Musculoskeletal Flashcards
1
Q
Fontanelle Characteristics
A
- Fontanelles present in infants
- allows for growth of brain and skull
- anterior closes 7-19 mths
- posterior closes 7-19 mths
2
Q
Epiphysis
A
ends of long bones
- remain cartilaginous until 20 years old when skeletal maturation is complete
- long bones are porous and less dense
3
Q
Peds Spine
A
convex in cervical and lumbar regions in babies
-cervical becomes concave with holding up of head and lumbar with walking
4
Q
Growing pains
A
muscles are pulled when bones grow quickly
5
Q
Bones of children
A
porous and less dense than adults
6
Q
Injury to epiphyseal plate
A
can impact future growth
7
Q
bones can bend, buckle, and break…
A
even with a simple fall
8
Q
Rapid growth of bones..
A
allows for rapid healing with a fracture
9
Q
what is needed for new bone growth?
A
calcium
10
Q
MS system at birth…
A
almost completely formed at birth
- muscles increase in length and circumference but not in number
- ligamens and tendons are stronger than bones until puberty
11
Q
Ligaments
A
connect bones, sprain
12
Q
Tendons
A
connects bones to muscles
grow in length and fibrous tissue as mechanical pressure is placed on them
13
Q
intoeing
A
when a child walks or runs, the feet turn inward instead of pointing straight ahead. It is commonly referred to as being “pigeon-toed.”
14
Q
Metatarsus adductus
A
when a child’s feet bend inward from the middle part of the foot to the toes.
15
Q
Clubfoot
A
congenital anomaly
-foot is twisted and involves muscles, bones and tendons
aka talipes equinovarus
16
Q
Etiology/Pathophys of Clubfoot
A
- exact cause unknown
- occurs in boys more than girls
- bilateral in half of cases
- most common in polynesian groups of pacific
- lowest among asian
17
Q
Clinical Management of CLubfoot
A
- cannot be corrected by exercise
- early tx essential to prevent complications
- serial casting tx of choice
- casting should start ASAP after birth, bones of feet begin to ossify
- foot is manipulated into position
- long leg cast changed q 1-2 wks
- manipulation and casting for 8-12 wks
- then brace and corrective shoes
18
Q
if clubfoot not corrected with casting…
A
surgical correction 3-12 mths of age
casting continues for 6-12 weeks after sx, then brace or corrective shoes
19
Q
Slipped Capital Femoral Epiphysis
A
- spontaneous displacement of the proximal femoral epiphysis
- between age of 10-16 before or during accelerated
- multifactorial: obesity, pubertal hormone changes, more freq in male
- can also be associated with endocrine disorders, growth hormone therapy, renal osteodystropthy and radiation therapy
20
Q
Clinical Manifestations fo Slipped Capital Femoral Epiphysis
A
- limp on affected side
- pain in hip, can also be referred to groin, thigh or knee
- shortening of lower extremity
- restricted internal rotation with on adduction
21
Q
Management of Slipped Capital Femoral Epiphysis
A
- bed rest to prevent further slippage
- surgical pinning-percutanous screw fixation
- preop BR or traction
- postop pain management, neuro status, cast care, and skin care
22
Q
Developmental Dysplasia of the Hip (DDH)
A
formerly congenital hip dysplasia
- femoral head and acetabulum impropertly aligned
- may include hip instability, dislocation, subluxation, or dysplasia
- occurs in girls more than boys…unilateral 80p of cases
23
Q
Causes of DDH
A
- positive fam hx
- breeched
- female infant’s hormones
- traditional swaddling
24
Q
Three degrees of DDH
A
- Dysplasia
- Subluxation
- Dislocation
25
Dysplasia
mildest form
abnormal structural development of acetabular roof
femoral head remains in the acetabulum
26
Subluxation
partial dislocation of hip
27
Dislocation
femoral head loses contact with acetabulum and is displaced posteriorly and superiorly
ligaments elongated and taut
28
Clinical Manifestations of DDH (infant)
- shortened limb on affected side
- restricted abduction of hip on affected side
- asymmetry of the gluteal and thigh fat folds...unequal gluteal folds when infant prone
- positive barlow test
- positive ortolani test
29
Clinical Therapy for DDH
- importance of early intervention
- screening done each well baby visit until walking
- if clinical signs are present, hip US done to confirm
- NB to 3 mths--Pavlik harness for abduction of hip
