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Physiotherapy Across Lifespan I > Orthopaedic Assessment and Intervention in infancy > Flashcards

Orthopaedic Assessment and Intervention in infancy Flashcards

1
Q

what percentage of births have major congenital disorder

A

2-3%

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2
Q

what is congenital muscular torticollis

A

latin for twisted neck
clinical sign of asymmetric neck posture - could be a result of multiple underlying disorder

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3
Q

how does congenital muscular torticollis typically present itself

A

presents with head tilted to one side and
rotated to the other

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4
Q

what are the three types of congenital muscular torticollis (CMT)

A
  1. Sternomastoid tumour (SMT)
  2. Muscular torticollis (MT)
  3. Postural Torticollis (PT)
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5
Q

Describe sternomastoid tumour

A

a type of congenital muscular torticollis
shortening of the SCM muscle due to a fibrotic mass

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6
Q

Describe Muscular torticollis

A

a type of Congenital muscular torticollis
shortening of the SCM
muscle but without a fibrotic mass
causes unilateral contracture of SCM muscle

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7
Q

Describe Postural Torticollis

A

a type of Congenital muscular torticollis
asymmetry of neck ROM,
following persistent positional preference of the head

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8
Q

what are the causes of SMT

A

true aetiology unknown
now thought to be damage of shortening of SCM due to intrauterine positioning/constraint - leads to venous occlusion

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9
Q

what is the typical presentation of SMT

A

palpable mass
develops around 2-3wks and resolves from ~4 months
size can range from less than 1cm to 4cm in diameter
contracture of SCM muscle causes neck to tilt to same side and rotate opposite side

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10
Q

describe rate of incidence of SMT

A

Incidence 0.4 - 3.9% of new-borns
3M:2F

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11
Q

What is muscular torticollis

A

results from the resolution of SCM mass after around 4/12
a non-contractile band of muscle is present

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12
Q

what would be observed in an objective assessment of a patient with muscular toticollis

A

non contractile band of muscle => shorterning and thickening of muscle on palpation
limited ROM

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13
Q

What is postural Torticollis

A

mildest form of CMT
a positional preference

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14
Q

what can cause postural torticollis

A

Can develop secondary weakness/tightness due to asymmetrical use and positional preference
this positional head preference develops near end of pregnancy
usually prefer R>L
Neonates don’t have enough head control to turn head so head preference persists

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15
Q

what would be observed in an objective assessment of a patient with postural torticollis

A

No morphological changes to SCM and full/almost full passive ROM CSp, but asymmetrical active CSp ROM

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16
Q

describe rate of incidence of postural torticollis in new borns

A

Incidence 16% of new-borns

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17
Q

what can be a by-product of postural torticollis

A

Babies’ skulls are soft, so this head preference can
lead to flattening of the skull on one side
(plagiocephaly) before or after birth

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18
Q

what is the origin of the word plagiocephaly

A

oblique head - greek

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19
Q

what is plagiocephaly

A

it is the flattening of the skull on one side before or after birth

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20
Q

what types of positional plagiocephaly

A

 Occipital flattening
 Ipsilateral ear pushed forward
 Ipsilateral forehead bossing
 Ipsilateral fuller cheek and eye
 Parallelogram shape

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21
Q

what is plagiocephaly associated with

A

intrauterine constraint
and prematurity

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22
Q

whay percentage of the brain is at adult volume once at birth, by 2 years old and by 5 years old

A

25% adult volume at birth
77% adult volume at 2 years old
90% adult volume at 5

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23
Q

what are sutures of the skull

A

fibrous bands of tissues, that connect the bones of the cranium, and meet at the fontanelles

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24
Q

why are the sutures of the skull fibrous

A

Being fibrous allows for some movement of
the bones of the skull (this enables an infant’s
skull to pass more easily through the birth canal and also allows for rapid brain growth

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25
Q

describe rate of incidence of plagiocephaly

A

38% of healthy full-term babies

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26
Q

what equipment can influence plagiocephaly

A

changes in
baby equipment / handling

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27
Q

what may be discovered in an infant with plagiocephaly during an objective assessment

A

No morphological changes to neck muscles
* But can develop secondary weakness/
tightness due to asymmetrical use
* This leads to further positional preference
of the head

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28
Q

craniosynostosis

A

a congenital anomaly with premature closure of one or more sutures between cranial bones

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29
Q

what are the possible consequences of craniosynostosis

A

It has the potential for negative neurologic and cognitive effects

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30
Q

what is the rate of incidence of craniosynostosis

A

6 per 10,000 births

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31
Q

types of craniosynostosis

A

metopic
sagittal
bicoronal
unicoronal
lambdoid
https://www.cincinnatichildrens.org/health/c/craniosynostosis

32
Q

what are the features of lambdoid synostosis

A

frontal protuberance
mastoid protuberance
posterior protuberance
ear displaced posteriorly
closed lambdoid suture

33
Q

what are the features of synostic plagiocephaly

A

hx of misshapened head at birth
palpable ridge over suture
ipsilateral ear is posterior and displaced inferiorly (anterior in deformational)
* becomes more severe with time

34
Q

neck massess detected in infants could also mean?

