Muskuloskeletal Disorders Flashcards
-what is Developmental Dysplasia of Hip
- s/s in newborn vs older childres
- hip instability after birth; usually associated with breech delivery
- assymetry and unequal number of skin fold on posterior thighs/glutes
- older child: limp, leg discrepancy
diagnostic evaluation for DDH
Ortolani and Barlow Test
ortolani- outward (abduction)
barlow- inward (adduction)
Ultrasound prior to 4 months of age
X ray after 4-6 months
populations at risk for Developmental Hip Dysplasia
female, history of DDH, oligohydramnios, high birth weight, firstborn
Pavlic Karness vs. casting for Dysplasia of hip
pavlic: prevents hip flextion and adduction
- skin care is important
- cothing and diaper should be under the straps
cast: for 12 weeks
what is the treatment for developmental dysplacia of hip in infants under 6 months
Pavlic Harness
- >6 months need surgery
how is Osteogenesis Imperfecta inherited
Autosomal dominant inherited disorder
what does osteogenesis imperfecta cause in the body
and what are s/s
extremely brittle bones, fractures, and bone deformities
s/s: BLUE sclerae, hearing loss, discolored teeth
how is osteogenesis imperfecta diagnosed and how is it treated
bone biopsy
-biphosphates, physical therapy, braces and splints,
what is congenital club foot
deformity of ankle and foot, involves bone and soft tissue contracture
how is congenital clubfoot diagnosed
diagnosed prenatally
symptoms of congenital clubfoot
affected foot is smaller,limb shorter, calf atrophy
what other disease can co-occur with congenital clubfoot
cerebral palsy, spina bifida, chromosomal defects
what populations is more likely to get congenital clubfoot
boys are affected 2x as often
how is congenital club foot diagnosed and treated
-physical exam
- serial casting until corrected
- if does not help by 3 months then surgery between 6-12 months of age
-abduction bracing at night for 3-5 years
an infant born with unilateral congenital clubfoot is at higher risk of having…..
chromosomal defects
scoliosis screening
Adam’s bend test: asymmetry of should height, scapular, or flank shape, or hip height
Standing radiographs to determine degree of curvature
therapeutic management for scoliosis
exercise, bracing, surgical intervention for severe curvature
what percent does a scoliosis curvature need to be to be considered severe and need surgical intervent.
over 25 degrees
what is Legg-Calve-Perthes
avascular necrosis of femoral head
clinical manifestations of Legg-Calve
delayed bone age, painless limp, stiffness of hip, decreased ROM, hip/thigh/knee pain, shortening ofleg affected
how do you test bone age
left wrist x-ray starting at age 3
diagnostic measure for Legg-Calve
XRAY, MRI
Treatment for Legg-Calve
initially-rest, limited weight bearing to reduce inflammation, traction to stretch the tight adductor muscles
meds- NSAIDS, PT, ROM exercises
what population ismorelikely to be affected by Legg-Calve
boys age 4-8
what is Slipped Capital Femoral Epiphysis
spontaneous displacement of the proximal femoral epiphysis in a posterior and inferior direction
ball of thight bone (femoral head) slips off the neck of thigh bonebecuase growth plate is damaged
clinical manifestations of Slipped Capital Femoral Epiphysis
limp, pain, episode of trauma with acute displacement, gradual displacement without definite injury
who is more at risk to get slipped capital femoral epiphysis
obesity, puberty hormone changes, bone changes
treatment for SCFE
goal: keep head of femur in acetabulum
- rest
- no weight bearing
- sometimes surgery
What is Juvenile Idiopathic Arthritis
chronic childhood arthritis (last for 6 weeks or longer)
chronic synovial inflammation with joint effusion, destruction, and destruction of cartilage
when is a child most likely to develop Juvenile Idiopathic Arthritis
Before 16 yrs
Peaks- 1 to 3 years and 8 to 10 years
clinical manifestation of JIA
90% of children have negative rheumatoid factor
stiffness, swelling, warm to touch, loss of mobility in affected joints, growth retardation
Meds and treatment for JIA
Meds: NSAIDS, antirheumatic drugs, tumor necrosis factor alpha inhibitors
Tx: PT/OT to strengthen muscles, mobilize joints, splinting
4 criteria for diagnosis of JIA
- age of onset is >16 yrs
- One or more affected joints
- Duration is >6 weeks
- Exclusion of others forms of arthritis
diagnostit procedure for JIA
XRAY- rules out fractures
what is an EMG
diagnostic measure to assess the health of muscles and the nerve cells that control them (motor neurons)
What is a CPK test
creatine phosphokinase (CPK)
- most specific test for muscular dystrophy
- elevated CPK levels indicate muscle disease
If you have upper motor neuron lesions this is primarily going to be___
cerebral palsy
what is the most common permanent physical disability in childhood
cerebral palsy
etiology of Cerebral Palsy
any perinantal/ neonatal brain lesions
prenatal infection, hypoxia, asphyxia, preterm birth
what is spastic cerebral palsy
most common type
presents hypotonia
Quadriparesis Cerebral Palsy
4 extremities are involved
- speech and swallowing difficulties
- tongue protrusion
- labile (eratic) emotions in some
developmental signs of CP
-poor head control after age 3 months
- stiff/rigid limbs
- unable to sit without support at age 8 months
- no smiling by age 3 months
- feeding difficulties
management of CP
mobilizations, meds, seizure control
what percent of CP patients have a normal IQ
50-60%
therapy goals for CP
- establish locomotion, communication, and self-help
- gain optimum integration of motor function
- correct defects are early and affectively aspossible
meds to treat spasticity in CP
diazepam and baclofen -muscle relaxant
valium- pain med
botox
signs of CP freqently present:
-delayed developmental milestones
- hyper or hypotonicity
- arching (feet, position)
- feeding difficulty
muscular dystrophies all have a genetic origin with
gradual degeneration of muscle fibers, progressive weakness, and wasting of skeletal muscles
genetic inheritance of Duchene Muscualar Dystr
x-linked (males are most exclusively affected)
cause of Duchene MD
dystrophin protein is absent
characteristic of Duchene MD
delayed motor development esp walking
- muscle weakness begins 3-5 yrs old
-progressive muscle weakness
-calf muscle hypertrophy
labs and diagnostic test for Duchene MD
Labs:Serum CPK and AST high in first 2 years of life
Test:confirmed by EMG, muscle biopsy,
what condition presents with Lordosis
Duchene MD
- accentuated lower back curve, belly pushing out
management of Duchene MD
no curative treatment
- maintain function in unaffected muscles as long as possible
- so do ROM, bracing, perform ADLs
- meds:corticosteroids like prednisone to increase muscle strength
in what conditions do children tend to be overweight or obese
Duchene MD and Legge-Calve
