Pathologies Flashcards
Accessory Navicular
Extra navicular
Incorporated into tibialis posterior tendon
Possible pain and tenderness in area
Associated with pes planus, putting strain on tib post tendon, leading to inflammation
Also possible irritation from side of shoes
Amyotrophic Lateral Sclerosis (ALS)
Amyotrophic Lateral Sclerosis AKA Lou Gehrig’s Disease
One of most common neuromuscular diseases, etiology unknown, not known to be autoimmune
Degeneration of upper and lower motor neurons
Unable to send messages to muscles which they control, which leads to atrophy
Nerves themselves degenerate, not myelin related (unlike MS)
LOSS of ability to control VOLUNTARY movement
Muscle Atrophy, Rapidly progressive weakness
Spasticity
Dysarthria (difficulty speaking)
Dysphagia (difficulty swallowing)
Dyspnea (difficulty breathing)
Cognitive function generally spared
Does not affect sensation
Steady decline, worsening symptoms
Fatal
Arthrogryposis
Congenital joint contractures
Rare 1 / 11 000 live births
Genetic/Environmental- intrauterine, decreased movement in womb
Abnormal fibrosis of the muscle tissue, causing shortening
Unable to perform passive extension/flexion in affected joints
Autonomic Dysreflexia
Sudden onset of excessively high blood pressure
Not treated promptly, may lead to seizures, strokes and death
Often occurs in spinal cord injured individuals with lesions above T6
Headache
Flushed face
Sweating
Slow heart rate
Reaction of autonomic (involuntary) nervous system to overstimulation (triggered by afferent stimuli), BP increases, HR slows and beomes irregular, BP cannot be restored to normal because of spinal cord damage
Causes Overfull bladder/bowel UTI Pressure sores Broken bones Tight clothing/DEVICES
Avascular Necrosis
Cellular death (necrosis) of BONE components due to interruption of blood supply
Without blood, bone tissue dies/collapses
If involves bones of a joint, often leads to destruction of joint articular surfaces
Blounts Disease
Growth disorder of the tibia
Causes lower leg to angle inward
AKA tibial bowing / vara
Can be rapidly progressive
Thought to be due to effects of weight on the growth plate
Inner part of the tibia just below the knee fails to develop normally, causing angulation of the bone
KAFO, or eventually surgery
Bunions/Bunionette
Hallux abducto valgus deformity
Lateral deviation of the great toe
Controversial etiology
Poorly fitting shoes, Genetic factors
Pressure applied to the side of the big toe, forces it inward toward and sometimes under or over the other toes
Bump is from swollen bursal sac or osseus anomaly, also part of the first met head tilted out
Tissue surrounding joint become swollen and tender
First met sesamoid bone may also become deviated
Orthotic splints
Toe spacers/separators
Orthotics (accommodative padding/shielding)
Surgery
Carpal Tunnel Syndrome (CTS)
Median entrapment neuropathy
Causes Paresthesia (tingling), Pain, Numbness
Palmar aspect of Thumb, index, middle, radial half of ring finger
Wrist pain
Sometimes through the night (seems to be aggravated when sleeping with flexed wrist)
Caused by crowding/irritation/compression of the median nerve within the carpal tunnel, thickening from irritated tendons or generalized swelling and irritation in the area can cause CTS
Carpal tunnel made up of carpal bones, 9 flexors tendons, connective tissue
Charcot Joint
AKA neuropathic arthropathy (joint disease)
Progressive degeneration of weight bearing joint
Bony destruction
Bony resorption
Joint Deformity
Decreased peripheral sensation, proprioception, fine motor control
Pathological process can result in
Ulceration
Superinfection
Loss of function
Amputation
Death
Underlying Mechanisms (2 theories)
Neurotrauma
- loss of peripheral sensation
- leads to progressive microtrauma to the joint
- damage goes unnoticed by patient
- resultant inflammatory resorption of traumatized bone renders region weak and susceptible to further trauma
- poor fine motor control generates unnatural pressure on certain joints
- leading to additional microtrauma
Neurovascular
- neuropathic patients have dysregulated autonomic nervous system
