paeds Flashcards
lift head at
3-4 months
sitting without support
4-9 months
standing with assistance
5-11 months
crawling
5-13 months
standing alone
7-16 months
walking alone
9-18 months
walking with assistance
6-14 months
osgood schlatter lesion is an osteochondroses in the-
tibial tubercle
an osteochondroses in the tibial tubercle is called a
osgood schlatter lesion
sindig larsen johnson lesion is located in the
inferior pole of the patella
an osteochondroses in the inferior pole of the patella is called a
sindig larsen johnson
ddx of toe walking
mm tightness global developmental delay tumour ankylosing spondylitis trauma e.g. #, burns CMT Angelmann's syndrome tethered cord transient focal dystonia venous malfunction of soleus cerebral palsy spd muscular dystrophy
antetorsion
medial twist of the distal end of the femur on the proximal end
anteversion
when the NOF and HOF are positioned towards the anterior asp of the body
retroversion
when the NOF and HOF are tilted away from the anterior aspect of the body
list off some OMs you could use on a 3 month old
wong baker AIMS up to 18 months old DSM 5 for autism and shit pirani score(TEV) gallop
name some OMs you could use on a 8 year old
8+ use VAS
4-18 se FLACC
paediatric balance scale 5-15 years
MABC/BOT 2
list some OMs you could use on a 12 year old
paediatric balance scale (5-15)
gallop
p FFP
outline the rating of reflexes 1-5
0= absent 1= hypo 2= normal 3= hyper reflexive 4= clonus 5 = sustained clonus
5 determinants of mature gait
S: step length increases with age
C: cadence decreases with age
A: ankle spred: pelvic span to ankle spread ration increases with age
W: walking speed increases with age
D: duration of single limb stance increases with age
ddx for kohlers
accessory navicular tumour # RA maybe tib post or TA tendinopathy
what manipulations are performed when casting
lateral shift of navicular, calc and cuboid.
do not move talus within aj
what are some potential causes of paediatric flat foot?
tarsal coalition
congenital vertical talus
peroneal spastic flat foot
tib post dysfunction
how would you rx growing pains
RCT for stretching quads, hamstrings, gastroc/sol
case series for in shoe wedging for pronated feet
is there a gender bias for kohlers?
yas there is a gender bias for kohlers: males 4:1
what is the normal age range for kohlers
2-9 years old
what is newborn STJN?
22 varus
STJ ROM = 45
newborn forefoot position
varus 12-15
metatarsus primus adductus
when is ossification complete in the whole body
25 yo
majority of acetabulm shape and depth is determined by …. what age
8 years old
what is the typical age range and gender ratio for osgood schlatters
boys 12-15
what is the treatment for osgood schlatters (tibial tubercle- bone builds up here)
address any mm strength/flexibility imbalances,
activity modification (directed by pain),
spontaneus resolution is common
NSAIDs
may need surgery
what is the typical age range and gender ratio for kohlers?
males > females 4:1
2-9 years old
what is the treatment for kohlers?
activity modification,
orthoses
short leg cast 6-8 weeks
what is the typical age range and gender ratio for friebergs
typically dancers 12-15 yo
what is the rx for friebergs
activity modification shoe wear modification short leg cast surgery aspirin (over 12s)
what is the typical age range and gender ratio for perthes
boys > girls 4 or 5:1
4-10 yo
what is the rx for perthes
monitor + analgesics
slings and casting
surgical (to encourage spherical moulding of HOF)
what is the rx for sindig larsen johnson (inferior pole of patella)
activity modification (directed by pain) tightness of quads may predispose
what is the typical age range and gender ratio for severs
boys 7-15
girls 5-13
** mostly boys aged 10-12
what is the rx for severs
activity modification
shoe wear
heel raises
calf stretching/strenght
what is the rx for iselins
offloading
orthoses
lateral wedging (?)
what is the rx for sheuermann’s
joint mobilisation
soft tissue therapy
bracing
surgery
osgood schlatters are typically seen in patients who play what kind of sports?
anything with running and jumping
which osteochondroses has spontaneuous resolution of sx? (only 10 % of cases are sx into adulthood)
osgood schlatters spontaneous resolution
ddx osgood schlatters
osteochondrosis dissecans (joint)
RA
meniscus injury
severs- how often does it present bilaterally ?
60% of cases are bilateral
severs- what are the limiting factors
the calcaneus has 2 ossifcation centres which fuse at around 16 years of age –> self limiting
what is a clinical dx tool for severs?
pain localised to post heel –> “squeeze test”
ddx of severs
retrocalcaneal bursitis, achilles tendinopathy bone tumour medial calc nerve entrapment tarsal tunnel syndrome RA
what is a clinical tool you could use to dx a kohlers?
get them to go up on their toes (i.e. trigger some tib post contraction) and see if they get pain
ddx of kohlers?
accessory navicular
#
RA
ddx of iselins
styloid #
accessory
RA
ddx friebergs
stress # march # synovitis neuroma RA
you have dx your pt with growing pains (using evans table). now what do you do?
implement a pain episode diary
mm stretching program : quads, hamstrings, triceps surae, 2 x 20-30 sec holds
if the pt doesn’t respond well then try shoe wedges
then try paracetamol, heat, massage, orthoses
if no response then pls consider red flags!
ddx of growing pains
juvenile arthritis bone tumour mm metabolism disorder fibromyalgia restless legs
outline the 3 theories of growing pains
anatomical: orthopaedic factors e.g. flat feet, genu valgum
fatigue theory: crazy active kids –> overuse of mm
psychological or emotional theory: avoiding school, looking for special rx etc.
