Musculoskeletal Disorders Flashcards
What is torticollis?
Torticollis is abnormal position of head and neck, due to unilateral contracture of sternocleidomastoid muscle that may be:
- congenital (most common)
- aquired
- atlantoaxial rotary subluxation (which is a displacement of C1 on C2)
What are the 5 etiological origins of torticollis?
- Compartment syndrome due to soft tissue compression of neck at time of delivery
- occlusion of venous outflow of sternocleidomastoid muscle
- Uterine crowding
- Neurogenic myopathy from trauma or ischemia
- Sterncleidomastoid muscle tumor
Signs and Symptoms of Torticollis?
- Child’s head tilted toward side of contracture
- chin rotated away from contracted side (origin of muscle on mastoid process)
Ddx for torticollis?
- Central nervous system tumors
- Syringomyelia
- Arnold-chiari malformation
- Ocular dysfunctions
- Paroxysmal torticollis of infancy
- Klippel-Feil syndrome
What are three physical findings of torticollis?
- Contracture of one of sternocleidomastoid muscles
- Fusiform, firm mass or “tumor”
- In body of contracted muscle
- Palable after 4 weeks of age, then recedes
- Plagiocephaly or asymmetry of face/skull development present with progressive deformity
How do you diagnose torticollis?
- Cervical radiograph
- to r/o congenital spine abnormalities (hemivertebrae)
- Hip ultrasound or x-ray, depending on age of child, to r/o DDH
- Other imaging ( MRI or CT scan) not indicated- abnormalities not detected unless neurogenic pathology (rare) exists
How do you manage torticollis?
- Conservative measures- initial treatment
- stretching exercises
- encourage infant stretching by placing toys, mobiles, items of interest in infant’s line of vision on the affected side
- Surgery recommended when
- defect persists beyond 1 year of age
- stretching exercises have been unsuccessful
- infant btw 1 - 4 years of age; best outcome for surgical release
What is Developmental Dysplasia of the Hip (DDH)?
DDH is abnormal development dislocation of the hip(s) or ligamentous laxity that is congenital, but may not be recognized until ambulation occurs.
What is the etiology of DDH?
- Intrauterine mechanical factors: breech presentation and infants w/oligohydramnios
- Genetic effects in primary acetabular dysplasia
- Increased incidence in first-born caucasian infants
DDH is more prevalent in which gender?
females and left hop involved more commonly than right
When are s/s of DDH detected?
Is either detected at birth or later on when infant is trying to ambulate
Signs and symptoms of DDH at birth?
Newborns
- instability w/o significant fixed deformity
- detected during newborn examination
What if DDH is undetected at birth?
- Untreated dislocation becomes fixed, with less instability, more limitation of movement (abduction)
- Limp noticeable at onset of walking
Ddx of DDH?
- leg length discrepancy
- Innocent hip “click”- not associated with movement of femoral head
- Arthrogryposis
- Cerebral Palsy
- Fracture of femur
What is the galeazzi sign?
It is a physical finding for infants with DDH.
- It’s knee height comparison w/infant in supine position with flexed hips/knees
- Asymmetry evident in DDH
- Shortening of the femoral segment limits abduction and full extension
- Not helpful finding for detecting bilateral dislocation
Infants with DDH will have limited ______ of the affected hip in older child
Will have limited abduction of affected hip in older child
What is Barlow’s sign?
Barlow’s sign is a physical finding in patients with DDH/
- Positive when movement of femoral head can be felt as it slips out onto the posterior lip of acetabulum
- Not diagnostic, but indicates need for surveillance
What is Ortolani’s sign?
It is a physical finding in patients with DDH.
- Newborn period- sometimes a click or clunk is heard as femoral head enters or exits acetabulum
- After newborn period- clicks is less apparent and decreased abduction of flexed legs (at hip) is more significant
What are the three degrees of hip dysplasia?
- Subluxation: first degree
- least severe
- femoral head rests in acetabulum
- can be dislocated partially by examination
- DIslocatable
- second degree
- hip can be dislocated fully with manipulation, but is reducible
- Dislocated hips
- third degree, most severe
- fixed dislocation
Infants with DDH, what diagnostic test is most reliable?
Physical exam is most reliable
Besides physical exam, what two other diagnostic testing can be used and at what age?
-Radiographs and Ultrasonography
Radiographs
- not commonly used before 6 months of age
- After 6 months of age assesses femoral head/acetabulum relationship
Ultrasonography
- Before 6 months of age due to lack of ossification of proximal femoral heads
- assesses hip stability and acetabular development
What is the treatment goal of DDH?
Goal is to restore contact between femoral head and acetabulum
In DDH, what is the management of infants with subluxation in newborn?
There is a high incidence of spontaneous improvement in perinatal period.
- Observe and reexamine 3 to 4 weeks after birth
In DDH, what is the management of infants with dislocated hips?
- Treat at the time of diagnosis
- Before 6 months of age:
- if unstable, stabilize with an abduction-flexion device (pavlik harness); triple diaper not effective- if device is ineffective, surgery is indicated
- After 6 months of age:
- child is usually to large and strong to tolerate brace (failure rate 50% after 6 months)
- surgical reduction indicated
