Pediatric Musculoskeletal Flashcards
1
Q
Genu Valgus
A
Knock-kneed
2
Q
Genu Varum
A
Bow-Legged
3
Q
Metatarsus Adductus
A
- In-turning of the foot only
- Tx: exercise of foot in opposite direction
4
Q
Trendelenburg Sign
A
- Can be used to identify conditions that cause weakness in the hip abductors
- Have the child stand the raise one leg off the ground
- If the pelvis drops on the raised leg side, the test is positive and indicates weak hip abductors on the side that is bearing the weight
5
Q
Scoliosis
A
- Lateral curve of the spine
- Usually consists of two curves: the original curve and a compensatory curve in the opposite direction
- Usually greater than 10-degrees; small curves <10-degree = not scoliosis
- Usually in thoracic or lumbar spine (sometimes both)
- Commonly idiopathic; may be congenital (vertebral anomalies, myelomeningocele); May be secondary to neurologic disorder (cerebral palsy, MD, polio)
6
Q
Idiopathic scoliosis
A
- Develops in adolescence
- Male=females in curves <10-degrees
- Females 7x more likely to have significant, progressive curve requiring Tx
- Progression typically occurs at age 10-16yrs, due to growth spurt, so menarche age is important to know
- Not associated with pain
- Pain suggests primary condition and requires further eval
7
Q
Kyphosis
A
- AP forward curve of thoracic spine
- Some postural, does not cause problems
- Sheuermann kyphosis: osteochondrosis that is an abnormality of the vertebral eiphyseal growth plates
- Rigid and painful
- X-ray: vertebral wedging, disc space narrowing
8
Q
Lordosis
A
- AP lumbar curve where abdomen and buttocks are protuberant
- If lumbar spine flattens when child bends forward it is physiologic; if not then refer
9
Q
Brachial Plexus injuries
A
- Usually obstetric cause with injury to C5-C8 and T1 from labor related factors (vacuum extraction, maternal anatomy)
- Classified according to Narakas Criteria
- Refer within 1st wk of life
- PT to maintain PROM
- Surgery
- Good prognosis but may take up to 2yr
10
Q
Narakas Criteria for Brachial Plexus Injuries
A
- I: Dysfunction of deltoid and biceps brachii muscles (C5, C6)
- II: Function of long hand flexors (C5-C7)
- III: Lack of upper limb function, possible minimal function of hand flexors (Whole plexus)
- IV: Lack of whole upper limb function (Group III and Horner syndrome positive)
11
Q
Brachial Plexes Injury S/S
A
- Arm, forearm, hand, and shoulder is assessed
- Erb Palsy: adducted arm, wrist flexed and fingers extended, characteristic “Waiter’s tip” posture
- Absent bicep reflex with absent Moro
- Limp wrist and hand with absent grasp reflex
- Horner Syndrome: Ipsilateral ptosis, miosis, enophthalmos, anhidrosis
- Limited neck motion
- Ruptured intraabdominal organs and fractures
- Fractures of clavicles, humerus, and spinal cord
12
Q
Clavicular Fracture
A
- Result of birth trauma, child abuse, accidents, sports
- S/S: difficult delvery; Lg. birth weight, forceps delivery; shoulder dystocia
- Irritability and pain with motion
- Decreased ROM
- Absent Moro
- Swelling
- Crepitus
- Discoloration
- Associated Erb Palsy
13
Q
Clavicular Fracture: Tx
A
- None with incomplete Fx
- Immobilization with incolmplete Fx: pin the sleeve of the infant’s arm to the front of the shirt for 1-2 weeks
- Sling immobilization in older child for 3-4wk
- Protect for 4-5wk
- NSAIDs, APAP
- Ortho consult with 100% displacement or neurovascular compromise
14
Q
Costochondritis
A
- Common cause of chest pain
- Inflammatory process of 1+ costochondral cartilages causing local tenderness and pain to the anterior chest wall
- S/S: referred rib pain (usually 7-10); acute or gradual onset; sharp, darting, dull quality; radiates from chest to upper ABD and sometimes back; tightness in chest by muscle spasm; exacerbated by coughing and physical activity
