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Musculoskeletal Conditions in Children Flashcards

1
Q

Hx in children:

A 
birth
age of symptom onset
 family history
 recent illness or injury
pain profile – Faces Pain Scale-Revised, FPS-R
 gait deviations, i.e., limping
 previous interventions
 preferred sleeping and sitting positions
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2
Q

Torsional conditions:

A

internal tibial torsion

external tibial torsion

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3
Q

Tibial torsion

A

measure thigh-foot angle in prone with knee flexed; longitudinal thigh axis and foot angle (FPA).

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4
Q

Internal tibial torsion (ITT)

A

negative value; prone sleeping or sitting on feet (risk factor)

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5
Q

External tibial torsion (ETT)

A

positive value; associated with medial knee osteoarthritis, osteochondritis dissecans, Osgood-Schlatter syndrome

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6
Q

Femoral anteversion:

A

Comparison of proximal and distal reference axes.

Femoral head lies anterior to frontal plane, excessive medial hip rotation

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7
Q

IR= 70-80 degrees

A

mild

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8
Q

IR 80-90 degrees

A

moderate

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9
Q

IR=90

A

severe

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10
Q

How is femoral anteversion measured?

A

Measure hip rotation in prone, neutral hip, knee 90 degrees

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11
Q

Interventions for Femoral Anteversion

A

Most not proven effective, e.g., bracing, twister cables, special shoes.
Avoid W-sitting, encourage tailor sitting.
Most cases spontaneous improvement without disability or degenerative arthritis

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12
Q

What does persistent femoral anteversion (10-14 years) indicate?

A

surgery (derotational osteotomy)

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13
Q

Foot Progression Angle (FPA):

A

axis of foot and line of progression.

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14
Q

FPA:

A

Mean(range): +10 degrees (-3 degrees to +20 degrees).

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15
Q

In -toeing FPA -5 to -10 degrees:

A

mild

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16
Q

In-toeing FPA -10 to -15

A

moderate

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17
Q

In-toeing greater than -15

A

severe

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18
Q

Differential dx of in-toeing/out-toeing:

A

prematurity, difficult birth, delayed motor skills, worsening over time, asymmetry may be signs of spastic diplegia (in-toeing) or Duchenne’s MD (out-toeing.)

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19
Q

Metatarsus Adductus (MTA)

A

Medial curvature of forefoot, slightly valgus hindfoot

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20
Q

Grade I MTA:

A

flexible, resolves 4-6 mos

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21
Q

Grade II MTA:

A

moderately flexible, corrects to midline; Rx: stretching exercises, straight-last shoes

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22
Q

Grade III MTA:

A

severe, no midline correction; Rx: manipulation, serial casting, corrective shoes; surgery if unresolved by 4 years

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23
Q

Calcaneovalgus

A

Hindfoot valgus, lateral forefoot curvature, excessive dorsiflexion; resolves spontaneously

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24
Q

Incidence of calcaneovalgus:

A

bilateral in > 30% of neonates; ‘packaging’ deformity.

