Pediatric MSK conditions Flashcards
Brachial plexus injury is usually due to traction on ______ during breech delivery of forceful traction and rotation of _____ during difficult delivery
shoulder; head
What is the most common brachial plexus injury?
Erb’s palsy
What nerve roots are involved in Erb’s palsy?
C5-C6
What position is the arm in Erbs palsy?
Waiter's tip - Shoulder - extension, internal rotation, adduction Elbow - extension Forearm - pronated Wrist and fingers - flexed
Grasp is (lost/intact) in Erb’s palsy
intact
Is there sensory loss in Erb’s palsy?
YES
Klumpke’s palsy = injury to the ____ _____
lower plexus (C7-T1)
What are 3 major impairments in Erb’s palsy?
- paralysis or weakness
- muscle imbalances
- learned non-use - delay in motor milestones
____ encompasses a spectrum of pathologic hip disorders in which hips are unstable, sublimated or dislocated, and/or have malformed actabla
DDH
Normal development of the femoral head and acetabulum are _________
co-dependent
The head must be stable in the hip socket for both to form _______ and _______
spherically; concentrically
What are 2 large risk factors for developing DDH?
- breech position
2. + family history
DDH is clinically ______ in infancy/early childhood
silent
There is poor prognosis of DDH if unstable and morphologically abnormal by __-__ years of age
2-3
What are 4 tests to do in the screening exam for DDH?
- LLD
- asymmetric thigh or gluteal folds
- limited or asymmetrical hip abduction
- Barlow/Ortolani
In the Ortolani maneuver, a subluxed or dislocated femoral head is reduced into the acetabulum with gentle hip ________ by the examiner
abduction
In the Barlow maneuver, a reduced femoral head is gently _______ until it becomes sublimated or dislocated
adducted
The _______ maneuver is a test of laxity or instability
barlow
What is the most important clinical test for detecting newborn dysplasia ?
Ortolani
3 management strategies of DDH?
- observation
- bracing
- Sx
6 long term implications of DDH?
- degenerative arthritis
- LLD
- limited hip abduction
- pain and disability
- premature hip replacement
- avascular necrosis
_______ ______ = congenital disorder of collagen synthesis
osteogenesis imperfecta
OI effects all _______ tissue
connective
What are 6 effects of OI?
- OP
- excessive fractures
- bowling of long bones
- spinal deformities
- muscle weakness
- ligamentous laxity
2 management strategies for OI?
- bisphosphonates
2. orthopaedics
PT management of OI?
function and participation!!!
At what age should you start to worry about toe walking?
if it persists past the age of 3
What are 2 differential diagnosis’s for ITW?
- autism spectrum disorder
2. CP
Are males or females more likely to be ITW?
males
There is a ___ association between ITW and language delays, learning impairments and prematurity
+++
3 symptoms aside from toe walking in ITW?
- pain in legs
- frequent tripping / falling
- ankle injuries
4 treatments for ITW management?
- casts/braces
- PT
- botox-A
- surgery
PT algorithm for ITW?
- stretching
- strengthening
- manual therapy
- balance/coordination exercises
- gait training
_____ disease = avascular necrosis of the femoral head due to loss of blood supply
legg calve perthes disease (LCP)
What are 5 possible causes of LCP disease ?
- trauma
- transient synovitis
- infection
- congenital or developmental vascular irregularities
- thrombotic vascular insults
Most common onset of LCP disease is ____ ages __-__ years
boys; 5-7
4 stages of LCP disease?
- condensation
- fragmentation
- reossification
- remodelling
______ = femoral head slips or is displaced from normal alignment on femoral neck
slipped capital femoral epiphysis (SCFE)
SCFE is often associated with onset of ______
puberty
5 clinical presentations of SCFE?
- pain in groin, medial thigh or knee
- limp
- ER of leg
- limited hip ROM
- inability to WB due to severe pain
Management of SCFE?
- surgery; stabilize growth plate with a pin fixation
- bedrest
- casting
- PT
Ogood-Schlatter disease (OSD) = ______ injury
overuse
OSD = _______ of tibial tubercle
apophysitis
OSD is common in boys ages __-__ years old and girls ages __-___ years old
10-15; 8-13
OSD management?
- ice
- rest
- stretch
- strengthen
Osteochondritis dissecans (OCD) = ______ lesion, distal femur most common
osteochondral
Ages of OCD?
13-17
Clinical presentation of OCD?
- generalized pain which increases with activity
- increase in pain with rotational movements
- swelling
- instability
- locking
_____ disease = localized disorder of bone remodelling
pagets
__-__ % of Paget’s disease is asymptomatic
70-90
______ disease normally involves multiple bones, especially axial skeleton
pagets
There is a very strong _____ link with pagets disease
familial
_____ = hormonal disorder that develops when your pituitary gland produces too much growth hormone during adulthood
acromegaly
_____ is characterized by short stature
dwarfism
Most common type of drawfism?
achondroplasia
What are the 2 types of dwarfism?
- disproportionate
2. proportionate
5 clinical presentations of LCP’s disease?
- limp
- pain
- +ve trendelenberg
- decreased ROM
- muscle spasm (++ abd and IR, flexion contracture)