A

cysts e.g. branchial cyst
Lymphadenopathies
Lymphangiomas
Tumours

35
Q

signs of neurological disturbance in infants

A

head tilt
vomiting in the am
headache in the am
loss of balance
regression of milestone
change in gait
weakness
behaviour change
ocular change

36
Q

what signs of spinal changes can be present in infants

A

head tilt/scoliosis
pain
weakness
anasthesia/parasthesia
loss of bladder/bowel conrol

37
Q

what is grisel syndrome

A

Atlanto-axial subluxation due to periligamentous inflammation following
infection/inflammation in the area

38
Q

after what surgery can grisel syndrome arise in infants

A

tonsillectomy/adenoidectomy

39
Q

what infection/inflammation is commonly present before grisel syndrome

A

Pharyngitis, tonsillitis, mastoiditis,otitismedia, retro-pharyngeal abscess

40
Q

what infections can affect protective posturing

A

infections in head or neck region e.g. osteomyelitis of CxSp or otitis media

41
Q

what is benign paroxysmal torticollis

A

episodes of torticollis (head tilts)
can last minutes (10mins) to months (2 months)
episodes become less frequent with age and stop by age 5

42
Q

what other signs and symptoms are associated with benign paroxysmal torticollis

A

pallor
vomiting
ataxia
irritability

43
Q

what is sandiers syndrome

A

By tilting head / arching back,
stretches oesophagus and relieves
pressure
CAN BE MISTAKEN FOR SEIZURE

44
Q

what is sandifer’s syndrome associated with

A

gastro-esophageal reflux disease(GERD)

45
Q

What are the signs of sandifers syndrome

A

irritable, coughing, breathholding, poor feeding, poor sleeping

46
Q

what are red flag signs for severe pain

A

Fractures,
osteomyelitis,
retropharyngeal abscess

47
Q

what are red flags of raised ICP

A

Sunset phenomenon
Bulging fontanelle
Vomiting
Headache
Drowsy

48
Q

What are may an acute onset of symptoms be a red flag for

A

Infection, abscess, Grisel Syndrome

49
Q

what is acid reflux a possible red flag for in infancy

A

GERD
Sandifer syndrome

50
Q

what is fever a possible red flag for in infancy

A

Infection, abscess

51
Q

what is dysmorphic features a possible red flag for in infancy

A

syndrome

52
Q

what is lymphadenopathy a possible red flag for in infancy

A

infection

53
Q

what is increasing head tilt a possible red flag for in infancy

A

Infection, tumour

54
Q

what is recurrent episodes tilt a possible red flag for in infancy

A

Benign paroxysmal torticollis

55
Q

what is recent change in function tilt a possible red flag for in infancy

A

Acute neurological event

56
Q

what topics should be covered whilst taking a subjective history in ortho infants

A

birth/medical history
asymmetry in head/neck, spine, hips, feets
development hx - asymmetry in sucking hand, feeding, rolling
investigation - depends on source of referral

57
Q

what is observed in the objective assessment

A

posture in different positions - supine, prone, upright
neonata asymmetry
baby most symmetrical by 4/12

58
Q

what milestones must an infant at 6/12 accomplish in supine

A

turn head either side
rolling on either side

59
Q

what milestones must an infant at 6/12 accomplish in prone

A

should have extended head and arms
head in midline or rotating either side

60
Q

how is the head tilt assessed

A

in supine, prone, upright
no head midline until 4 months but is normal for some tilting at young age
head midline should be present by 4 months in prone

61
Q

what should be assessed in objective assessment of infant

A

head preference of positioning - to check for positional torticollis
check for head tilt in supine, prone, upright for all sorts of torticollis, sandifers syndrome
check cranio facial features for craniosynostosis
observe and palpate neck for SMT, SCM tumour or nodes,
hearing vision abnormalities
check for other conditions - look for asymmetries in spine, hips, feet

62
Q

how is the cervical spine rom assessed in infants

A

make sure baby is relaxed and in age appropriate positions and stimulation
if PROM try and have the head over the edge of surface
stabilise trunk, block shoulder, support head
bring the babys hand to mouth

63
Q

what is the estimated degree of cervical rotation if an infant can get their chin past their shoulder

A

100 degrees

64
Q

what is the estimated degree of cervical rotation if an infant can get their chin to their shoulder

A

90 degrees

65
Q

what is the estimated degree of cervical rotation if an infant can get their chin to mid-clavicle

A

70 degrees

66
Q

what is the estimated degree of cervical rotation if an infant can get their chin to nipple line

A

45 degrees

67
Q

how is passive side flexion of CxSp completed in infants

A

in supine
stabilise shoulder
palmar surface of hand should make contact with posterior aspect of skull and finger tips should make contact with temples of the infant

68
Q

how is muscle strength assessed in infants

A

righting response
head always wants to stay upright
test by holding baby and tilting trunk side to side as age appropriate
look for functional Ax - pull to sit, rolling over, supine to sit up, reach up

69
Q

what is the muscle function scale

A

Measures lateral head righting while holding the infant horizontally

70
Q

what does the muscle function scale score 0 mean?

A

if head below horizontal

71
Q

what does the muscle function scale score 1 mean?

A

head horizontal
The child must hold head at least 5 sec to score that level

72
Q

what does the muscle function scale score 2 mean?

A

2 slightly above horizontal <45degrees
The child must hold head at least 5 sec to score that level

73
Q

what does the muscle function scale score 3 mean?

A

2 slightly above horizontal >45degrees
The child must hold head at least 5 sec to score that level

74
Q

what does the muscle function scale score 4 mean?

A

4 holding very high above horizontal nearly vertical
The child must hold head at least 5 sec to score that level

75
Q

what is the physio management of CMT/plagiocephaly

A

 CSp and trunk active ROM
 PROM (if AROM not full)
 Development of age-appropriate,
symmetrical movement
 Environmental adaptations
 Parent/carer education

76
Q
A

Physiotherapy Across Lifespan I (14 decks)

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