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PNP: Physical Assessment > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Genu Valgum

A

Knock Knees; abnormal if the child has been walking for less than one year

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2
Q

Genu Varum

A

Boe legged; normal until child has been walking for one year

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3
Q

Ortolani Manuever

A

Contralateral hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly

  • Put hands on greater trochanter and check hips one at a time
  • Anterior; pushing his up
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4
Q

Barlow Maneuver (3)

A
  1. Adduct the hip while pushing the thigh posteriorly
    * Posterior; displacing hips
  2. If the hip goes out of the socket, it is called “dislocatabale” and the test is termed positive
  3. Confirmed the dislocation by performing Ortolani maneuver to reduce or relocate the hip; clunk it back into the socket (clunk = dislocation)
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5
Q

Benign Causes of Toeing in and Toeing Out (3)

A
  1. Foot: metatarsus adductus
  2. Tibia: internal tibial torsion
  3. Hip: femoral neck ateversion
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6
Q

Metatarsus Adductus (4)

A
  1. metatarsals are deviated medially; may cause intoeing
  2. Deformity of the upper one half forefoot
  3. Skin crease may be located on the medial aspect of longitudinal arch
  4. Sign of metatarsus adduction: push the baby’s foot up and down and the crease straightens out
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7
Q

Rickets Signs and Symptoms (8)

A
  1. Frontal bossing
  2. Protuberance on the costochondral borders (rosary)
  3. Widened ends of bones
  4. Low serum phosphate level
  5. Abnormal Vitamin D level
  6. Short stature
  7. Very bow-legged
  8. Irritability
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8
Q

Internal Tibial Torsion (4)

A
  1. Nonpathological normal variation under age 5
  2. Rotational deformity resulting from internal molding
  3. Patella faces anterior position –> The hips and knees are found to be normally aligned, with the patellas facing anteriorly, but the lower legs and feet are rotated inward.
  4. Children who sit with their feet on the floor should be encouraged not to
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9
Q

Femoral Anteversion (6)

A
  1. Normal variation
  2. Maximum at age 3
  3. Delayed correction may result in persistent intoeing
  4. Bilateral without any other disease association
  5. Condition corrects with time
  6. On examination, the child is noted to stand with the thighs, knees, and feet all turned inward. An increase in internal rotation over external rotation is apparent on assessment of range of motion of the hip
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10
Q

Congenital Clubfoot (Talipes Equinovarus) (4)

A
  1. The entire foot is positioned in plantar flexion (equinus)
  2. The hindfoot is maintained in a position of fixed inversion (varus)
  3. The forefoot exhibits an adductus deformity, often combined with supination
  4. May cause pain and have arthritis
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11
Q

Legg-Calve-Perthes Disease Manifestations (8)

A
  1. Pain localized to hip, thigh, or knee
  2. Decreased ROM – Child won’t like when you move the hip or log roll the hip
  3. Usually prefers externally rotated hip
  4. Limited internal rotation and abduction
  5. Limp – antalgic and/or trendelenburg gait
  6. Pain and limp may be activity related
  7. May be small for chronological age
  8. Bears less weight on affected side
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12
Q

Blounts Disease (6)

A
  1. Isolated growth disturbance of medial tibia epiphysis
  2. More common in A.A.
  3. Compression injury to the medial growth plate
  4. No evidence of ligamentous laxity
  5. The affected side has a lateral thrust causing marked bow-legged appearance
  6. Growth plate is injured causing the thrust outward
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13
Q

Osgood Schlatter Disease

A
  1. Swelling and pain on anterior tibial tuberosity
  2. Avulsion injury tibial spine
  3. Ages 10-15 years
    - Tanner stage 3 for a girl
    - Tanner stage 4 for a boy
  4. Their bone has grown but muscle hasn’t caught up, so quadriceps go down leg and insert into anterior tibial tuberous; as you use the leg, the muscle is grinding against the bone, causing an apothesitis
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14
Q

