Musculoskeletal Disorders Flashcards
Osgood Schlatter Disease
inflammation of the tibial tubercle as a result of repetitive stress mostly commonly at age 11-14, associated with rapid growth spurt
Toxic synovitis
self-limiting inflammation of the hip, most likely due to viral or immune cause; most commonly between ages 2-6 and affects males more than females
S/sx of toxic synovitis
painful lymph unilateral involvement insidious onset (been there for a while) internal rotation causes hip spasm no obvious signs of infection on inspection/palpation (no pain with palpation)
Management of toxic synovitis
analgesics
bed rest as needed
typically benign and self-limiting
hospitalization should be considered if the patient has a high fever or septic arthritis is suspected
Legg-calve-perthes disease (LCPD)
aseptic or avascular necrosis of the femoral head
Etiology of LCPD
unknown–but maybe d/t vascular disruption
high dose steroids
slightly shorter stature or delayed bone age compared to peers
most common in Caucasian boys, ages 4-9
Sometimes seen in kids with sickle cell disease
S/sx of LCPD
insidious onset of limp with knee pain, which may also migrate to groin/lateral hip
pain less acute and severe than transient synovitis or septic arthritis
afebrile
Physical findings of LCPD
limited passive internal rotation and abduction o hip joint–starts outside of knee and moves to hip
may be resisted by mild spasm or guarding
hip flexion contracture and leg muscle atrophy occur in long-standing cases
Management of LCPD
goal is to restore ROM while keeping femoral head within acetabulum
Observe if:
F-ROM
Diagnosis of LCPD
radiograph studies
Slipped capital femoral epiphysis (SCFE)
spontaneous dislocation of femoral head (slipped ice cream cone)
Etiology of SCFE
unknown–may be due to puberty-related hormone changes
generally occurs WITHOUT severe, sudden force or trauma
typical during growth spurt and prior to menarche
RARE
more common in males and African American adolescents
greater among obese and those with sedentary lifestyles
S/sx of SCFE
pain in the groin and often referred to thigh and/or knee
when acute onset, pain will be severe with the inability to ambulate or move hip
Physical findings: unable to properly flex hip as femur abducts/rotates externally; may observe limb shortening, resulting from proximal displacement of metaphysis
Treatment of SCFE
immediate referral to orthopedist; no ambulation permitted
monitor other hip for same problem
Genu Varum
Bowleg–“too much rum, walk bowlegged”
Genu varum is considered normal until what age?
2 years old
When should you refer genu varum to ortho?
when it continues after age 2
if it is unilateral
or if it becomes progressively worse after the first year
Genu Valgum
knock-knee–stuck together with gum
Knees are really close, ankle space is increased
typical in preschool children–most resolves by age 7
The distance between the ankles in menu valgum is how much?
3 inches
Scoliosis
lateral curvature of the spine–most common in adolescents
occurs more often in females with an 8:1 ratio, familial in 70% of cases
Adam’s Forward Bend Test
to check for scoliosis–bend forward and look for curvature
asymmetry of shoulder, ribs, hips, and waistline
When to refer for scoliosis
if painful or if greater than 25 degree curvature
Nursemaid Elbow
common in injury in young children resulting from swinging or pulling child’s arm–radial head subluxation
Signs and symptoms of nursemaid elbow
inability/refusal to use affected arm
pain with supination
holds arm across body with thumb up
**significant swelling/bruising justifies X-ray
Elbow fracture
associated with injuries resulting from straight, outstretched arm falls
S/sx of elbow fracture
Fat pad sign
- no fracture is visible on X-ray
- the lateral view demonstrates elevation of the anterior and posterior fat pads
- even if fracture cannot be visualized on a radiograph, that fat-pad sign suggests the presence of an occult fracture
Ankle sprain
stretching and/or treating of the ligaments around the ankle, typically involving the lateral ligament complex
most common sports injury
most common musculoskeletal injury
usually a forced inversion (lateral ankle) or eversion (medial ankle)
S/sx of a grade 1 sprain:
stretching, but not tearing
local tenderness
stretching
CAN bear weight and full ROM
S/sx of a grade 2 sprain:
partial (incomplete) tearing of a ligament, some joint instability but definite end-point laxity
pain with weight bearing
limited ROM
edema/ecchymosis
possibly an X-ray is warranted
S/sx of a grade 3 sprain:
complete ligamentous tearing, joint unstable with no definite endpoint to ligamentous stressing
significant bruising/swelling
no ROM
no weight bearing
possibly an x-ray warranted
Radiograph is indicated in an ankle sprain according to the Ottawa ankle rule, which says:
there is pain near the malleoli and
bone tenderness is present at the posterior edge of the distal six cm or the tip of either malleolus or the patient is unable to bear weight for at least 4 steps at the time of injury evaluation
Management of an ankle sprain
RICE (all grades typically respond) rest: ice: 30 min on, 30 min off, repeat compression: immediate to reduce edema and support instability elevation:
NSAIDS
Developmental Dysplasia of the Hip
abnormal dislocation of the hip in which the femoral head is partially or completely displaced from the acetabulum
Galeazzi’s sign
compare knee height with infant supine, hips and knees flexed
asymmetry suggests DDH
not helpful if bilateral
What age can you use the barlow and ortolanis test until?
barlow- until 6 months
ortolani’s- until one year old
Muscular dystrophy
progressive genetic disorder beginning in the lower extremities and progressing to the upper extremities and torso
most common inherited neuromuscular disease in children
affects 1:3500 males
typically diagnosed at age 3-5 years
Signs and symptoms of muscular dystrophy
lose strength in large muscles and core first
abnormalities of gait and posture developmental clumsiness cannot keep up with developing peers gower's maneuver firm, large, woody calves (healthy muscle replaced by degenerative tissue) decreased proximal muscle strength wheelchair dependent by age 12 eventual death from cardiopulmonary failure
Gower’s maneuver
gets up like a crab
child walks hands up legs to attain standing position when getting up–suggests pelvic girdle weakness
Laboratory and diagnostics with muscular dystrophy
elevated CK (15,000 to 35,000)
myopathy
decreased ejection fraction
necrotic degenerating fibers