- desensitized joints receive significantly greater blood flow
- hyperemia leads to osteoclastic
Treatment
immobilization total contact cast
Pneumatic AFO
Surgical correction
Takes 6-9 months for edema/erythema to recede
Charcot Marie Tooth (CMT)
Hereditary Motor and Sensory Neuropathy, Demyelinating neuropathy
One of most common inherited neurological disorders affecting approx 1 / 2500
Characterized by
Progressive loss of muscle tissue
Touch sensation
Symptoms usually begin late childhood, early adulthood
Initial symptom is foot drop Claw toe/Pes Cavus Atrophy muscle tissue in legs Weakness in hands and forearms Loss of touch sensation Neuropathic pain
Possible respiratory/GI problems
Must avoid prolonged periods of immobility as it can accelerate symptoms of CMT
Mutations cause defects in neuronal proteins
Cause Demyelinating neuropathy
SCHWANN CELLS demyelinated, Myelin sheath may be damaged, may lead to axonal degeneration
Schwann/Myelin/Axon damage leads to poor nerve conduction
Chondromalacia Patella (CMP)
Inflammation of underside of the patella and cartilage softening
AKA patellofemoral pain syndrome
Condition may result from acute injury to the patella or chronic friction between the patella and groove in the femur through which it passes during knee flexion
Overuse, injury, neuromas, malignment, patellar maltracking etc.
can cause deterioration and break down of the cartilage
Cartilage no longer smooth, making movement painful
Club foot - Talipes Equinovarus
Congenital deformity involving one foot or both
Inversion of subtalar joint, complete hindfoot inversion
Adduction of forefoot at talonavicular joint and calcaneo cubiod joinit
Equinus and varus ankle
Supination of entire fotot
Plantarflexed
May appear to be walking on ankles, lateral sides of their feet
No single known cause, usually single isolated birth defect, associated with other birth defects such as spina bifida
Serial casting has shown to be effective
Followed by AFO orthosis to hold feet in plantargrade position
Denis Browne Bar, AFO, FO
Surgery usually not necessary however 2 are performed
Tenotomy- release of achilles tendon
Anterior tibial tendon transfer- tendon moved from first ray to the first ray to the third ray in order to release inward traction of foot
Compartment Syndrome
An acute (trauma) or chronic (repetitive activity) condition affecting an upper or lower extremity
Characterized by increased pressure within a muscle compartment causing severe pain
Swelling within compartment contained by fascia causes increased intracompartmental pressure
Compression of muscles, nerves and blood vessels within a closed space can lead to muscle, nerve and circulatory system damage
If left untreated, extensive tissue death can occur, amputation may be necessary
Can lead to volksmans contracture
Congenital Diaphragmatic Hernia (CDH)
Congenital malformation of the diaphragm
Most common type is Bochdalek hernia (95% of cases) - hole is posterolateral corner of diaphragm, allows passage of abdominal viscera into chest cavity
Malformation of diaphragm allows abdominal organs to push into the proper lung formation
Life threatening pathology in infants
Causes death due to 2 complications
Pulmonary hypolasia- incomplete development of the lungs
Pulmonary hypertension - excessively high blood pressure in pulmonary artery/vein
Associated with scoliosis
Depuytren’s Contracture
Fixed flexion contracture of the hand due to palmar fibromatosis (palmar fascia abnormally thick)
Inherited proliferative connective tissue disorder
Palmar fascia thickens and shortens so that tendons connected to fingers cannot move freely
Fingers bent toward the palm, cannot be fully extended
Decreased ability to grip objects
Usually painless
Ring and little finger most commonly affected, middle finger in more advanced cases, index and thumb usually spared
Contractures progress slowly
Table top test for diagnosis, hand on table, see if fingers touch the table
Dequervain’s Tenosynovitis
Pain inflammation of 2 tendons in the thumb (extensor pollicus brevis, abductor pollicus Longus)
Pain, swelling, tenderness over thumb side of the wrist and base of the thumb
