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Medpsych: Final > Musculoskeletal disorders in children > Flashcards

Musculoskeletal disorders in children Flashcards

1
Q

what are congenital defects?

A

defects in body form or function that are present at birth

can be localized or generalized

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2
Q

what is simple webbing syndactyly?

A

Soft tissue only

Surgical release usually performed when child is 1-2 years old

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3
Q

what is true syndactyly?

A

Fusion of bone, nails and soft tissue

May be associated with absence of bony/neurovascular unit

Surgical goal- maximal fx and appearance by school

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4
Q

what are vestigial tabs?

A

extra digit, removed during neo-natal period

non complicated surgery

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5
Q

what are anomalies of the medial, radial aspect of the UE associated with?

A

blood, heart or kidney (systemic) problems

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6
Q

which type of sydactyly is more difficult to tx?

A

when there are metacarpals missing

may be neurovascular absence

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7
Q

what occurs during hip displasia?

A

Abnormality development of femur, acetabulum or both Due to positioning in utero (2nd & 3rd trimester)

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8
Q

what sex does hip displagia affect more?

A

females 2x more

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9
Q

what are the clinical manifestations of hip displagia?

A

Asymmetry, limb length discrepancy, dislocation, + Trendelenburg, pain

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10
Q

what should infants with hip displagia be tested for?

A

be evaluated for other anomalies like torticollis (tightness neck with head lateral flexion and rotation), metatarsus adductus

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11
Q

what does tx of hip displagia depend on?

A

severity of the displasia

children less than 4 months- pavlik harness- keeps femur in abduction and flexion, allows acetabulum to reshape

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12
Q

what is a positive trendelenburg sign?

A

pelvic drop on side of the elevated leg when pt stands on 1 leg, inability to maintain level pelvis in unilateral stance
indicates weakness or instability on the standing leg

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13
Q

what can hip displasia eventually cause?

A

difficulty walking and subluxation/dislocation of hip

Could have spasming of neck muscles and misaligned metatarsals

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14
Q

what are Talipes?

A

any deformity of the foot

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15
Q

what are Equinovarus foot deformity positions?

A

Plantar flexed
Inverted
Abducted

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16
Q

what is Positional equinovarus?

A

Simple Soft tissue shortening (maybe in utero)
Short recovery
rapid correction; serial casting for 1-3 months

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17
Q

what is Idiopathic congenital equinovarus?

A

short tissue contraction

may need surgery or Serial casting- 1-6 months

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18
Q

what is Teratologic Equinovarus?

A

Neuromuscular (Spina Bifida)
Casting usually fails, needs more extensive surgery
AKA clubfoot

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19
Q

what are traumatic causes of limb amputation?

A

MVA, power tools, etc.

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20
Q

what are pathological causes of limb amputation?

A

Done in response to disease, like malignant tumor

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21
Q

what are congenital causes for limb amputation?

A

Teratogens (drugs, virus etc.)
Amniotic bands
Metabolic diseases (mom’s diabetes)
Called “limb deficiencies”

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22
Q

what is amniotic band syndrome?

A

when amniotic bands constrict fingers, limbs or other parts in utero

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23
Q

what is a terminal amputation?

A

No distal remaining portions
All parts missing below level of involvement

Ex: girl born without arm below elbow

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24
Q

what is a longitudinal amputation?

A

Distal portions remain
Partial absense of limb alone one side

Ex: radial club hand
Entire radius is missing
Associated with complete tissue defects

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25
Q

what is amelia?

A

complete absence of limb

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26
Q

what is meromelia?

A

partial absence of limb

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27
Q

what is hemimelia?

A

absence of half limb

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28
Q

what is phocomelia?

A

flipped like appendage attached to trunk

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29
Q

what is acheiria?

A

missing hand or foot

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30
Q

what is adactyly?

A

absence of metatarsal or metacarpal

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31
Q

what is aphalangia?

A

absent digit (finger or toe)

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32
Q

what is the tx protocol for LE amputation?

A

Fitted with prosthesis when child beginning to walk

Early fitting essential for balance, walking, acceptance

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33
Q

what is the tx protocol for UE amputation?

A

Fitted as early as 6 months to foster bilateral activities

If fitted after 2 years old, rate of rejection is high

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34
Q

what is Arthrogryposis Multiplex?

A

stiffness, deformity of many joints

Defect is aplasia and hypoplasia of many muscle groups during embryonic development
Joints controlled by these muscles dont move in utero + fail to develop normally

muscle abnormality is static but secondary changes in jts progress with age

35
Q

what is aplagia vs hypoplasia?

