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Physical Assessment > Neuroskeletal Assessment > Flashcards

Neuroskeletal Assessment Flashcards

1
Q

What is the function of the neuroskeletal system?

A
  • provides stability and mobility
  • protects vital organs
  • skeleton is flexible and joints are elastic
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2
Q

What elements are included in the neuroskeletal system?

A

includes joints, bones and supporting tissues

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3
Q

What are bones comprised of?

A

mostly comprised of cartilage; store Ca, Phos & produce RBCs

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4
Q

What is important to review in the infant’s prenatal history?

A
  • oligohydramnios (amniotic fluid permits mvmt)
  • breech
  • abnormal growth patterns
  • teratogenic agent exposure
  • birth trauma
  • multiple gestation
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5
Q

What is flexion?

A

bending a limb at a joint

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6
Q

What is extension?

A

straightening a limb at a joint

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7
Q

What is abduction?

A

moving a limb away from the midline of the body

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8
Q

What is adduction?

A

moving a limb toward the midline of the body

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9
Q

What is pronation?

A

facing downward

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10
Q

What is supination?

A

facing upward

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11
Q

What is dorsiflexion?

A

flexion toward the back, as in flexion of foot so that the forefoot is higher than the ankle

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12
Q

What is plantar flexion?

A

extension of the foot so that the forefoot is lower than the ankle

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13
Q

What is rotation?

A

turning as in face to the side

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14
Q

What is valgus?

A

bent outward or twisted away from the midline of the body

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15
Q

What is varus?

A

turned inward

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16
Q

What is everted?

A

turning out and away from the midline of the body

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17
Q

What is inverted?

A

turning inward toward the midline of the body

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18
Q

What is normal position of the term infant?

A

limbs flexed
legs partially abducted at hip
head turned to one side

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19
Q

What can extremity positioning reflect?

A

intrauterine positioning

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20
Q

How should tremors in the arms and legs with crying be interpreted?

A

normal in first 4 days of life

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21
Q

What does an infant in breech positioning typically look like?

A

flexed, abducted hips and extended knees; corrects with time and passive joint manipulation

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22
Q

What are the bones most likely to break in labor?

A

1) clavicle

2) humerus

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23
Q

How far should the neck rotate at birth?

A

80 degrees

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24
Q

What is the degree of lateral flexion of the neck?

A

40˙ right and left

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25
Q

What is the degree of anterior flexion of the neck?

A

chin should touch or almost touch the chest

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26
Q

What is the degree of extension of the neck?

A

occipital part of the head should touch or almost touch back of the neck

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27
Q

What is torticollis?

A
  • spasmodic, unilateral contraction of neck muscles
  • firm, fibrous mass or tightness appreciated mid sternocleidomastoid muscle
  • 1-2cm mass (hard, immobile)
  • R affected more than L
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28
Q

When does torticollis present?

A

not seen in immediate newborn peril; by 2weeks of age

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29
Q

What is the cause of torticollis?

A

birth trauma or ischemia in utero

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30
Q

How does torticollis present?

A

head tilted toward shoulder on affected side, chin rotated away from affected shoulder

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31
Q

How is torticollis treated?

A

can lead to plagiocephaly; stretching exercises can correct it

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32
Q

What is Klippel- Feil syndrome?

A
  • defect of the cervical vertebrae (reduction in the # of vertebrae and fusion of 2 or more)
  • neck shorter than usual
  • motion is limited
  • confirmation by Xray
  • mistaken for torticollis
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33
Q

When should a fractured clavicle be suspected?

A

1) difficult delivery
2) irregularity in contour
3) crepitus on palpation
4) tenderness on palpation- may become edematous

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34
Q

What should be suspected if an infant fails to move an extremity?

A

1) spinal cord injury
2) brachial plexus injury
3) fracture

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35
Q

What is VACTERL?q

A 
V- vertebral anomalies
A- anal atresia
C- cardiac anomalies
T- TE fistula
E- esophageal atresia
R- renal anomalies
L- limb anomalies
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36
Q

What can cause a brachial palsy?

A

1) traumatic delivery

2) stretching injury to brachial plexus (C5-C8, T1); traction injury on the neck from delivery

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37
Q

What is Klumpke’s palsy?

A

LOWER ARM paralysis; wrist and hand are paralyzed

  • C8- T1
  • no Moro, negative grasp
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38
Q

What is Erb’s palsy?

A

UPPER ARM paralysis; holds arm adducted and internally rotated with extension of elbow, pronation of forearm and flexed wrist

  • C5-C6-C7
  • No Moro, positive grasp
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39
Q

What is Horner’s syndrome?

