Musculoskeletal and Neuromuscular Dysfunction

Question 1

Osteogenesis imperfecta

Answer 1

Brittle bone disease - group of 4 heterozygous inherited disorders characterized by connective tissue and bone defects - biochemical defect causes a reduction in the synthesis of collagen

Question 2

Osteogenesis imperfecta signs

Answer 2

Frequent fractures, thin skin, hyperextensible ligaments, epistaxis, blue sclera, easy bruising, excess diaphoresis, mild hyperpyrexia, deafness, x-ray shows multiple normal callous formations at new fracture sites

Question 3

Osteogenesis imperfecta treatment

Answer 3

Bisphosphonates - increase bone density
IV pamidronate - pain relief in severe cases
Handle child carefully
Prevent obesity - low calorie, high fiber diet
Vit C and D supplementation
Maintain good oral hygiene so teeth do not break

Question 4

Developmental dysplasia of the hip

Answer 4

Group of congenital abnormalities of the hip joints which includes subluxation, dislocation, instability, and teratologic dislocation

Question 5

Hip subluxation

Answer 5

Incomplete contact between the articular surface of the acetabulum and the femoral head

Question 6

Hip dislocation

Answer 6

Full loss of contact between the articular surface of the acetabulum and the femoral head

Question 7

Hip instability

Answer 7

Passive manipulation allows for the subluxation or dislocation of the hip

Question 8

Hip teratologic dislocation

Answer 8

Antenatal dislocation

Question 9

Developmental dysplasia of the hip signs

Answer 9

Ortolani and Barlow signs, asymmetrical gluteal folds, limited abduction of affected hip, Galeazzi sign (different in knee heights)
Older children - limping, toe walking, Trendelenburg sign (pelvis drops when standing on opposite leg)

Question 10

Developmental dysplasia of the hip treatment

Answer 10

0-6 months - Pavlik harness, abduction device
6-18 months - traction followed by closed reduction with cast immobilization
Older children - surgical correction

Question 11

Femur fracture is common in ____

Answer 11

Abuse

Question 12

Fracture of epiphyseal plate causes potential for ____

Answer 12

Growth deformity

Question 13

Bend fracture

Answer 13

Bone bends to breaking point, does not straighten without intervention

Question 14

Buckle fracture

Answer 14

Compression failure of the bone with bone telescoping on itself

Question 15

Greenstick fracture

Answer 15

Incomplete fracture

Question 16

Fractures - healing time

Answer 16

Neonates - 2-3 weeks
Early childhood - 4 weeks
Later childhood - 6-8 weeks
Adolescence - 8-12 weeks

Question 17

Fracture signs

Answer 17

Five Ps - pain, pulse, pallor, paresthesia, paralysis

Deformity, swelling, bruising, muscle spasms, tenderness, impaired sensation, loss of function, crepitus, shock

Question 18

Fracture treatment

Answer 18

Move injured part as little as possible
Elevate, cold packs
Prevent compartment syndrome, infection (osteomyelitis), renal calculi (fluids), pulmonary embolism

Question 19

Compartment syndrome

Answer 19

Increased pressure within a closed space compresses circulation to nerves and muscles within the space
Caused by casts, hemorrhage, trauma, burns, surgery
Treated by fasciotomy

Question 20

Slipped capital femoral epiphysis

Answer 20

Ball of the upper end of femur slips off in a backward direction due to weakness in the growth plate - develops during accelerated growth after onset of puberty
Can be a complication of growth hormone therapy
Considered an emergency - necrosis of femur head can occur without prompt treatment

Question 21

Slipped capital femoral epiphysis signs

Answer 21

Hip or knee pain, limp, unable to bear weight, affected hip does not have full ROM, hip usually turned outward and may appear shorter

Question 22

Scoliosis

Answer 22

Spinal deformity involving lateral curvature of the spine, spinal rotation, and thoracic hypokyphosis

Question 23

Cerebral palsy

Answer 23

Group of disabilities caused by injury or insult to the brain either before or during birth or in early infancy

Question 24

Spastic cerebral palsy

Answer 24

Most common type
Hypertonicity with poor control of posture, balance, and coordinated movement, and impairment of fine and gross motor skills
Active attempts at motion increase abnormal postures
Hemiparesis = one side affected
Quadriparesis = all four extremities affected
Diplegia = similar body parts affected (eg. both arms)

Question 25

Dyskinetic/athetoid cerebral palsy

Answer 25

Involves abnormal involuntary movement, dyskinetic movement of mouth, drooling and dysarthria, movements are choreoid, dystonic, ataxic

Question 26

Duchenne’s muscular dystrophy

Answer 26

Group of disorders that cause progressive degeneration and weakness of skeletal muscles - dystrophin, a protein product in skeletal muscle, is absent
Death occurs in adolescence usually from infection or cardiopulmonary failure

Question 27

Duchenne’s muscular dystrophy signs

Answer 27

3-5 years of age - weakness in pelvic girdle, delays in motor development, difficulties running/riding bike/climbing stairs, abnormal gait, Gower’s sign
Walking ceases between age 9-12
Cardiac and breathing problems

Question 28

Duchenne’s muscular dystrophy treatment

Answer 28

Monitor temperature - at risk for malignant hyperthermia
Maintain optimal physical mobility
Compensate for disuse syndrome