15
Q
Back Pain: Red Flags (4yr or less)
A
- Self-imposed activity limitation
- Systematic symptoms
- Nighttime pain
- Neurologic symptoms
- Increasing pain
- Gait disturbances
- Muscle weakness
- Changes in bowel or bladder
16
Q
Back Pain Workup in Children
A
- Blood, x-ray, CT, MRI
- Think: Nothing, diskitis, osteomyelitis, fracture, tumor, abuse, herniation, spondylosis
17
Q
Hip Dysplasia
A
- Femoral head and acetabulum are in improper alignment
- Congenital, or develops in infancy/childhood
- Findings: (+) Ortolani, etc; with missed Dx, contractures and limited ROM; limited abduction of affected hip; asymmetric gluteal folds; shortened limb; marked lordosis w/toe walking; Trendelenburg sign
- Mgmt.: orthopedics, Pavlik’s Harness; surgery
18
Q
Legg-Calve-Perthes
A
- Infarction of the bony epiphysis of the femoral head
- Presents as avascular necrosis due to insufficient blood supply to the femoral head
- Marrow becomes necrotic, area becomes weak, and fracture occurs at the epiphysis
- Articulation of the head in the hip is interrupted
- If bone reossifies, the femoral head flattens and there is a poor outcome
- Findings: Limp; pain in anterior thigh, knee; limited ROM; Trendelenburg gait; muscle spasm; atrophy of quads and thigh muscle; decreased abduction, internal rotation, and extension of the hip; pain on internal rotation
- Dx: Ap and frog leg views; refer
- Tx: bracing, traction, surgery
19
Q
Slipped Capital Femoral Epiphysis
A
- Salter-Harris Type I Fx through the proximal femoral physis from stress around hipp applied at growth plate
- Usually in overweight children, at the onset of puberty
- Findings: pain in hip, groin, thigh, knee; limp; obesity; delayed puberty; decreased internal rotation, external rotation of the thigh when hip is flexed; atrophy of thigh and gluteal muscles; if unstable, can’t bear weight
- Dx: AP, Lat, frog leg; orthopedics, NWB immediately, surgery, monitoring
20
Q
Femoral Anteversion
A
- Head and neck of femur are rotated anteriorly
- Children sit in “W”
- intoeing gait
- Knees mediallly rotated
- Discourage “W” sitting and take ballet lessons
21
Q
Genu Varum
A
- Bowing of the legs
- May represent Blount disease, Rickets, tumor, neurologic conditions, usually nothing
- Considered NL up to 3yr; after this, pathologic
- Intercondylar (knees) distance with ankles together >4-5in suggests need for further evaluation
- Mgmt.: usually only observation; refer if questionable
22
Q
Genu Valgum
A
- Knock-knees
- Lasts about 7-8yrs
- Usually physiologic
- Bilateral tibial femoral angle less than 15-degrees is NL
- Intermalleolar (ankles) distance with knees together >4-5in suggests need for further eval
- Refer with short stature
- Usually no intervention needed
23
Q
Osgood-Schlatter
A
- Microtrauma of the deep fibers of the patellar tendon at its insertion on the tibial tuberosity
- Usually in adolescents after a growth spurt
- Findings: pain increases during and immediately after the activity and decreases when the activity is stopped; pain over the tibial tuberosity with swelling, tenderness
- Dx: X-ray can be used but not always necessary
- Mgmt.: RICE; strengthening for quads, hip extension, hamstrings; NSAIDs; Patella tendonstrap; refer for severe cases
24
Q
Pes Planus (Flat Foot)
A
- If not permanent, resolves by 3yrs
- Arch is present when not weight bearing, but disappears with weight bearing
- Midfoot can sag
- NL ROM
- Rigid flat foot may require orthopedic intervention
25
Q
Talipes Equinovarus (Clubfoot)
A
- 3 elements:
1) Ankle is in equinus (foot in pointed tow position)
2) Sole of the foot is inverted as a result of the hindfoot varus or inversion deformity of the heel
3) Forefoot has a convex shape of MA - Foot cannot be manually corrected
- refer to ortho
