MSK & Articular Dysfunction Flashcards by Grace McNally

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

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what is the most difficult aspect of illness in children?

immobility

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how does immobilization affect the MUSCULAR system?

decreased strength and endurance
atrophy
loss of joint mobility

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how does immobilization affect the SKELETAL system?

bone demineralization
negative calcium balance (calcium leaves bone)

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bone demineralization increases risk of ___________

fractures

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how does immobilization affect METABOLISM?

decreased metabolism

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how does immobilization affect calcium levels?

hypercalcemia

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how does immobilization affect stress hormones?

decreased production

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how does immobilization affect the CARDIOVASCULAR system?

altered blood volume distribution
venous stasis
decreased vasopressor effects
dependent edema

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how does immobilization affect the RESPIRATORY system?

decreased oxygen consumption
decreased vital capacity
decreased resp muscle strength
crackles
aatelectasis

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how does immobilization affect GASTROINTESTINAL system?

decreased muscle tone
distension
constipation
anorexia

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how does immobilization affect the INTEGUMENTARY SYSTEM?

decreased circulation and pressure increases risk for pressure ulcers

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how does immobilization affect the URINARY system?

difficult to pee in bed
urinary retention

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what is a normal finding associated with immobilization, that we often have to educate parents about?

developmental regression

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what are soft tissue injuries?

injuries to muscle, ligaments and tendons

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how do most soft tissue injuries occur?

play
sports

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what are some examples of soft tissue injuries?

dislocations
SCFE
sprains
strains

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what is an SCFE?

slipped capital femoral epiphysis
femoral head displaces from growth plate

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what is RICE?

rest
ice
compression
elevation

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what is the most common injury in children?

fractures

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how do children heal compared to adults? why?

faster
more osteogenic

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fractures are rare in ____________ except when a result of ____________

rare in infants
except when caused by motor vehicle accidents

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what is the most frequently broken bone?

clavicle

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how do neonates end up with broken clavicles?

birth trauma
shoulder dystocia

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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?

1. lateral curvature 2. spinal rotation 3. 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?

what are the management interventions for juvenile arthritis?

NSAIDs (naproxen) steroids DMADs (methotrexate) encourage exercise