Motion may be difficult and painful especially when pinching/grasping objects
Difficulty gripping
From Overuse, Repetitive Hand or wrist movement, or possibly trauma
Finkelstein Test
Make fist with thumb placed in palm
Wrist ulnarly deviated
Down’s Syndrome
Genetic disorder caused by presence of all or part of a third copy of chromosome 21
Most common chromosome abnormality in humans
Physical growth delays
Muscle hypotonia
Excessive joint laxity, atlanto-axial instability
Excessive space between large toe and second toe
Lateral Epicondylitis
AKA Tennis elbow
Painful condition of elbow caused by OVERUSE (racquet sports or other activity) or trauma
NON inflammatory, Degeneration of tendon’s attachment, weakening of anchor site, placing greater stress on area
Point of soreness/tenderness over lateral epicondyle
Pain from gripping movements of the wrist, especially wrist extension
Extensor muscles/tendons on lateral epicondyle of humerus damaged from overuse
Tendon usually involved is Extensor Carpi Radialis Brevis (ECRB)
Medial Epicondylitis
AKA golfer’s elbow, pitcher’s elbow
Overuse injury (or trauma) affecting flexor-pronator muscles originating on medial epicondyle
Repetitive flexing, gripping, swing, can cause microtears in tendons
Pain and inflammation of tendons
Femoral Anteversion/Retroversion
Anteversion - Inward twisting of the femur
Retroversion- Outward twisting of the femur
Often occurs symmetrically
In toeing gait, look to see if patella turned inward
Bow-legged appearance
Caused by position in uterus, genetic?
Normal child born with 40 degrees femoral anteversion
Gradually decreases to 10 to 15 degrees at adolescense
Guilian-Barre
Rare neurological disorder where body’s immune system attacks its own peripheral nerves
Often follows viral/bacterial infection
3 / 100 000, mostly age 30-50
Results in inflammation of the myelin and blockage of nerve conduction
Motor, sensory, autonomic nerve failure
Acute symptoms can take place over few hours or days
Muscle weakness/paralysis Difficultly breathing/swallowing Inability to move eyes Shortness of breath Sensation may be affected
Severity of nerve damage range greatly, most experience ascending symmetrical muscle weakness in lower and upper extremity
Following acute onset of condition, most patients gradually improve and recover, but some are left with life long disability
Orthoses to aid in weakness (most commonly drop foot), prevent contracture
Haglunds Deformity
Bony Enlargement at the back of the heel
Also swelling and redness at back of heel
Most often leads to painful bursitis (inflammation of fluid filled sac between tendon and bone)
Soft tissue near the Achilles tendon insertion becomes irritated when bony enlargement rubs against shoes
“pump bump”
Hammer toes
Deformity of PIP joint of the 2nd, 3rd or 4th toe, causing it to be permanently bent, resembling a hammer
Most frequently results from wearing poorly fitting shoes
Having toes flex for long periods can cause muscles to shorten
Doctor can prescribe orthosis to push down on toes to force them to stretch out muscles
Physical therapy, shoes with soft spacious toe boxes, surgery
Related to claw toes
which is dorsiflexion of MTP joint and flexion of PIP and DIP
Kohlers Disease
Rare pediatric bone disorder of the foot
Found in children between 6-9. typically boys
Avascular necrosis of the navicular
Navicular bone temporarily loses blood supply, Tissue in bone dies and bone collapses
Pain, tenderness and swelling in in-step
Treatment usually involves resting affecting foot, pain relievers, avoid putting pressure on foot
Sometimes cast that stops below the knee is worn for 6-8 weeks
When cast is taken off, patient prescribed arch support for 6 months
Once navicular returns to normal, symptoms abate
When treated, causes no long term problems in most cases
Rarely, can return in adults
Legg Calve Perthes Disease
Childhood hip disorder
Initiated by a interruption of blood flow to the femoral head
Due to lack of blood flow, bone dies (avascular necrosis)
Healing occurs when new blood vessels revascularize dead bone, removing dead bone, however leads to loss of bone mass and weakening of head
