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how brachial plexus injury happens
trauma to shoulder or spine during vag delivery
traction on shoulder
traction/ rotation of head during delivery of shoulder
complicating factors fr brachial plexus injury
maternal diabetes high birth weight prolonged labour sedated hypotonic infant heavily sedated mum
difficult c section
brachial plexus segments
c5-t1
most common impairment from brachial plexus injury
erbs palsy
erbs palsy segments / impact
c5-6
Grasp is INTACT
sensory loss
position of erbs palsy
waiters tibe shoulder - ext, IR, add elbow - ext forearm - pro wrist/fingers - flexed
T/F erbs palsy is lower plexus injury
F - UPPER PLEXUS
whats klumpkes palsy
lower plexus injury
c7-t1
whats erb klumpke injury
whole arm
c5-t1
what do you see in ppl with brachial plexus injury
paralysis / weakness
mm imbalance
learned non use
what kind of mm imbalance would you see in brachial plexus injury
abnormal substitution movements weird arm postures contractures subxlactions / dislocation deformity
PT management in brachial plexus injury
functional training ROM Splinting education sensory awareness
T/F brachial plexus injury can be surgical
t
T/F impairment in AROM and PROM of UE supination and shoulder IR are common for kids with brachial plexus injury
F - External rotation
is balance rehab relevant to brachial plexus injuries
yes
development dysplasia of the hip
DDH
hip disorders that are unstable, sublax or dislocate
T/F normal development of femoral head and acetabulum are co dependent
T
risk factors for DDH
breech position position incorrect LE swaddling positive family history first born foot abnormalities
most important risk factors in screening for DDH
breech position
positive family history
is DDH very apparent in infancy / early childhood
no its silent but early detection is critical
can mild forms of DDH resolve without treatment
yes
when is there a poor prognosis for DDh
unstable and morphologically abnormal by 2-3 yrs old
how to screen for DDH
ultrasound leg length discrepancy asymmetric gluteal folds limited hip abd gentle Barlow / Ortolani test safe swaddling abnormal gait
Ortolani
dislocated femoral head is reduced with ABD
the most important clinical test for detecting newborn dysplasia
ortolani
barlow
you dislocate it with ADD
tests laxity / instability
is ortolani or Barlow test better
orto
management of DDH
observe
abduction brace
surgical
long term implications of DDH
degenerative arthritis leg length discrepancy limited hip abd pain early hip replacement avascular necrosis
osteogenesis imperfecta
congenital disorder of collagen synthesis - all connective tissue
T/f osteogenesis imperfecta presents widely differently
T - as osteoporosis , excessive fractures, spinal deformities , mm weakness, lig laxity
medical management of osteogenesis imperfecta
bisphosphonates orthopaedic solutions (splint, case, rod)
T/F vitamin C / D are effecting in preventing fractures
false
bisphosphonates
reduced fracture rate
improve bone density
improve functional status
physiotherapy management in osteogenesis imperfecta
function and participation
idiopathic toe walking (ITW)
atypical in kids after 3
what is ITW associated with
positive family history
language/ learning delays
out of phase firing of gastroc, soleus , tib ant
ITW symptoms
toe walking
pain in legs
frequen tripping
ankle injuries
ITW mangement
cast, PT, botox, surgery
whats PT do with ITW
stretch, strengthen, manual therapy, balance , gait training
does ITW impact activities
not really
Legg calve perthes disease
AVN of femoral head
when does legg calve perthes happen
3-13
but most common is boys 5-7
stages of legg calve perthes
condensation
fragementation
reossificaiton
remodelling
clinical presentation of legg calve perthes
limp pain trendelenburg decrease ROM mm spasm
how is range impacted in Legg calve perthes
ABD, IR, hip flexion limited
managing legg calve perthes
relieve pain
contain the femoral head while bone remodels
restore ROM, strength, balance, gait
partial WB crutches
casting
surgerical
T/f you could be in a cast for over 1 year with legg perthes
true up to 2 years
what causes slipped capital femoral epiphysis SCFE
excessive force on growth plate
fat
trauma
puberty
clinical prevention SCFE
pain in groin / knee
leg ER
limited hip F, ABD, IR
can’t WB
Management of SCFE
surgery
bed rest
casting
pT
Osgood Schlatter
apophysitis of tibial tubercle
boys 10-15
girls 8-13
osgood schlatter presentation
anterior pain at tibial tubercle
bump on tibial tubercle
worse with activity
how to assess osgoods
palpation
radiograph
OSD management
ice rest, stretch ham and quads
Strengthen
can they return to sport with OSD
yes, you might have mild discomfort during growth but crack on
whats OCD
osteochondritis dissecans
whens OCD
13-17
what causes OCD
trauma
uneven / excessive pressure
disruption of blood to bone
genetics
clinical presentation of OCD
pain with activity pain with rotational swelling instability locking
acromegaly
pituitary gland produces too much growth hormone
increase in bone size
too much growth hormone
gigantism
signs and symptoms acromegaly
enlarged hands and feet
changes in face shape (protrude low jaw and brow, enlarged nose, thickening lips, gap in teeth)
complications of acromegaly
hypertension OA diabetes sleep apnea carpal tunnel vison loss
T/F dwarfism is mostly genetic
yes
most common type of dwarfism
achondroplasia
t/F dwarfism mostly happens in families where both families are average height
t
difference disproportionate and proportionate dwarfism
some parts are small vs all parts are small
proportionate dwarfism when do you have it
present at birth
early childhood
management dwarfism
early diagnosing / treatment helps
shunt to relieve brain pressure
correct surgeries
physio ROM, strength
