Paediatric conditions 2.0 Flashcards
What is osgood -schlatter syndrome? what is it caused by?
Activity related pain and swelling at insertion of patellar tendon on tibial tubercle - self-limiting
Caused by minor degree of separation of tibial tubercle, associated with patella alta
Osgood-schlatter syndrome S&S
acute severe pain - limp, low grade discomfort (exacerbated by running or playing sports)
Osgood-schlatter syndrome Rx
What is the time period for recover?
- ice, rest, decrease activity, avoid squatting and jumping
- brace, cast in severe cases
- generally resolves in 6 weeks if following precautions, most cases within 3 months (tubercle fuses to tibia
What is osteochondritis dessicans? Where does it most commonly occur?
Lesion of subchondral bone and articular surface (distal femur most common - lateral surface of medial femoral condyle, also femoral capital epiphysis and talus)
What causes osteonchondritis dessicans?
Ischemic necrosis - exact cause of this unknown
Osteochondritis dessicans S&S
- frequently asymptomatic, pain
- swelling around knee
- antalgic gait
- locking (if fragment separates)
Osteochondritis dessicans Rx
- most self-limiting, immobilization
- graduated activity with quads strengthening
- surgery if separation and intra-articular fragment (in skeletally immature
What is idiopathic toe walking?
Walking milestone normal but up on toes, child otherwise appears completely normal
Can often walk flatfooted if prompted
idiopathic toe walking S&S
child walks and runs on toes, variable degree of tightness in plantarflexors (restricts passive DF), always symmetrical
Idiopathic toe walking Rx
- hard to treat, mainly cosmetic
- AFO’s
- PT (ROM, strength)
- serial casting
- botox
- surgery controversial
What is congenital muscular torticollis? What may cause it?
- Unilateral shortening or fibrosis of SCM at birth or shortly after
Causes:
- birth trauma
- intrauterine malposition
- perinatal compartment syndrome
- genetics
- Increased risk with prolonged time on back
Congenital muscular torticollis associated conditions
- plagiocephaly
- facial asymmetry
- hip dysplasia
- MSK anomalies (ie. metatarsus adductus – uterine packing)
- brachial plexus injury
- TMJ dysfunction
- developmental delay (during period of torticollis or longer)
3 types of torticollis
1) SCM “tumor” with palpable mass in SCM (not a neoplasm but scar tissue)
2) Muscular torticollis without palpable tumor but thickening and/or shortening of SCM
3) Postural torticollis where clinical features present without tumor or muscle tightness
5 “other” causes of torticollis
- Boney malformations (ie. Klippel-Feil syndrome, cause child to adopt suboptimal postures)
- Ocular torticollis (superior oblique muscle weakness, head tilt to correct double vision)
- Space occupying lesion (ie. posterior fossa tumors)
- Abnormal muscle tone (spasticity, dystonia, hypotonia, etc.)
- Reflux (ie. Sandifer syndrome)
What would you include in a torticollis assessment
- History – pregnancy/birth history, HPI, current health, feeding, treatments, etc.
- Observation – resting posture (various positions), face/head shape, ocular alignment, movement quality, etc.
- ROM – AROM/PROM c-spine flexion & rotation, hips & extremities, supine vs. prone, sitting vs. standing, etc.
- Strength & tone – lateral head righting ( >4 months) symmetrical side to side, functional activities/gross motor skills, palpate for any masses/muscle tone
- Development
Torticollis treatment
- Stretching
- Strengthening of weak neck & trunk muscles
- Positioning (tummy time)
- Environmental adaptations
- Parental education
- Other options include botox, T.O.T. collar, surgery, etc.
What is plagiocephaly
The misshaping and flattening of an infant’s head through sustained external directional force
4 components of pediatric examination
Hx
Systems Review
Intervention
Re-examination
What is included in a peds History
- prenatal
- birth
- general health
- milestones
- procedures/interventions
- goals
What is included in a peds systems review
- cardiorespiratory
- integumentary
- MSK
- neuro
- communication/cognition/learning
- level of consciousness
- orientation
- emotional/behavioral
4 Peds outcome measures
FMS - Functional mobility scale
GMFCS - gross motor functional classification system
GMFM - Gross motor functional measure
COPM
FMS (functional mobility scale) - population, scoring, purpose
age 4-18 with CP,
rates walking ability at 5, 50, 500 m (for home, school and community), questions not observation
N-6 want a high score
Used to figure out what device they will need
GMFCS - Scoring, population, purpose
5 levels (I= high fxn, V= limited)
For kids with CP, based on self initiated movement
Good for communication between families and health care professionals and goal planning
what if the GMFM (Gross motor functional measure)
standardized test for gross motor function for children with CP, all items that a 5 year old (normal development) would do, can measure over time to see change and set realistic goals
