Musculoskeletal Functions- Kids Flashcards
Sprain?
Tearing of a ligament due to injury
🞂 Strain?
Injury of muscle or tendon (overuse, repetitive use without rest)
🞂 Varus?
deformity of bending inward toward the midline of the body
🞂 Valgus?
deformity of bending outward away from the midline
🞂 Adduction?
: lateral movement TOWARD midline
🞂 Abduction?
: lateral movement AWAY from midline
◦ Primary ossification complete at birth
◦ By___ years old skull reaches adult size
16
◦ PF closes (parietal bone)
at 2-3 months
The parietal bones are the two bones located toward the back of your baby’s skull. They cover the top of the head and meet the occipital bone in the back of the head. The parietal bones also connect to the frontal bones, the two bony plates that cover your little one’s forehead and top of the head toward the front.
◦ AF closes by
In the skull, AF stands for anterior fontanelle, which is a soft spot on a baby’s head where the skull bones are not yet fused together. The anterior fontanelle is the larger of the two fontanelles on a baby’s head and is located near the front, top of the head.
18 months
Fontanelles allow the skull bones to shift during birth and for the brain to grow. They typically close by the time the baby is 18 months old. If the anterior fontanelle closes too early, it’s known as craniosynostosis, which can limit brain growth or create an abnormal head shape.
◦ Long bones are porous and less dense as adults (reason why bones may break, bend or buckle with minor injuries)
🞂 Long bones
◦ At bones grow, cartilage at the epiphyses is replaced by osteoblasts (immature bone cells)🡪push the end of the bone away from the shaft
◦ Calcium ossifies the new bone
At _ age skeletal muscle maturation is complete?
◦ 20 years
◦ Thicker periosteum
◦ Bone is more elastic
◦ Allows for unique fracture types
◦ Torus (buckle)
◦ Greenstick
◦ Bowing
Torus (buckle fracture)
Greenstick fracture?
Bowing fracture?
What happens before a tendon rupture?
avulsion
In avulsion of a tendon, also known as an avulsion fracture, occurs when a tendon or ligament pulls away a small piece of bone:
Symptoms: Sudden pain and a popping sound, swelling, and bruising
Common locations: Hip, elbow, ankle, knee, heel, or pelvis
Causes: Falls, car accidents, or sports injuries
Treatment: Rest, ice, a splint or cast, or surgery
Recovery time: 3–12 weeks, depending on the bone, surgery, age, and physical condition
◦ Muscles do not increase in number
BUT increases in length & circumference
◦ When do muscles reach max capacity for girls?
Reach max diameter in girls at ~10 years
When do muscles reach max capacity for boys?
in boys at ~14 years
◦ Muscle strength advances until about age?
25-30 years
◦ Until puberty, ligaments & tendons are stronger
than bone
◦ Tendons grow in
Length
Assessment: Muscles
🞂 Symmetry
🞂 Fine & gross motor skills
🞂 Tenderness
🞂 Masses
🞂 Weakness in tone
🞂 Can a school age child rise from sitting to upright normally?
🞂 Description of daily activities
🞂 Are developmental milestone met
Assessment: Joints
◦ Movements smooth & symmetrical
◦ Tenderness
◦ Decreased ROM
◦ Inflammation
◦ Crepitus/grinding
◦ Masses
◦ Recent report of injury
Metatarsus Adductus
◦ Most common foot abnormality!!!
◦ Inward turning of forefoot “in-toeing”
◦ Incidence 1:1000
◦ Cause: in utero positioning
◦ Treatment: ROM
◦ If severe, serial casting
◦ Braces
◦ Nursing: ROM exercises with diaper changes, cast care
Clubfoot (Talipes Equinovarus)
◦ Incidence: 1-2 per 1000
◦ Affects twice as many boys as girls
◦ 50% is bilateral
◦ Genetic predisposition
◦ Associated with increased risk for DDH (developmental dysplasia of hip)
Causes of Club foot (Talipes Equinovarus)?
◦ Congenital-most common, isolated defect
◦ Positional: restricted movement while in utero, easiest to treat
◦ Teratologic: associated with other disorders, syndromes, abnormalities of the CNS
Treatment Clubfoot?
◦ Passive ROM exercises for mild cases
◦ Manipulation and serial casting
◦ Change cast every 1-2 weeks
◦ Repeat until foot is in correct position, usually by 3 months of age
◦ Ponseti casting most common
◦ May need Achilles tenotomy
◦ After casting, a brace or special shoes may be needed for a time period
Clubfoot: Complications
◦ Correction may not be totally successful
◦ Difficulty walking r/t underdevelopment of calf muscle
◦ Development of arthritis in cases of severe clubfoot
Bow Legs (Genu Varum)
◦ Knees are far apart d/t bowing
◦ Bowing common until age 2-3 years
◦ Persistent abnormality may indicate rickets
◦ X-ray, CT may be helpful with diagnosis
Bow Legs (Genu Varum) Treatment?
