture site and enter surrounding tissue
what is involved in the work-up for a non-accidental fracture?
skeletal survey
- to look for other injuries
blood work
- to determine if there is anything that makes them more susceptible to fractures
how do we assess fractures?
5 Ps
what are the 5 Ps?
pain
pallor
paralysis
parasthesia
what is a 6th P?
pressure
what is a common complication that the 5 Ps might indicate?
compartment syndrome
what is compartment syndrome?
swelling is restricted by cast
what is CSM?
colour
sensation
movement
what is a supracondular cast?
goes elbow to fingers
what is osteosarcoma?
malignant bone tumour
osteosarcoma is most common in what bones?
long bones
shoulder
tibia
femur*
what are some manifestations of osteosarcoma?
pain
limping
palpable mass
how is osteosarcoma treated?
chemotherapy (to shrink)
rotaionplasty
what is a rotation-pasty?
remove affected bone and knee
rotate lower leg 180 degrees
use heel as knee
what is DDH?
developmental dysplasia of hip
what are the hip abnormalities associated with DDH?
shallow acetabulum
subluxation
dislocation
what is shallow acetabulum (DDH)?
mildest form of DDH
what is subluxation (DDH)?
incomplete disclocation
what is a risk factor for DDH?
breech birth
what are some signs of DDH?
shortened limb
restricted abduction
unequal gluteal folds
positive ortolani and Barlow tests
what tests are used to screen for DDH?
Barlow and ortolani tests
what is the Barlow test?
tests if the hip can be dislocated
adduct hip (in)
what is the ortolani test?
tests if dislocation can be reduced
abduct hip (out)
what is the pavlik harness?
used to treat DDH
keeps hips in bent outward position to promote realignment
what is the spica cast?
for more serious DDH
uses cast to immobilize hip
what is osteogenesis imperfecta?
brittle bone disease
genetic collagen disorder
what are some signs of osteogenesis imperfecta?
frequent fractures
what are some considerations for OI?
gentle handling
what is scoliosis?
spina deformity in 3 planes
what are the 3 planes of scoliosis?
- lateral curvature
- spinal rotation
- thoracic hypokyphosis
what causes scoliosis?
unknown
when does scoliosis most often become noticeable?
after growth spurt
how is scoliosis diagnosed?
standing radiographs
asymmetry
primary and compensatory curves
what is mild scoliosis? how is it treated?
< 25 degrees
monitor
what is moderate scoliosis? how is it treated?
25-50 degrees
brace
what is severe scoliosis? how is it treated?
50+ degrees
spinal fusion surgery
we wait until the child ___________ before final fusion surgery for scoliosis
stops growing
what is osteomyelitis?
bone infection
what are the sources of osteomyelitis?
exogenous
hematogenous
what is the most common organism that causes osteomyelitis?
S. aureus
symptoms of osteomyelitis begin ____________
suddenly
symptoms of osteomyelitis resemble __________ and _____________
arthritis
leukemia
what are the signs of osteomyelitis?
bone pain
fever
redness
swelling
increased WBCs
increased inflammatory markers
how is osteomyelitis diagnosed?
bone biopsy + cultures
x-ray (late detection)
MRI
what are the interventions for osteomyelitis?
start IV antibiotic right away for 4-6 weeks
bed rest and immobility
pain management
nutrition
monitor renal, hematological and liver function
what is juvenile idiopathic arthritis?
autoimmune joint inflammation
what are the possible causes of juvenile arthritis?
immune disorders
genetics
what is the peak age of onset for juvenile arthritis?
1-3 years
what are the symptoms of juvenile arthritis?
stiffness
swelling
decreased mobility
warmth
tenderness
decreased growth
how is juvenile arthritis diagnosed?
blood work
- increased WBCs
- increased CSR
- increased ESR
- antibodies
- genes
is there a cure for juvenile arthritis?
no
what are the management interventions for juvenile arthritis?
NSAIDs (naproxen)
steroids
DMADs (methotrexate)
encourage exercise