3 Es for orthotics?
Efficacy
Expense
Ethics/justification
what are some tests we can do on a kid with flat feet?
tib post: see how many times they can do a single leg toe raise in 10 secs jacks test FPI 6 FMM flexible or rigid/ gait analysis
it is common for kids to have flat feet until the age of about _____
10
excessive lordosis is a red flag for ____
osteomalacia
TB of spine
what is ehler’s danlos syndrome?
a big group of inherited connective tissue disorders involving jjoint hypermobility, skin hyperextensibility and tissue fragiliaty
what are the most likely/take home characteristics/consequences of down syndrome - relevant to pods
hypotonia : when going from sit to stand they will typically go through a tripod position rather than squats - problematic because he will fall heaps more (discouraging) and doesn’t help with position + ROM at hips and knees
broad flat square foot –> arch profile wont emerge when going onto toes
probably won’t be walking at 2
your pt has genu valgum and they are over 8 years. what pathologies could they have?
renal osteodystrophy
metaphyseal dysplasias
olliers disease (tumour like condition)
your pt is over 8 and has a valgum. what do you do?
needs to be investigated
x rays if indicated
rx if pain with gait, cosmetic concern, knee pain
when are x rays indicated in childhood genu valgum?
over 8 hx trauma/infection short stature unilateral or asymmetryy metabollic bone disease (mostly rickets)
what are some reasons (i.e. underlying conditions) for pathologic genu varum
physeal disruption post trauma or infection
metabollic bone disease e.g. rickets
generalised skeletal dysplaisa
focal fibrocartilaginous dysplasia
define pathologic genu varum
infantila and adolescent onset
physeal disruption post trauma or infection or metabolic bone disease (rickets) or dysplasias
what are some of the complications of SUFE?
very serious. you need to get them to hospy ASAP osteonecrosis chondrolysis (cartilage destroyed) OA impingement
what is the typical presentation of SUFE?
12-14 yo maybe overweight antalgic gait out toeing shortening of affected limb obligatory lateral rotation of the thigh when you try to flex their hip (pt supine)
acute: # like pain, unable to WB
chronic: groin pain + radiating to anteromedial thigh + med knee, antalgic limp, pain for more than 3 weeks, no sudden exacerbation, 3 weeks after acute phase
what is SUFE?
slipped upper femoral epiphysis. when the neck and shaft of the femur displace upwards and anteriorly
what tests would you do on someone with suspected perthes?
medial rotation: will be decreased
abd: will be decreased
ROM: will be decreased
trendelenburg sign will be seen
telescope the knees –> there will be shortening of the limb
gait analysis: limp, exacerbated by activity
what are the 3 stages of a perthes?
a) blood supply is disturbed
b) softening and collapse of bone
c) re-establishment of BS + repair + modelling of HOF
define perthes and describe what it does to the shape of the HOF
idiopathic juvenile avascular necrosis of HOF
HOF widens and flattens
what are the 3 main broad categories of etiology of DDH ?
- lig lax; maternal relaxin crosses placenta? genetic predisposition
- prenatal positioning: breech, big babies, 1st born, oligohydramnios
- post natal positioning: swaddling in HJ extended position
which hip is usually affected in DDH?
left hip because left goes under right in the foetal position
when do the vertebrae parts fuse?
3-5 years of age
ddx of back pain in kids
neoplasm infection UTI OM diskitis spondylosis disk herniation slipped or # vertebral apophysis inflammatory bowel disease hydronephrosis ovarian cysts
pt under 4 years with back pain. what is the most likely dx?
infection or neoplasm
pt under 10 years with back pain. what is the most likely dx?
diskitis
vertebral OM
neoplasms
pt over 10 with back pain. what is the most likely dx?
secondary to trauma or overuse
yes/no: do the cuneiforms have ossification centres at birth?
no- the cuneiforms and navicular do not have ossification centres at birth?
at what age do the 3 acetabulum epiphyseal centres fuse?
17-18 yo
majority of acetabular shape and depth is determined by what age?
8
what does a staheli arch index of over 1.15 in a child aged 6-10 mean?
anything over 1.15 in kids aged 6-10 is abnormal
in mid childhood what position should the tibia be in?
10 external
at age 1 what position should the tibia be in?
5 ext
at birth what position should the tibia be in?
neutral/patallel or slightly internal
what should the position of the tibia be for older children ?
14-20 ext
how do you measure tibial torsion?
thigh foot angle
your pt is 12 months old and has a banana shaped foot. what is your dx and list possible sub types
postural metatarsus adductus
simple metatarsus adductus
complex metatarsus adductus
skew foot: iatrogenic or acquired
you have a pt with metatarsus adductus. what objective assessments would you do?
classify the type, severity and flexibility
put the little foot in your peace finger
stroke the medial and lateral borders to see if it spontaneously corrects
check rearfoot alignment
check frontal and transverse plane alignment of forefoot
x ray isn’t appropriate in mild cases but can be used to find the metatarsus adductus angle (between the midfoot and 2nd met bisection)
ddx of metatarsus adductus
calcaneovalgus clubfoot (talipes equinovarus TEV) forefoot adductus skewfoot supination of STJ internal tibial torsion femoral anteversion (tumour, RA)
why shouldnt you put the wrong she on a kid with metatarsus adductus?
because it causes too much forefoot abduction and promotes a pronated foot type
what is the treatment for metatarsus adductus?
mild flexible: manipulations at every nappy change
mlld-moderate flexible: splinting
mod-severe: serial casting
rigid serial casting ( rays recommended and then maybe surgery)