Can lead to deformity of the femoral head
Secondary changes to the shape of the hip socket
Treatment - Traction
Muscle/ligaments around hip usually very tight
Cannot properly position head in acetabulum
Traction gradually stretches muscles allow femur to position itself well in socket
Secondly, child is casted or braced to hold position in place
Goals
Hold head of thigh bone in hip socket, so that head can remold itself in round shape
Permit limited joint ROM
Scottish Rite Orthosis
Toronto Legg Perthes Orthosis (tries to get internal rotation)
Trilateral socket hip abduction orthosis (ischial weight bearing)
Best success if child < = 6 yr old
Median Nerve Palsy
Median nerve damaged
Caused by deep, penetrating injuries to the arm, forearm, or wrist
May also be due to blunt force trauma or neuropathy
Lack of ability to abduct and oppose thumb due to paralysis of the thenar muscles, “ape hand deformity”
Sensory loss in the thumb, index finger, long finger, and radial aspect of ring finger
Weakness in forearm pronation, wrist and finger flexion
ADLs difficult (brushing teeth, tying shoes, turning door knobs etc.)
Dynamic splint which pulls thumb into opposition can help prevent further deformity
Resting WHO maintains C-space
Thumb spica for function
Tendon transfers shown to be effective in restoring function
Mortons Neuroma
AKA Morton’s metatarsalgia
Benign neuroma of an intermetatarsal plantar nerve
Most commonly between
2nd - 3rd
3rd - 4th
Characterized by pain and/or numbness when weight bearing
Burning, paresthesiae (tingling)
Direct pressure between the metatarsal heads will replicate the symptoms
As will compression of the forefoot between the finger and thumb, as to compress the transverse arch of the foot (Mulder’s sign)
Foot orthotics prescribed, arch support and metatarsal pad positioned under the space between the two affected metatarsals
Pad helps splay metatarsal bones, create more space for nerve so as to relieve pressure and irritation
Sometimes corticosteroids prescribed to relieve inflammation and to help end symptoms
MRSA
Methicillin-Resistant Staphylococcus Aureus
Bacterium responsible for several difficult to treat infections in humans
Through process of natural selection, has become resistant to antibiotics
Weakened immune systems are at greater risk of infection than general public
Typically colonizes respiratory tract, open wounds, urinary tract, catheters
Can cause small red bumps accompanied by fever, rash can become deep, pus-filled boils
Can also infect vital organs and lead to widespread infection (sepsis), necrotizing pneumonia
Osteogenesis Imperfecta
Congenital bone disorder
Genetic, 1 / 20 000 live births
Characterized by brittle bones that are prone to fracture, loose joints, poor muscle tone
Defective connective tissue, or absent ability to make it, usually Type I Collagen deficiency
8 Types
No cure
Treatment aimed at increasing overall bone strength to prevent fracture and maintain mobility
Patella Femoral Syndrome
Pain caused by patella being pushed against side of femoral groove
Cause of pain often results from
Abnormal forces, increased pull of vastus lateralis relative to vastus medialis, with acute or chronic lateral patello femoral subluxation/dislocation)
OR
Prolonged repetitive compressive or shearing forces (running or jumping) on PF joint
Thinning and softening of articular cartilage under patella (chondromalacia) or medial or lateral femoral condyles
Synovial irration/inflammation
Subchondral bony changes in distal femur or patella
Typically seen in active populations (runners, bikers, basketball players etc.) presenting as localized anterior knee pain
Treatment, strengthen vastus medialis to balance out lateralis force
Rest
Orthosis
KO may allow patella to track better, reduce lateral drift of patella
FO arch support may reduce over pronation which reduces knee balgus
Peripheral Vascular Disease
Obstruction of large arteries
Causes acute or chronic ischemia
Can result from atherosclerosis, inflammatory processes leading to stenosis/embolism/thrombus formation
Claudication- pain, weakness, numbness, cramping of muscles
Impaired healing
Sores, wounds, or ulcers heal slowly or not at all
