Pediatric MSK disorders

Question 1

________= apex of angulation away from midline

Answer 1

varus

Question 2

________ = apex of angulation towards midline

Answer 2

valgus

Question 3

What are three causes of in-toeing in children

Answer 3

1. from the foot: metatarsus adductus
2. from the tibia: internal tibial torsion
3. from the femur: femoral anteversion

Question 4

What is metatarsus adductus?

Answer 4

medial angulation of the forefoot present at birth, can usually be corrected with manipulation on exam

Question 5

When is surgery indicated for metatarsus adductus?

Answer 5

feet have enough deformity to cause problems wearing shoes

Question 6

Though internal tibial torsion is very common at birth, it is usually not detected until ________

Answer 6

children begin walking

Question 7

Internal tibial torsion and femoral anteversion are both likely due to ________ positioning

Answer 7

in utero

Question 8

What is treatment for internal tibial torsion?

Answer 8

None, usually deteriorates by about age 5. Braces or bar and shoe devices to not speed up resolution

Question 9

Children with femoral anteversion have significantly increased ______ rotation of the hip

Answer 9

internal

Question 10

Femoral anteversion usually resolves by about age ____

Answer 10

10

Question 11

When is surgery indicated for internal tibial torsion?

Answer 11

continuing to cause tripping after 8 yrs old

Question 12

When is surgery indicated for femoral anteversion?

Answer 12

causes “miserable malalignment syndrome” with anterior knee pain

Question 13

Describe the normal progression of sagittal plan development of the lower extremities

Answer 13

• varus/ bowlegged at birth
• valgus/ knock kneed by about 3 years
• relatively straight adult alignment by about 6 years

Question 14

Guided growth therapy requires detection of abnormalities before puberty and an open ______

Answer 14

physis

Question 15

Describe guided growth surgery

Answer 15

the growth plate is tethered on the convex side, allowing the concave side to continue to grow until the leg is straight

Question 16

_______ is a pathologic bowing of the lower extremity resulting from varus of the tibia

Answer 16

Blount disease

Question 17

What causes Blount disease?

Answer 17

compressive forces on the medial portion of the proximal tibia causing inhibition of physeal growth in an asymmetric fashion

Question 18

What children are at risk for Blount disease?

Answer 18

heavy toddlers
early walkers
additional internal tibial torsion

Question 19

What is the treatment for Blount disease?

Answer 19

• bracing to attempt to decrease medial tibial forces and promote normal growth
• may require surgery to re-align tibial and rebalance forces across the growth plate

Question 20

What is the treatment for Blount disease?

Answer 20

• bracing to attempt to decrease medial tibial forces and promote normal growth
• may require surgery to re-align tibial and rebalance forces across the growth plate

Question 21

How is “adolescent” Blount disease different from the infantile form?

Answer 21

• presents later
• treated with guided growth, bracing is not effective
• due to obesity

Question 22

What are two pathologic processes that should be considered in a child with leg bowing?

Answer 22

rickets, bone dysplasia

Question 23

Scoliosis is due to asymmetric growth of the ____ spine relative to the _____ spine

Answer 23

anterior vs posterior

Question 24

Scoliosis is due to asymmetric growth of the ____ spine relative to the _____ spine

Answer 24

anterior vs posterior

Question 25

What are the proposed etiologies of scoliosis?

Answer 25

genetics hormonal influences including melatonin structural deficiencies- fibrillin, elastin, collagen

Question 26

Left untreated, spinal curves in scoliosis progress at what rate?

Answer 26

about 1 degree per month | only the most severe curves continue after skeletal maturity

Question 27

Severe curves in scoliosis can cause _________ compromise

Answer 27

cardiorespiratory

Question 28

What is the treatment for scoliosis?

Answer 28

bracing | surgical straightening and spinal fusion

Question 29

The risk of _______ of scoliosis is highest in children who develop scoliosis before age 10.

Answer 29

progression

Question 30

A foot arch develops in most children by about ____ years old

Answer 30

8

Question 31

Are orthotics helpful in development of foot arch in children?

Answer 31

NO | actually barefoot is best

Question 32

Clubfoot includes four deformities:

Answer 32

metatarsus adductus, cavus (high arch), hindfoot varus and equinus