Pediatric Hip/LE Orthosis Flashcards
Positioned in flexion & abduction in utero leads to tight hip ______ & anteriolateral orientation of acetabulum.
What may cause hip dislocation and what happens to the labrum?
flexors
kicking may cause posterior dislocation and labrum can be everted and flattened
Barlow maneuver
- What is a positive test?
- bad - dislocating hip
- from horizontal abducted position, bring leg to horizontal adduct and try to dislocate hip posterior (bad – dislocating hip)
- Positive test: ”clunk” palpated as femoral head slides posteriorly over posterior acetabular rim (“sign of exit”)
Ortolani maneuver
- What is a positive test?
- good - relocating hip
Hips placed in 90 deg flexion (neutral rotation), f/b gentle abduction of the hip while lifting leg anteriorly - Positive test: ”clunk” palpated as femoral head slides anteriorly over posterior acetabular rim (“sign of entry”)
What is the best way to determine a hip dislocation in a 3-13 month baby? What is a positive finding?
hip abduction ROM
- in supine w/ 90 deg hip flexion - hip abducted and abducted
- finding - <75 deg abduction and 30 deg adduction past midline
What is the best way to determine hip dislocation in older children?
observation of limping, Trendelenburg gait, in-toeing, out-toeing
What is a Slipped Capital Femoral Epiphysis (SCFE) and what are complications?
- Sudden or gradual anterior displacement of femoral neck from capital femoral epiphysis
Complications
- AVN
- chondrolysis
What is the most common disorder of the hip among adolescents? What is the average age for male and female?
Slipped Capital Femoral Epiphysis (SCFE)
Average age
- male - 14.4 years
- female - 12.1 years
Symptoms and Physical Exam of SCFE
Symptoms
- knee/lower thigh pain as inital symptom
- medial thigh pain
- pain is dull/aching
Physical Exam
- limping, often ER of involved LE seen at foot
- mild weakness of leg
- Diminished ROM (most limited IR, ABD, flexion)
- unstable - inability to bear weight or consistent with fracture presentations
What do patients who have a SCFE have medial thigh pain?
obturator nerve involvement
What is Legg-Calve-Perthes Disease and its history?
- Blood supply to femoral head is interrupted and femoral head necrosis begins (unknown cause)
History
- insidious onset
- gradual progression over several years
Symptoms and Physical exam of Legg-Calve-Perthes Disease
Symptoms
- vague ache in groin, medial thigh, and medial knee (obturator nerve distribution)
Physical Exam
- gait abnormality
- small child
- thigh muscle atrophy
- ROM limitations (most limited w/ IR and ABD)
- hip flexion/hip ADD contracture
What are lifts and wedges used for? What biomechanical changes occur with a wedge?
lifts - leg length discrepancy > 3/8 in
wedge - small leg length discrepancy
- places pt in PF which causes knee extension
What are rocker bottom shoes used for?
decrease met head pressure
What type of orthotic insert is better for more subluxed, rigid, and deformed feet?
accommodative - provide protection or relief
- better for impaired sensation
What type of orthotic insert is better for more normal foot but has extra motion?
functional - control and support the subtalar joint, rearfoot, and/or forefoot
- influences the biomechanics of the foot
What is the most common structural foot deformity? What is common with this deformity?
rearfoot varus - inversion of calcaneus
- high arches are common
In rearfoot varus, what motion is limited and why?
limited pronation due to lack of calcaneal eversion
What does gait of rearfoot varus look like?
increased lateral heel contact, rapid and excessive pronation
What is rearfoot valgus? What motions are limited?
rearfoot valgus - eversion of calcaneus in neutral
- limited supination and excessive pronation
What are orthotic options for rearfoot varus? Why?
medial wedge - to help control amount of pronation
forefoot valgus gait
excessive supination during loading response and stance
forefoot valgus orthotic options? Why?
lateral forefoot wedge
- limit supination and promote pronation
Which forefoot structural abnormality is more likey to have MSK injuries such as chronic ankle sprains? Why?
forefoot valgus
- more rigid foot that stays in supination so they have trouble distributing forces in foot
forefoot varus gait
excessive pronation during stance, lack of re-supination at terminal stance and pre-swing
What is the difference between forefoot varus and rearfoot varus?
forefoot varus patients never re-supinate
What muscle is typically weak with forefoot varus patients?
posterior tib due to hypermobile subtalar and lack of supination (PF, ADD, INV)
- post tib - plantarflexor
forefoot varus orthotic option
Post medial to control pronation bc foot never resupinates prior to push off and patients tend to have flexible foot type
What is the goal of prophylactic (PKO) knee brace?
mitigate or prevent soft tissue or ligamentous injury to the healthy knee
What is the goal of functional (FKO) knee brace?
- provide mechanical stabilization that is usually provided by anatomical structures
- protect the joint following surgical repair and return to sport