Diminished hair growth and nail growth on affected limb and digits
Causes- smoking, diabetes, high cholesterol, hypertension
Plantar Fascitis
Painful inflammatory process of the plantar fascia, connective tissue, or ligament on the plantar surface of the foot
Pain usually felt on underside of heel
Often most intense with first steps of the day
Overuse of plantar fascia
10% will experience it in their lifetime
Associated with long periods of weight bearing, hyper-pronated, flat feet
Also associated with heel spurs, small bony calcification on the calcaneus (plantar fasciitis causes spur no vice versa)
Trauma
Lack of fat pad
Abnormal biomechanics (over-pronation)
Psoriatic Arthritis
Type of inflammatory arthritis that appears in people with skin disease psoriasis
10-30 % of individuals with psoriasis will get it
Cause unknown
Pain, swelling, warmth in joints
Swelling in fingers and toes
Pain in and around feet and ankles
Achilles tendinopathy/ Plantar Fasciitis
Extreme exhaustion that does not go away with adequate rest
Arthritis may be mild, or may progress to more destructive joint disease
No cure
Radial Nerve Palsy
AKA wrist drop
Person cannot extend wrist, hangs flaccidly
Penetrating wound (at or below clavicle, damage to posterior cord which terminates as the radial nerve)
Humerus fracture
Lead poisoning
Repetitive injury, applying pressure along route of the radial nerve
Depending on level of lesion (diagnosis with nerve conduction test)
Inability to abduct shoulder beyond 15 degrees Inability to extend forearm Reduced ability to supinate hand Reduced ability to abduct thumb Sensory loss
Dynamic splint
Reflex Sympathetic Dystrophy
AKA Complex regional pain syndrome (CRPS)
Intense burning pain, stiffness, swelling, discoloration that most often affects the hands
Arms legs pain can also be affected
2 Types
1 - occurs after an illness or injury that did not directly damage nerve in the affected area
2- follows a distinct nerve injury
Cause unknown, commonly occur after injury or surgery, pressure on nerve, infection, cancer, stroke etc.
Orthosis for protection?
Sever’s Disease
AKA calcaneal apophysitis
Inflammation of growth plate at the back of the heel heel (wear Achilles attaches) of growing children, typically adolescents, during growth spurt
Pain in the heel
Caused by repetitive stress on achilles tendon, damages growth plate to heel
Thus particularly common with physically active children
Shin Splints
AKA medial tibial stress syndrome
pain in lower part of leg between knee and ankle
caused by repeated trauma to connective muscle tissue surrounding tibia
Usually attributed to overloading of muscles of the lower extremities or to biomechanical irregularities
Muscle imbalance, inflexibility
Increasing activity/intesity/duration too quickly can lead shin splints
Tendons and muscles unable to absorb impact of shock forces as they fatigue
Disruption of Sharpey’s fibers connecting medial soleus fascia to periosteum of tibia, impact force eccentrically fatigues soleus, create tibial bending or bowing
Excessive pronation at subtalar joint is associated factor, causes tibial twisting and overstretching of lower extremity muscles
Spondylosis
Degenerative osteoarthritis between center of spinal vertebrae and or neural foramina
As space between 2 adjacent vertebrae narrows, compression of nerve roots emerging from spinal cord can cause subsequent sensory/motor disturbances (radiculopathy)
Pain
Paresthesiae
Muscle weakness
Direct pressure on spinal cord can cause myelopathy
Global weakness
Gait dysfunction
Loss of balance
Loss of bladder/bowel control
Labelled by area of back involved (cervical, thoracic, lumbar)
Spondylolysis
Defect of pars interarticularis of the vertebral arch
Fracture in thin piece of bone that connects upper and lower segments of the facet joints
Great majority of cases occur in lowest of lumbar vertebrae (L5), but can occur in other lumbar and thoracic vertebrae
May be asymptomatic for a long time
Symptoms often appear during teenage growth spurt, often those participating in sports involving hyperextension of back (gymnastics, weightlifting, football etc.)