◦ Braces worn at night
◦ Surgery for severe cases
Knock Knees (Genu Valgum)
◦ Ankles are far apart when knees are together
◦ Treatment: Braces during day and night
◦ Benign condition
Developmental Dysplasia of the Hip (DDH)
◦ Abnormal development of hip
◦ Varies in severity from subtle dysplasia (instability) to irreducible dislocation
◦ 60-80% are transient and will resolve by 2 months (conservation treatment initially)
◦ Incidence: 1.5-2.5 per 1000 live births
◦ More common in girls than boys
◦ LEFT hip most common (as result of positioning in utero with left side of fetus against the mother’s sacrum)
◦ Predisposing factors of Developmental Dysplasia of the Hip (DDH)?
◦ Intrauterine placing
◦ Mechanical forces (size of infant, multiple births, breech presentation)
◦ Genetic predisposition
◦ Maternal estrogen effects (causes joint laxity of hip joint, especially in females who are estrogen-sensitive)
What are some signs of Developmental Dysplasia of the Hip?
🞂 Asymmetric gluteal and thigh folds
🞂 Limited abduction of hip
🞂 Shorter femur on affected side
🞂 Limp in older children, waddle
🞂 Positive Barlow maneuver (affected hip moved from socket)
🞂 Positive Ortolani’s (hip is reduced back into socket)
DDH signs?
🞂 Trendelenberg sign: abnormal downward tilting of pelvis when bearing weight
Barlow Test? (DDHS)?
Ortoloni Test (DDHS)?
DDH Treatment?
Pavlik Harness
Pavlik Harness?
◦ Developed in 1950s
◦ Keeps hips in abducted position to stabilize the femoral head within the socket
◦ Spontaneous movement results in nonviolent, forced abduction and reduction
◦ Weight of LE may also play a role in keeping hips in abducted position
Pavlik Harness?
◦ Contraindicated for infants with major muscle imbalance (spina bifida, joint stiffness, arthrogryposis)
◦ Worn continually for 3-4 months
◦ Monitor effectiveness by US
◦ Failure linked to improper use & noncompliance
DDH- Spica Cast?
◦ Used for kids older than 6 months or failed Pavlik harness
◦ Position cast on pillows
◦ Keep cast elevated till dry
◦ Touch with palms, not fingers until dry
◦ Note color & temp of toes
◦ Give bed baths to avoid getting cast wet
◦ Reposition frequently
◦ Teach parents care of child
DDH Complications?
◦ Avascular necrosis of femoral head d/t excessive abduction. Incidence 1-28%
◦ Excessive flexion causing injury to the femoral nerve
Legg-Calve-Perthes Disease***** KNOW!!
⚫ Avascular necrosis of femoral head
Legg-Calve-Perthes Disease Sx’s?
mild pain in hip, affected thigh 2-3 cm shorter
⚫ Common in males 2-12 yo
Management of Legg-Calve-Perthes Disease?
⚫ Femoral head must stay in socket until ossification is complete
⚫ Hips must stay abducted with traction
⚫ Treatment takes more than 2 years
Slipped Capital Femoral Epiphysis Caused by?
the displacement of the proximal femoral epiphysis due to disruption of the growth plate
◦ Head of the femur is displaced medially and posteriorly relative to femoral neck
Slipped Capital Femoral Epiphysis is commonly seen in?
in adolescent, obese males
Slipped Capital Femoral Epiphysis is classified as stable if?
child able to bear weight on affected extremity
Slipped Capital Femoral Epiphysis is classified as unstable if?
unable to bear weight
A healthy child who presents with pain and limp may have?
Slipped Capital Femoral Epiphysis
Vague sx’s!!
Slipped Capital Femoral Epiphysis
◦ Pain can be referred into the thigh or the medial side of the knee
◦ Limited internal rotation of hip
Slipped Capital Femoral Epiphysis Diagnostics?
◦ Lateral radiographic view of hip/femur – frog legged
◦ Treatment:
◦ Referral to orthopedic surgeon
DUCHENNE MUSCULAR DYSTROPHY
JUVENILE RHEUMATOID ARTHRITIS
SCOLIOSIS
Scoliosis is a chronic condition that causes an abnormal sideways curve of the spine, usually in the shape of an S or C:
Scoliosis
Symptoms
Uneven shoulders or hips, head not centered with the body, difference in rib cage height, waist uneven, skin changes over the spine
Risk factors
More common in girls, can run in families, but not all cases are genetic
Treatment
Depends on the severity and location of the curve, and whether it’s temporary or permanent. Mild cases may only require checkups, while more severe cases may require bracing or surgery.
Complications
Breathing problems, low back pain, spinal infection, nerve damage, leakage of spinal fluid
FRACTURES