A

reflects injury to sympathetic nerve at C8-T1
The symptoms occur on the same side as the lesion of the sympathetic trunk. It is characterized by myosis (a constricted pupil), ptosis (a weak, droopy eyelid), and anhidrosis (decreased sweating over the forehead)

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40
Q

How does phrenic nerve palsy present?

A

symptoms usually apparent at birth
cyanosis
increased WOB
asymmetrical chest mvmt

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41
Q

What percentage of brachial plexus injuries will achieve complete recovery?

A

30% as edema resolves

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42
Q

If function r/t brachial plexus injury does not return by 3 months, what long term sequela can be expected?

A

muscle atrophy > impaired bone growth > osteoarthritis > scapular winging > scoliosis

43
Q

How do palmar creases develop?

A

result from intrauterine movement

44
Q

How do the hands of infants with Down’s syndrome appear?

A

simian crease, short fingers, incurved little finger, low set thumb

45
Q

What is the distance front the tip of the middle finger to base of the palm?

A

6.75 cm (+/- 1.25 cm)

46
Q

What is macrodactyly?

A

enlargement of finger/ toe

- may be normal or a sign of neurofibromatosis

47
Q

What should be suspected with the presentation of overlapping 2nd and 3rd fingers?

A

TRISOMY 18

48
Q

What is clinodactyly?

A

crooked digits; can be a normal finding

49
Q

What is syndactyly?

A

congenital webbing of fingers or toes; the more severe, the greater the likelihood of bone abnormalities

  • fx deteriorates when multiple digits are involved
  • tx depends on severity- ortho consult
50
Q

What is polydactyly?

A

extra digits; more common in AA; familial tendency

51
Q

What is the most common presentation of polydactyly?

A

floppy digit or skin rage on ulnar side of hand (post axial)

- tx depends on extent of anomaly

52
Q

What is sprengel’s deformity?

A

winged or elevated scapula; one sits higher than the other

53
Q

What is lordosis?

A

abnormal inward curvature of the lumbar and cervical regions of the spine

54
Q

What is kyphosis?

A

an exaggerated rounding of the back

55
Q

What is an occult dysraphism?

A

a tethered spinal cord; may be symptomatic at birth of at 2-4 years (dx more likely if 2+ symptoms present)

  • lesions, dimples, hair tuft
  • foot and spinal deformities
  • weakness in the legs
  • low back pain
  • change in gait
  • scoliosis
56
Q

What is a plinodial dimple?

A

“simple dimple”; located < 2.5cm from gluteal cleft

- assess for sinus tract or observable base

57
Q

What is a hamartoma?

A

benign abnormal growth that’s made up of the same tissues from which is grows

58
Q

What is a meningocele?

A

usually involve more than one vertebra

  • the meninges, covered by thin, atrophic skin, protrude through the bony defect
  • spinal roots and nerves are all normal, neurologic deficits are unusual
59
Q

What is a myelomeningocele?

A

congenital NTD; functional defect of the lower extremities

60
Q

What is the etiology of a myelomeningocele?

A

occurs very early in embryologic development; caudal end of neural tube fails to close permitting meninges and sometimes spinal cord to protrude into a sac like structure

61
Q

In what population does developmental dysplasia of the hip most commonly occur?

A

1) first born children (r/t tight uterus)
2) females (estrogen causes pelvis to be looser)
3) infants in breech position regardless of how they are delivered

62
Q

How should children with developmental dysplasia of the hip be managed?

A
  • u/s at 6 weeks and X-ray at 4 months
  • does not always present in the newborn period
  • all infants should be checked at every health visit for the first year
63
Q

How should hips be sassed in the newborn?

A

1) check for stability
2) asymmetry of gluteal folds
3) Allis’ sign
4) Barlow and Ortolani maneuvers

64
Q

What percentage of infants with normal hips will have asymmetric gluteal folds?

A

25%

65
Q

How do you assess for Alli’s sign?

A
  • feet flat on bed
  • align femurs
  • bend both knees
  • tip of big toes in same horizontal plane
  • note height of knees
    • sign= one knee is higher than the other (head of femur is out of the acetabulum)
  • suspect hip dislocation > shorter on one side of dislocation
66
Q

What does Ortolani test for?

A

hip reduction- produces a reduction of a dislocated femoral head into acetabulum by abduction
(you’re assuming the hips are dislocated and you’re trying to reduce the joint)

67
Q

What does a + Ortolani indicate?

A

feeling a distinct clunk as the femoral head repositions into the acetabulum (clicks and snaps may be heard, but not a/w pathology)

68
Q

What does Barlow test for?

A

tests for hip dislocation by evaluating if the femoral head can be dislocated from the acetabulum with pressure

69
Q

What does a + Barlow indicate?

A

feel a clunk over lateral edge indicating femoral head has slipped out of acetabulum

70
Q

What is arthrogryposis?