A 
aplasia = failure to develop
hypoplasia = underdevelopment
36
Q

what are LE issues during Arthrogryposis Multiplex?

A

Hip dislocation
Knee flexion or extension contracture
Severe club foot

37
Q

what are UE issues during Arthrogryposis Multiplex?

A 
Shoulder adduction and internal rotation
Elbow extension
Wrist flexion
Finger extension
Poor thumb control
38
Q

what is seen in kids with arthrogryposis?

A

Baby isnt moving in womb
Don’t get better but cognitively okay
PROM can maintain motion
Wheelchair bound

39
Q

what is Osteogenesis Imperfecta?

A

Inherited disorder of connective tissue affecting bone
Brittle bone disease
Can be in womb or when child falls
Multiple healed fractures seen

40
Q

what are the levels of Osteogenesis Imperfecta?

A

Severe- evident at birth

Mild- evident when child begins to walk

41
Q

what can Osteogenesis Imperfecta be mistaken for?

A

battered child

42
Q

what are the features of Osteogenesis Imperfecta type 1?

A

most mild
Bones predisposed to fracture; fractures occur before puberty
Norma/near-normal stature
Loose jts + muscle weakness
Sclera has blue, purple, gray tint
Triangular face
spinal curvature
Bone deformity absent or minimal
Brittle teeth
Hearing loss, often beginning in early 20s or 30s
Collagen structure normal, but the amount is < normal.

43
Q

what are the features of Osteogenesis Imperfecta type 2?

A

more severe
Freq lethal at or shortly after birth, often due to respiratory problems;
some lived into young adulthood
Numerous fractures and severe bone deformity
Small stature with underdeveloped lungs
Collagen improperly formed

44
Q

what are the features of Osteogenesis Imperfecta type 3?

A 
most severe (only those who survive prenatal)
Bones fracture easily; fractures present at birth, and x-rays reveal healed fractures from before birth 
Short stature 
Sclera have a blue, purple, gray tint 
Triangular face 
Spinal curvature 
Loose joints and poor muscle development in arms and legs 
Brittle teeth possible 
Respiratory problems possible 
Bone deformity, often severe 
Barrel-shaped rib cage 
Hearing loss 
Collagen improperly formed
45
Q

what is the cause of Osteogenesis Imperfecta?

A

Errors in synthesis of collagen

Gene responsible for encoding of collagen mutates

46
Q

what are the clinical manifestations of Osteogenesis Imperfecta? (prob type 2)

A 
Osteoporosis and increased fx rate
Bony deformation
Vascular weakness (aortic aneurysm)
Blue sclera
Poor dentition (teeth) from brittle bones
47
Q

what does OT tx for kids with Osteogenesis Imperfecta?

A

to learn transfers

As child ages how to problem solve and measuring for right fit wheelchair

48
Q

what are rickets?

A

Disorder in which growing bones fail to become mineralized
Abnormal density of bone
Soft bones, skeletal deformities

49
Q

what are the causes of rickets?

A 
(vit. Deficiency)
Insufficient Vitamin D
Insensitivity to Vit D
Wasting Vit D by kidney
Inability to absorb Vit D and calcium
50
Q

What is scoliosis?

A

Rotational curvature of the spine

51
Q

what is functional scoliosis?

A

from a cause other than the spine itself
ie can be leg length discrepancy, pain
Can become structural if underlying cause is not corrected

52
Q

what is structural scoliosis?

A

due to rotation of vertebrae
Vertebrae twist
can be idiopathic
May need surgery

53
Q

what are the classifications of structural scoliosis?

A

Infantile- develops during 1st 3yrs of life
Juvenile- develops from 4 years to onset of adolescence
Adolescent- develops after 10 years of age (Most common)

54
Q

what are the gender incidence of structural scoliosis?

A

Mild— boys = girls

Severe—- girls 5x more frequent than boys

55
Q

what is the Pathophysiology of structural adolescent scoliosis?

A

Abnormality of balance center in midbrain

Genetic component, 30% within families

56
Q

what are the Pathologic changes of structural adolescent scoliosis?

A

Soft tissue- muscles & ligaments shorten on concave side of curve
Due to twisting
Progressive deformity of spine and ribs

57
Q

what are the clinical manifestations of functional scoliosis?