Pain spreads across lower back
Generally worse with vigorous exercise or activity
Back orthosis for support (intraabdominal pressure) and prevention of flexion/anterior translation
Spondylolysthesis
Spondylolysis with anterior translation of the superior vertebrae over the inferior one
Tar Syndrome
Rare genetic disorder
Characterized by absence of radius bone in forearm
Dramatically reduced platelet count, can lead to bruising and potentially life-threatening hemorrhage
Tibial Torsion
Inward twisting of tibia
Most common cause of intoeing
Medial torsion improves with time
Lateral torsion worsens
Can occur due to position of the baby in the uterus
Denis-Browne Bar worn at night
Torticolis
Abnormal, asymmetrical, fixed or dynamic tilt, rotation or flexion of the head and/or neck
Variety of causes
Congenital- etiology uncertain, birth positioning
Damage to sternocleidomastoid muscle
Shortening, excessive contraction
Sometimes sternocleidomastoid tumor, may disappear but leaves musce fibrotic
Acquired Muscular- pain to neck muscles (sternocleidomastoid, trapezius) Tumors in base of the skull Infections (ear, posterior pharynx) Certain Drugs
TOT collar- irritant, encourages child to laterally flex and rotate to the opposite side
Soft PVC tubing with tubes positioned anterior and posterior to crest of the trapezius
Triple Arthrodesis
Surgical procedure whose purpose is to
Relieve pain in the rear part of the foot
Improve stability of the foot
Correct deformity of the foot
Commonly carried out on patients with joint degeneration resulting from arthritis or severe flat foot deformity
Creation of a stable, balanced, plantargrade foot for ambulation
Fuses 3 main joints of the hindfoot:
Subtalar joint
Calcaneocuboid joint
Talonavicular joint
Ulnar Nerve Palsy
Decreased sensation to little finger part of ring finger
Pain
Tingling, Numbness
Weakness
Cause
Illness that damages nerve
Direct trauma
Long term pressure on the nerve, could be caused by swelling or injury of nearby body structure
Froments Sign
Specifically test adductor pollicis (innervated by ulnar)
Patient holds flat object like piece of paper between thumb and index finger
Examiner attempts to pull object out of the subject’s hand
Wind Swept Deformity
Describes abnormal valgus deformity in one knee in association with varus deformity in the other
May also occur at the hip
Abduction and external rotation of one hip with opposite hip in adduction and internal rotation, may occur in association with hip dislocation and scoliosis
Ehlers Danlos syndrome
Inherited connective tissue disorder
Defect in collagen leading to hypermobility
Abnormal collagen renders skin, joints, muscles, ligaments, blood vessels more elastic
Severity of mild to life threatening
Joints may subluxate/dislocate easily, braces can help control ROM to prevent unnatural joint positions
Bracing also helps to support injuries/pain related to the condition
Pectus Carniatum
AKA pigeon chest
Deformity of the chest characterized by a protrusion of the sternum and ribs (oppose is pectus excavatum)
Overgrowth of cartilage cause sternum to protrude forwards
Usually occurs
- post open heart surgery, way that it heals
- congenital
- during male puberty growth spurt
Relatively common, Occurs 1/400
Heart and lung function may be affected
Associated with scoliosis
May be a cosmetic issue, self image
Customized orthosis
Direct pressure applied over protruding area can produce excellent outcomes
Front and back compression plates anchored to aluminum bars bound by tightening mechanism
Can be worn under clothes
Peripheral Neuropathy