Slipped Capital Femoral Epiphysis Signs (8)

A
  1. Painful limp
  2. Obligate external rotation
  3. Loss of internal rotation

Classic sign = leg rotated out and not wanting to rotate it inward

  1. Trendelenburg gait
  2. May or may not have hx of recent trauma
  3. Pain may be in knee
  4. Flexion contracture
  5. Weak extensors, so hip drops when walking
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15
Q

Classifications of SCFE (6)

A
  1. Acute – SnS for 3 weeks
  2. Acute on chronic – SnS > 1 month, sudden increased pain

Degree of slip:

  1. Mid slip – less than 1/3rd diameter of femoral neck
  2. Moderate slip – less than ½ diameter of femoral neck
  3. Severe slip – greater than ½ diameter of femoral neck
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16
Q

Faber Test (3)

A
  1. Specific for problems of sacroiliac joint
  2. FABER = hip flexion, abduction and external rotation
  3. Take leg and cross it over the standing leg; unable to do this with bad hips
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17
Q

Hip Rotation Test (3)

A
  1. Roll the thigh of a supine positioned child
  2. Painful and limited in all traumatic infectious and inflammatory conditions of the hip
  3. If you can log roll 30 degrees, more likely transient synovitis
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18
Q

Pain in osteogenic sarcoma

A

Pain is usually over 10 with history of intermittent pain and swelling over several weeks

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19
Q

Pain in Ewings Sarcoma

A

Primary symptom is pain with possible fever and tenderness

20
Q

Ewing sarcoma (3)

A
  1. Moth eaten destructive lesion in shaft of long bone with onion skin periositis
  2. Flat bone presentation is sclerotic
  3. Higher prevalence in adolescents and young adults (10-20)
21
Q

Scoliosis (3)

A
  1. More than 10 degrees of scoliosis is abnormal
  2. Most common pattern is right thoracic and left lumbar
  3. Use scoliometer: angle of more than 7 degrees is associated with 20 degrees of scoliosis
22
Q

Osseous Lesions (2)

A
  1. Can cause painful scoliosis (osteoid osteoma or osteoblastomas)
  2. The scoliosis actually occurs as a result of muscle spasm secondary to the painful, inflammatory lesion in the spine (“painprovoked scoliosis”)
23
Q

Kyphosis (3)

A
  1. Excessive curvature in the thoracic spine; curvature of the spine in the saggital plane
  2. Thoracic spine has a kyphotic curve of 25-50 degrees, with a similar amount of lordosis in the lumbar spine in saggital plane
  3. Hyperlordosis (increased sway back) at lower back
24
Q

Scheuermann’s (4)

A
  1. Increased kyphosis of 45 degrees or more with three adjacent vertebrae at the apex of kyphosis
  2. More rigid
  3. Has tight hamstrings or contracted pectoral muscles
  4. Autosomal dominant inheritance pattern
25
Q

Spondolyolysis (5)

A
  1. Stress fracture of vertebrae that makes up the spinal column
  2. Most common in fifth vertebra in lower back or fourth lumbar vertebra
  3. Low back pain is usually self limited and seldom lasts
  4. Any pain persisting past 2-3 weeks should be referral
  5. There is a loss of structural integrity of the vertebral pars interarticularis, the bone that lies between the superior and inferior articular facets
26
Q

Spondolyolysis Assessment (4)

A
  1. Near midline pain that can be localized with one finger accuracy
  2. 85% of spondylolysis occurs at L-5
  3. Full range of motion with pain at extremes of extension—Hamstrings are tight
  4. Scotty dog sign
27
Q

Spondylolisthesis (6)

A
  1. Pre requisite: spondylolysis
  2. occurs when one vertebra slips forward on the adjacent vertebrae
  3. Gradual deformity of lower spine
  4. Narrowing of vertebral canal
  5. Associated with pain (could have marked low back pain)
  6. Most common at lumbosacral area
28
Q