-over 6 mths--closed reduction sx and spica cast
older child over 18 mths--open or closed operative reduction, casting, and bracing (some may need preop Bryant's traction
30
Pavlik Harness
- allows movement
- ensure hip flexion and abduction
- does not allow hip extention and adduction
- teach parents proper application of the harness
- teach daily care
- feed in upright position, how to change diaper without removing the harness
- harness is worn 23 hours per day, observe for reddened or irritated areas
- check toes for circulation--undershirt and socks worn to prevent rubbing of the skin
31
Nursing Management of DDH
- ARNP/MD: assessment of hip at birth and continues a well child visits
- RN: nursing care depends on the tx, provide cast care, educate regarding Pavlik harness, spica cast, prevent complication from immobility, maintain traction
32
Scoliosis
Lateral S or C shaped curvature of the thoracic or thoraco-lumbar spine
- more than 10 deg is abnormal
- most common spinal deformity
- most often in girls during growth spurt age 10-13 years
33
Types of Scoliosis
1. structural
| 2. functional
34
Structural scoliosis
spine curves laterally with vertebral rotation
may be congenital, idiopathic or acquired
more serious, progressive
35
Functional scoliosis
no rotation, no progression
36
Clinical Manifestations for Scoliosis
- generally becomes noticeable after preadolescent growth spurt
- truncal asymmetry, uneven shoulders and hips, a one-sided hip rib hump and prominent scapula
- may have complaints of ill fitting clothes
37
Clinical Tx of Scoliosis
- goal: limit or stop progression of curvature
- tx depends on degree of curvature
- mild: exercises to improve posture
- mod: bracing 23 hrs per day and goal is to avoid increase of curvature
- severe: surgery to fuse spine
38
Mild Scoliosis degrees
10-20
39
Moderate Scoliosis degrees
20-40
40
Severe Scoliosis degrees
40 or more
41
Postop care for Scoliosis
- pain control, PCA
- IS
- cough and deep breathe
- reposition q 2hrs
- ROM exercises
- ambulation as per MD order
42
Osteromyelitis
most frequently seen in children 10 years or younger
staph aureus is the most common causative organism
caused by direct inoculation of bone during trauma, puncture or sx
can also be caused by pre-existing infection such as tonsilitis or impetigo or from an adjacent infected bone or joint
usually involves femur or tibia
43
Clinical Manifestations of osteomyelitits
General:
- hx of trauma
- child is ill appearing
- irritability, restlessness
- fever
- tachycardia
- dehydration
Local:
- tenderness
- warmth
- diffuse swelling over the bone
- very painful extremity
- involved extremity involved in semi-flexion
- surrounding muscles tense and resist movement
44
Osteomyelitis Management
- long term IV AB at least 6 wks
- sx intervention if AB do not work or the infection spreads to the joint
- nursing: comfort, pain management, positioning, wound care as applicable, family support and education child will be discharged with IV line and AB
45
Muscular Dystrophies
group of inherited diseases- Duchenne most common
- largest group of muscular diseases in children
- all have genetic origin with gradual degeneration of muscle fibers, progressive weakness, and wasting of skeletal muscles
- all have increasing disability and deformity with loss of strength
- all are terminal...from few to many years
46
Duchenne Muscular Dystrophy
DMD
- also called pseudohypertropic muscular dystrophy--enlarged calves due to infiltration of fatty tissue
- most severe and most common of muscular dystrophies in childhood
- x-linked inheritance pattern; one third are fresh mutations
- incidence 1 in 3500 male births
47
Characterisitics of DMD
- onset between first 3-4 years of life
- progressive muscle weakness, wasting and contractures
- calf muscles hypertrophy (muscle replaced with fat)
- progressive generalized weakness in adolescence
- death from resp or cardiac failure
48
Clinical Manifestations of DMD
- delayed walking, waddling gait, frequent falls, gower maneuver (use arms to raise themselves to standing position)
- lordosis
- profound muscular atrophy in later stages
- mental deficiency common
- gower maneuver
49
Toddlers with DMD
- late walkers
| - enlarged calf muscles
50
Preschoolers with DMD
-