Damage or disease of nerves of the Peripheral nervous system
Causes Diabetes Alcoholism Immune system disease Infection Trauma
Motor/sensory loss
Plagiocephaly
Misshapen infant head
Develops in response to prenatal and postnatal force acting on infants head
Plagio- parallelogram shape
Scapho- long A-P
Brachy - wide M-L
Cause Multiple births First born Premature birth Vacuum/Forceps delivery Torticolis Sleep position preference
Flattened side corresponds with anterior positioning of ipsilateral ear and forehead
Appropriate time to treat with helmet is 4-6 months
Orthotist creates space between helmet and skull over short dimension
Infant’s head grows in path of least resistance
Neurofibromytosis
Genetic disorder that disturbs cell growth in your nervous system
Causes tumor to form in nerve tissue, usually benign (non cancerous)
Possible symptoms
Bowed legs
Bone abnormalities (scoliosis)
Hypotonia
Motor Incoordination
Parkinson’s disease (PD)
Degenerative disorder of the CNS
Result from death of dopamine generating cells in substantia nigra, region of midbrain
Lack of formation and activity of dopamine
Leads to Parkinsonism
Tremor Rigidity- stiffness from increased muscle tone Hypokinesia- decreased bodily movement Bradykinesia -slowness of movement Postural Instability Difficulty walking
Cause is unknown
Huntington’s Disease
Neurodegenerative genetic disorder
Affects muscle coordination and leads to cognitive decline and psychiatric problems
Chorea
Abnormal involuntary writhing movements
Erb’s Palsy
Paralysis of arm caused by injury to upper group of brachial plexus, specifically upper trunk (C5-C6)
Most commonly occurs in infants due to difficult delivery (1-2/1000 live births)
- forceps delvery
- prolonged birth
- breach birth
4 types
- Neuropraxia- stretches but does not tear nerves, usually heals on its own
- Neuroma - damages some nerve fibers, causes scar tissue that may impinge remaining tissue
- Rupture - nerve torn, will not heal on its own
- Avulsion - nerve torn from spinal cord, impossible to repair
Signs and Symptoms
- paralysis of structures innervated by C5-C6 nerve roots, most commonly suprascapular, musculocutaneous, and axillary nerves
- paralysis of subscapularis, deltoid, biceps, brachialis
- loss of sensation of the arm
- arm hangs, shoulder medially rotates, elbow extended, forearm pronated
Surgical treatment
Gunslinger brace
Congenital Hip Dysplasia AKA Developmental Hip Dysplasia
Refers to continuum of abnormalities of the immature hip
Diagnosed after birth
Subluxation, Dislocation, Acetabular dyplasia (shallow acetabulum), Unstable hip (excessive laxity, prone to subluxation)
If left untreated can lead to painful debilitating degenerative arthritis
Exact cause not known, possible genetic predisposition
Ortholani Test- put back in, medially against greater trochanter audible clunk
Barlow’s Test- try to push out laterally and posteriorly against lesser trochnater
Hip flexion of 90 degrees and abduction of 45 is best to seat femoral head well into acetabulum
Pavlik Harness
Freika Pillow
Possible use of Scottish Rite Orthosis, for older ambulators
Treatment time 3,4 months
Volksmann’s ischemic contracture
Lack of blood flow to forearm
Usually due to increased pressure from compartment syndrome
Trauma to the arm can also be a cause
Decreased blood flow causes muscle damage, leaves them scarred and shortened
Decreased sensation//weakness
MIld- contracture of 2 or 3 fingers
Moderate - all fingers flexed, thumb stuck in palm, loss of some feeling in hand
Severe- muscles in forearm that both flex and extend the wrist are involved