A

describes congenital joint contractures in two or more areas of the body; “curving of joints”

71
Q

What can cause ankle and foot rotational deformities?

A

oligohydramnios, macrosomia, multiple gestations

72
Q

When does the plantar fat pad disappear?

A

by 1 yr of age

73
Q

What is metatarsus adductus?

A

most common foot anomaly, will spontaneously correct; caused by intrauterine positioning; foot is turned in; can be structural- if foot cannot be brought past midline, it will not self correct

74
Q

What are risk factors from club foot?

A

LGA, smoking in 1st trimester, early amnio (amy of fluid never fully recovers)

75
Q

When is sandal toe present?

A

45% of trisomy 21; can be a normal variant

76
Q

In infants with brachial plexus injury, what other injury should be assessed for?

A

5% of infants will also have phrenic nerve damage

77
Q

When is “frog legged” posture considered abnormal?

A

> 32 weeks GA

78
Q

Describe tremors/ jitteriness.

A

Rapid alternating movement of equal amplitude in all directions

79
Q

Describe clonic movements.

A

as seen with sz; fast & slow components, cannot be stopped with holding; rhythmic; horizontal eye deviation

80
Q

Why does sz presentation in infants differ from adults?

A

neurons are not as integrated with sporadic neuronal firing

81
Q

When do sleep/wake cycles regulate in an infant?

A

< 28 weeks- hard to identify a state
longer sleep periods in preterm
cycles are more appropriate by 32 weeks
alertness readily seen by 37 wk

82
Q

How is active tone assessed in the pull to sit maneuver?

A

have to be able to resist pull of gravity; term infant: contracts shoulder and arm muscles, flexes neck (absent < 33 wk), head comes up then falls forward

83
Q

When is opisthotonus observed?

A

bacterial meningitis, severe HIE, tetanus, kernicterus and IVH

84
Q

What is the purpose of testing deep tendon reflexes?

A

to assist in determining the integrity of the spinal cord and peripheral nervous system

85
Q

When are deep tendon reflexes weak or absent?

A

1) <28 weeks
2) birth asphyxia
3) sepsis
4) encephalopathy
* * exaggerated with NAS

86
Q

What does the patellar reflex test?

A

L2-L4; normal response- extension of knee and visible ctx of quadriceps

87
Q

What does the biceps reflex test?

A

test C5-C6; normal response- flexion of biceps muscle

88
Q

What is clonus?

A

rapid mvmt of a particular joint due to sudden/abrupt stretching of tendon

89
Q

How much clonus is expected in a preterm and term infant?

A

PT < 10 beat; FT< 5 beats

*** more than 10 at any age is abnormal; sustained = cerebral irritation

90
Q

When does the rooting reflex appear and disappear?

A

onset at < 28wks; disappears by 3-4 mos

91
Q

When does the sucking reflex appear and disappear?

A

onset at 28 weeks- readily elicit at 32-34 weeks; disappear by 12 mos

92
Q

When should the asymmetric tonic neck reflex appear?

A

onset at 35 weeks; absent or sustained= CNS abnormalities

93
Q

When does the hand grasp appear and disappear?

A

onset at 28-34 weeks, disappear by 2 mod; if weak = CNS or local nerve/muscle damage

94
Q

When does the plantar grasp appear and disappear?

A

disappears by 8-9 months; prelude to walking; if weak- lower spinal cord injury/defect

95
Q

When does the babinski reflex appear and disappear?

A

onset 34-36 weeks, abnormal after 2yrs; evaluates spinal cord innervation- does not require a functional brain

96
Q

When does the truncal incurvation reflex/ Galant reflex appear and disappear?

A

onset at 28 weeks, disappears by 3-4 months; if negative could be a spinal cord lesion or injury

97
Q

When does the steeping reflex appear and disappear?

A

onset at 37 weeks, more active after 72 hours post birth

98
Q

When does the Moro reflex appear and disappear?

A

onset at 28 weeks, disappears by 6 months

99
Q

What is the Moro reflex a reaction to?

A

produced by suddenness of stimulus, not distance of fall

100
Q

How should an asymmetric or absent Moro be interpreted?

A
  • brachial plexus injury or upper extremity injury

- underlying CNS pathology

101
Q

What is habituation?

A

defense mechanism enabling infant to alter response to repeated stimuli; term infant is able to control effect of surrounding environment by regulating his/her physiological and emotional response to stimuli

102
Q

What is an organized infant?

A

infant maintains stable VS, smooth state transitions and smooth movements

103
Q

What is an unorganized infant?

A

infant will exhibit changes in HR, color, will have sudden state changes, may become jittery and/or hypotonic

Physical Assessment (11 decks)

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