Epiphyseal Plate

A

cartilaginous tissue that separates diaphysis and epiphysis

*At skeletal maturity, epiphyseal plate closes

29
Q

Ossification Centers (2)

A
  1. Primary center of ossification = diaphysis

2. Secondary center of ossification = epiphysis

30
Q

Radial Nerve Test

A

Ask patient to do a “thumbs-up”; test sensation in the 1st dorsal web space

31
Q

Median Nerve Test

A

ask patient to do an ‘A-OK’ sign; test sensation in volar aspect of index finger

32
Q

Ulnar Nerve Test

A

ask patient to spread or cross their fingers; test sensation in pinky finger
*Motor fibers can be assessed by asking the patient to spread fingers like a fan

33
Q

Fracture Configurations (Know all 5)

A
  1. Plastic- bowed beyond natural recall
  2. Buckle/Torus – compression at metaphysis and diaphysis junction
  3. Greenstick – disrupts but does not completely break cortex
  4. Avulsion – tearing away of part of bone by ligament or tendon
  5. Complete – fracture through the bone
34
Q

Type of Physeal Fractures (5)

A
  1. Type I: separation of physis only
  2. Type II: separation of physis with a triangle fragment of metaphysis
  3. Type III: separation of physis and passes through metaphysis into joint
  4. Type IV: fracture passes through metaphysis, physis, epiphysis and into joint
  5. Type V: compression injury of physis, diagnosed in retrospect
35
Q

Upper Arm Injuries (2)

A
  1. Fractures of the humerus are more common in children
  2. Shoulder dislocations are more common in older teenagers
    - Acute dislocation requires prompt reduction
36
Q

Trendelenberg Test (3)

A

Test of hip weakness

1st: Have child stand with one leg up
2nd: Pelvis should rise on side of leg that is lifted

  1. If it drops, the abductor weakness is present on opposite side = POSITIVE TEST
    * If left leg is weak and you lift it, the right side drops
37
Q

Assessment of Lower extremity complaints (2)

A
  1. Straight leg raises will make a herniated lumbar disc have pain in foot or leg
  2. Straight leg raise assess hamstring tightness more accurately than standing toe touching
38
Q

Strain

A

Injury to the muscle tendon unit attached muscle to bone

*Injury to tendon

39
Q

Sprain

A

Injury to ligament (holds joint together)

40
Q

Signs and Symptoms of Ankle Injury (5)

A
  1. Pain with limitation of motion
  2. Swelling and tenderness over the anatomic course of the injured structure
  3. Laxity of ligament is best appreciated after the injury and before swelling sets in
  4. Point tenderness over the growth plate indicate a Salter fracture
  5. Tenderness below a lateral malleolus suggest a sprain
41
Q

When is an ankle x-ray necessary? (Ottowa Ankle Rules)

A
  • The patient has pain in the malleolar zone
    AND:
  • Either bone tenderness over areas of potential fracture (specifically the posterior edge tip of the lateral or medial malleolus)
    OR
  • Cannot bear weight for 4 steps immediately post injury and in the ED or office
42
Q

Ottoawa Ankle Rule

A

A patient with an ankle sprain will present with swelling, ecchymosis, and tenderness over the anterior talofibular and calcaneofibular ligaments
-may not have ecchymosis if the ankle sprain is acute

43
Q

Child Abuse Soft Tissue Injuries

A

burns, lacerations, welts, abrasians, multiple injuries in different stages of healing

*more common than fractures

44
Q

Common fractures in child abuse

A

corner metaphyseal, rib, vertebral body, bilateral fractures of long bones before walking age

45
Q

Corner Metaphyseal Lesion (3)

A
  1. Bucket handle fractures
  2. Found in children less than 2
  3. Caused by sudden pulling, twisting or yanking of extremity (think abuse)

PNP: Physical Assessment (21 decks)

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