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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
describe rate of incidence of plagiocephaly
38% of healthy full-term babies
26
what equipment can influence plagiocephaly
changes in baby equipment / handling
27
what may be discovered in an infant with plagiocephaly during an objective assessment
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
28
craniosynostosis
a congenital anomaly with premature closure of one or more sutures between cranial bones
29
what are the possible consequences of craniosynostosis
It has the potential for negative neurologic and cognitive effects
30
what is the rate of incidence of craniosynostosis
6 per 10,000 births
31
types of craniosynostosis
metopic sagittal bicoronal unicoronal lambdoid https://www.cincinnatichildrens.org/health/c/craniosynostosis
32
what are the features of lambdoid synostosis
frontal protuberance mastoid protuberance posterior protuberance ear displaced posteriorly closed lambdoid suture
33
what are the features of synostic plagiocephaly
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
neck massess detected in infants could also mean?
cysts e.g. branchial cyst Lymphadenopathies Lymphangiomas Tumours
35
signs of neurological disturbance in infants
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
what signs of spinal changes can be present in infants
head tilt/scoliosis pain weakness anasthesia/parasthesia loss of bladder/bowel conrol
37
what is grisel syndrome
Atlanto-axial subluxation due to periligamentous inflammation following infection/inflammation in the area
38
after what surgery can grisel syndrome arise in infants
tonsillectomy/adenoidectomy
39
what infection/inflammation is commonly present before grisel syndrome
Pharyngitis, tonsillitis, mastoiditis,otitismedia, retro-pharyngeal abscess
40
what infections can affect protective posturing
infections in head or neck region e.g. osteomyelitis of CxSp or otitis media
41
what is benign paroxysmal torticollis
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
what other signs and symptoms are associated with benign paroxysmal torticollis
pallor vomiting ataxia irritability
43
what is sandiers syndrome
By tilting head / arching back, stretches oesophagus and relieves pressure CAN BE MISTAKEN FOR SEIZURE
44
what is sandifer's syndrome associated with
gastro-esophageal reflux disease(GERD)
45
What are the signs of sandifers syndrome
irritable, coughing, breathholding, poor feeding, poor sleeping
46
what are red flag signs for severe pain
Fractures, osteomyelitis, retropharyngeal abscess
47
what are red flags of raised ICP
Sunset phenomenon Bulging fontanelle Vomiting Headache Drowsy
48
What are may an acute onset of symptoms be a red flag for
Infection, abscess, Grisel Syndrome
49
what is acid reflux a possible red flag for in infancy
GERD Sandifer syndrome
50
what is fever a possible red flag for in infancy
Infection, abscess
51
what is dysmorphic features a possible red flag for in infancy
syndrome
52
what is lymphadenopathy a possible red flag for in infancy
infection
53
what is increasing head tilt a possible red flag for in infancy
Infection, tumour
54
what is recurrent episodes tilt a possible red flag for in infancy
Benign paroxysmal torticollis
55
what is recent change in function tilt a possible red flag for in infancy
Acute neurological event
56
what topics should be covered whilst taking a subjective history in ortho infants
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
what is observed in the objective assessment
posture in different positions - supine, prone, upright neonata asymmetry baby most symmetrical by 4/12
58
what milestones must an infant at 6/12 accomplish in supine
turn head either side rolling on either side
59
what milestones must an infant at 6/12 accomplish in prone
should have extended head and arms head in midline or rotating either side
60
how is the head tilt assessed
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
what should be assessed in objective assessment of infant
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
how is the cervical spine rom assessed in infants
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
what is the estimated degree of cervical rotation if an infant can get their chin past their shoulder
100 degrees
64
what is the estimated degree of cervical rotation if an infant can get their chin to their shoulder
90 degrees
65
what is the estimated degree of cervical rotation if an infant can get their chin to mid-clavicle
70 degrees
66
what is the estimated degree of cervical rotation if an infant can get their chin to nipple line
45 degrees
67
how is passive side flexion of CxSp completed in infants
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
how is muscle strength assessed in infants
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
what is the muscle function scale
Measures lateral head righting while holding the infant horizontally
70
what does the muscle function scale score 0 mean?
if head below horizontal
71
what does the muscle function scale score 1 mean?
head horizontal The child must hold head at least 5 sec to score that level
72
what does the muscle function scale score 2 mean?
2 slightly above horizontal <45degrees The child must hold head at least 5 sec to score that level
73
what does the muscle function scale score 3 mean?
2 slightly above horizontal >45degrees The child must hold head at least 5 sec to score that level
74
what does the muscle function scale score 4 mean?
4 holding very high above horizontal nearly vertical The child must hold head at least 5 sec to score that level
75
what is the physio management of CMT/plagiocephaly
 CSp and trunk active ROM  PROM (if AROM not full)  Development of age-appropriate, symmetrical movement  Environmental adaptations  Parent/carer education
76

Physiotherapy Across Lifespan I (14 decks)

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