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25
Angular condition:
genu varum | genu valgum
26
Genu varum:
often with ITT, bowlegged and pigeon-toed. | Physiologic genu varum improves after age 2
27
Red flags in genu varum:
systemic disorders, e.g., Rickets, if developed after age 4 or worsening over time
28
Different dx in genu varum:
early weightbearing, weight > 95th percentile, African-American, family history; obesity in adolescence. Tx: observation < 3 yrs; surgery after age 4
29
Genu valgum:
associated with overweight, out-toeing FPA, awkward gait, flat feet; c/o anterior knee pain, patellofemoral instability, circumduction gait, difficulty running
30
Secondary impairments in genu valgum or varum:
varum or valgum) with torsional malalignment: knee extensor injuries, ITB syndrome, stress fractures, plantar fasciitis
31
When does the arch develop?
2-6 years
32
Flexible flat foot:
present in sitting, disappears in standing, arch on tiptoes
33
Talipes Equinovarus (TEV), Clubfoot
Congenital deformity – forefoot adductus, hindfoot varus caused by tarsal bone deformities, capsular and ligamentous changes. shorter foot, smaller calf, flexible heel, decreased talocalcaneal angle
34
Treatment for TEV:
Correction for mobility and strength, plantigrade, cosmesis, shoe wear using serial casting, percutaneous tenotomy, bracing (3 mo), night splinting (2-4 yrs) (Ponseti technique
35
Developmental Dysplagia of Hip (DDH)
abnormal development or growth due to mechanical causes (36-40 wks).
36
Incidence of DDH:
23% of breech presentations, 60% of affected infants are firstborn, 5x more females
37
Red flags for DDH:
Postnatal swaddling with ligamentous laxity; high rate of associated torticollis, MTA
38
Red flags for DDH in infancy:
limited hip ROM, or at least 5-10o asymmetry after 1 mo, asymmetrical thigh skin folds, +Galeazzi sign, positive Barlow or Ortolani signs until 2-3 mo
39
Interventions for DDH in infancy:
Pavlik harness (0-9 mo) - hip flexion and abduction enhances acetabular development, allows kicking that promotes spontaneous reduction
40
Complications of DDH in infancy:
AVN of femoral head, femoral nerve palsy, inferior dislocation, erosion of posterior acetabular rim, monitoring through ultrasonography.
41
Red flags for mild DDH:
undiagnosed or mild DDH in infants, toddlers without impairments or restrictions
42
Mild DDH 18-24 months:
abnormal gait, limp, Trendelenberg sign (unilateral), waddling gait (bilateral).
43
Mild DDH Mid-30’s (women), mid-50’s (men)
degenerative hip disease may require total hip replacement; residual hip dysplagia may be associated with osteoarthritis
44
Mild DDH in late teens:
degenerative arthritis, hip pain, limp
45
Clinical Dx of Growing pains
mild-severe pain in non-articular, bilateral pain in shins, calves, thighs, popliteal fossa; c/o late in day or night, pain-free in morning; episodic
46
Exam of growing pains:
no signs of inflammation, r/o more serious conditions; possibly related to rapid growth and joint hypermobility
47
Treatment of growing pains:
symptomatic, e.g., massage, stretching, anti-inflammatory meds
48
Idiopathic Scoliosis
lateral curvature of spine > 10° unknown origin, most common form diagnosed by age of onset: infantile (0-3y), juvenile (3-10y), adolescent (after 10 yrs
49
Adolescent idiopathic scoliosis, AIS – structural scoliosis
fixed, visible rotary component with forward trunk flexion. identified by location and apex of primary curve
50
Why does a compensatory curve develop?
keep head and trunk aligned, i.e., convexity to left in cervical or lumbar regions More than 90% of AIS is Right thoracic or Left lumbar.
51
Monitoring for curves in scoliosis:
less than 25 degrees
52
Scoliosis curves treated non surgically:
25-40 degrees
53
Scoliosis curves treated surgically:
greater than 40 degrees
54
Idiopathic Toe Walking (ITW)
Common in new walkers; may be family history | May be associated with soft neurological signs, speech/language, fine/gross motor delays
55
Inverventions for ITW:
Exercise program of GAS stretching, dorsiflexor strengthening and gait training. Night splints, dynamic AFO’s, serial casting for prolonged stretch
56
Septic Arthritis
bacterial joint infection that can destroy joint within 48 hours of symptom onset, causing permanent deformities
57
Limping DD birth-5 years:
JRA, nonaccidental trauma, hemophilia, discitis, popliteal cycts, bone tumors
58
Limping DD 3-8 years:
Kohler syndrome - osteochondrosis of navicular due to temporary loss of blood supply; generally resolves spontaneously
59
Transient Synovitis
< 10 years, resolves in 7 days w/ conservative treatment, i.e., limited WB/activity, bed rest
60
Occult fractures
usually benign, acute limp, limp or refusal to walk, no history of trauma, infection
61
Osteochondroses
5-10 years: – localized necrosis, regeneration during periods of rapid bone growth., Osgood Schlatter; irritation of tibial tubercle; idiopathic cases typically stress related, e.g., repetitive trauma
62
Accessory Navicular
Prevalence 10%; Type II (projection from medial navicular) due to repetitive trauma, pain in adolescence
63
Tarsal Coalition:
8-12 years; failed segmentation between tarsal bones, e.g., talocalcaneal, calcaneonavicular
64
Tarsal coalition red flags:
limited subtalar joint motion (inversion), rigid flat foot causing increased stress on adjacent joints; secondary degenerative arthritis, pain, peroneal spasm
65
Freiberg disease
13-18 year old girls, is idiopathic segmental AVN of the second metatarsal head caused by repetitive stress, e.g., running, with micro-fractures
66
Freiberg disease red flags:
forefoot pain, swelling localized to 2nd metatarsal, limited MP ROM; treatment with proper footwear, metatarsal pad, limited activity for 4-6 weeks; casting if more severe
67
4 stages of Legg-Calve-Perthes disease
inital, fragmentation, reossification, residual
68
Chronic SCFE:
most common, hx of limp and pain lasting weeks/months, loss of hip ROM (IR/abd).
69
Acute SCFE:
immediate, severe pain and restricted hip IR/abd from significant trauma or minor fall or twisting injury
70
Acute-on-chronic SCPE:
sudden epiphyseal slippage with acute symptoms after chronic slip with hip, thigh, or knee aching
71
SCPE red flags:
groin pain referred to anteromedial thigh, knee; obesity with knee pain; antalgic gait; limited hip IR/flexion with positioning in ER/shortened
72
PT goal for SCPE:
minimize displacement, maintain ROM, prevent joint collapse through activity modification, limiting weight-bearing (AMD); anti-inflammatory meds to prevent degenerative arthritis
73
Sever Disease (calcaneal apophysitis):
7-14 year-olds; osteochondrosis of calcaneous due to overuse, repetitive sheer on Achilles tendon causing cartilage fragmentation/avulsion
74
Osteochondritis Dissecans (OD):
12-20 year-olds, 2:1 males, active in sports. Localized necrosis of medial femoral condyle, separation of subchondral bone >> revascularization, reabsorption, re-ossification
75
Achondroplasia (dwarfism)
2-4.7/10,000, 80% random mutation; most common osteochondrodysplasia. abnormal limb to trunk length ratio, shorter proximal limb segments, frontal forehead bossing, cuboid-shaped vertebrae may cause narrowing, spinal cord compression
76
Secondary complications of achondroplasia:
(20-47%): lumbar lordosis, short tubular bones, pedicles, hands

Pediatrics (13 decks)

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