A

Spinal curve
Prominence of 1 hip
Rounded shoulder
Curve disappears when forward flexion

58
Q

what are the clinical manifestations of structural scoliosis?

A

Asymmetry of hips and shoulders

Prominence of scapula and ribs

59
Q

how do you tx functional scoliosis?

A

treat underlying problem

60
Q

how do you tx structural scoliosis?

A

Surgery
Curves greater than 45-50 degrees
Spinal fusion with instrumentation

Bracing
25-35 degree curves
Low profile bracing
23 hours/day

61
Q

what is Osteomyelitis? how does it occur?

A

bone infection
Bacteria enters bone from bloodstream + lodges in medulary cavity- full of phagocytotic activity, usually infection doesn’t occur.
So, bacteria goes to end of bone under epiphiseal plate where less phagocytosis, primary infection can be est

62
Q

what are the predisposing factors of osteomyelitis?

A 
Impetigo
Chicken pox
Infected burns
Cerebral abscess
Drug addiction
Direct trauma
63
Q

who is more likely to get osteomyelitis?

A

males twice as frequent as females, 3-12 y/o

64
Q

what are the clinical manifestations of osteomyelitis in infants?

A

fever, failure to move limb, multiple sites in one bone

65
Q

what are the clinical manifestations of osteomyelitis in children?

A

Fever with system signs of toxicity
swelling, redness, tenderness, not using limb
Usually long bond

66
Q

what are the clinical manifestations of osteomyelitis in adolescents?

A

Less frequently affected

Vertebrae can be affected (c/o back pain)

67
Q

what are connective tissue diseases?

A

Juvenile Rheumatoid Arthritis
System lupus erythematosus
Dermatomyositis
Scleroderma

68
Q

what are the 3 modes of onset for Juvenile Rheumatoid Arthritis- JRA?

A

Pauciarticular arthritis- fewer than 5 joints
Polyarticulart arthritis- more than 5 joints
Systemic disease

69
Q

what are the characteristics of JRA?

A

large joints, C-spine commonly
large joints, involved, less joint pain than adults, sero-negative, rheumatoid nodules also in heart, lungs, eyes and other organs
(not form of childhood RA)

70
Q

what are the progressions of JRA?

A

Pauciarticular (few joints involved initially) (sero-negative for ANA), will resolve over time

Systemic (Stills Disease) or sero (+) may progress to adult RA

71
Q

what are the goals in therapy for JRA?

A

control inflammation, minimize deformity
2nd: splints in extension to reduce for upper and lower limbs
Help problem solving for school

72
Q

what is Osteochondrosis?

A

avascular bone
Blood isnt getting to the bone sometimes during period of rapid growth
collective term for insufficient blood supply to growing bone

73
Q

what are the causes of osteochondrosis?

A

vascular impairment, trauma, genetic predisposition

Associated with pain with activity, resolves with rest

74
Q

what can osteochondrosis cause?

A

Disturbances in blood supply to primary and secondary sites of ossification during periods of rapid bone growth may result in variety of skeletal deformities

75
Q

what is Osgood-Schlatter Disease?

A

Disease of the knee

Pre & adolescent boys more than girls, maybe due to sports

76
Q

how do you tx Osgood-Schlatter Disease?

A

rest with casting or bracing

77
Q

what is Leg-Calve-Perthes Disease?

A

interruption of blood supply to hip

78
Q

what is the incidence, onset and tx of Leg-Calve-Perthes Disease?

A

boys 5 times more frequently than girls; onset 3-10 y/o

Tx- anti-inflammatory meds, surgery

79
Q

how do brachial plexus injuries occur to infants?

A

Caused by traction injury to brachial plexus during birth

May range from mild stretching to tearing of trunks or avulsion of nerve roots

80
Q

what do brachial plexus injuries result in?

A

mixed sensory and LMNL problems

81
Q

what is Erb’s Palsy injury?

A 
(upper arm)
50-60% of cases
Injury to C5-6 nn roots
Deformity- shoulder IR, elbow flexion
“chauffeur's tip”
82
Q

what is Klumpke’s Palsy injury?

A 
(lower arm)
25% of cases
Injury to C8-T1 nn roots
Elbow and finger extension
Waiter’s tip
83
Q

how do you evaluate for abuse?

A

Skeletal X-ray especially if younger than 2
Complete physical exam (soft tissue)
Ophthalmologic exam (retinal detachment as in shaken baby syndrome)
MRI, CT
Hx for each identified injury

Medpsych: Final (5 decks)

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