Pediatric Orthopedic Disorders Flashcards
What is congenital Muscular Torticollis?
Unilateral shortening of the SCM resulting in cervical SB and contralateral rotation
If your patient has left torticollis what two impairments would they have? Right torticollis?
Left: decreased R SB and L rotation
Right: decreased L SB and R Rotation
What are the 7 possible reasons for Torticollis?
Birth trauma
Fetal position or uterine compression (big or multiple babies)
Ischemic injury
Abnormal vascular pattern
Muscle rupture
Plagiocephaly
Back to Sleep- slight injury+ no tummy time+ rotation during sleep
How could plagiocephaly cause torticollis?
R posterior occipitoparietal flatness-> R cervical rotation (supine/carseat/swing)-> SCM shortens
Give the general CMT impairments (there are 7)
- Palpable fibrotic tumor in involved SCM (almond)
- Tight anterior and posterior neck muscles
- Trunk curved towards affected SCM
- Plagiocephaly
- Poor feeding due to asymmetry of jaw and tongue muscles
- Vision impairment
- Gross motor delay
If a baby is stuck with L torticollis what movements and GMS will be limited? Right torticollis?
Left: unable to roll L, R SB, and L rotate
Right: unable to roll R, L SB, and R rotate
What activities will be limited for this child?
- Decreased purposeful symmetric movements of the heads
- Poor midline control
- Decreased WB on involved side
- Poor expression of UE PE and equilibrium reactions- due to poor head righting reaction
- Decreased ability to roll towards affected side
- Asymmetry in movement at an early age carries through and limits the achievement of next milestone
How would you eval and treat a baby with torticollis?
Eval: GMS, head shape (anthropometrics), PROM/AROM
Treat: Manual stretching, encouraging GMS, HEP, orthotist referral
What is plagiocephaly?
Cranial asymmetry of forehead and/or occiput occurring in first 3 months of life
Left torticollis can cause plagiocephaly issues. What are these?
Common flattening of right occipitoparietal bone
Common bossing of right frontal bone
Right ear shifted anteriorly
Brachycephaly is another cranial asymmetry. What is this?
Wide head with flattening of front or back of skull (or both)
Symmetry in face
Maybe from Back to Sleep and no tummy time
Scaphocephaly is cause by what?
Long narrow head shape
Caused by side lying (common in preemies)
Describe craniosynostosis.
- Premature closure of sutures in skull (normal closing 1-2 years old)
- Head shape does not match plagio, brachy, scapho
- Parallelogram most common and del. on which suture closes
- MUST be treated or increased ICP occurs
What are some options parents have if their child has plagiocephaly?
- Positioning off flat spot- side lying, sitting, holding
- Helmet for remodeling
- DOC Band- allows room for skull to grow
Describe DDH and how often it is seen.
Developmental Dysplasia (Dislocation) of the Hip- abnormal development of growth: acetabulum concavity and depth, spherical femoral head
1/100-births dysplasia 1/1000- births dislocated
6:1 female-male ratio
What are the 4 classifications of DDH?
- Subluxed: femoral head lies partially beneath acetabular roof but can be reduced
- Dislocatable: Femoral head within acetabulum but can be fully dislocated with Barlow maneuver
- Dislocated: Femoral head completely out of acetabulum
- Teratologic: Femoral head has dislocated at early stage during embryonic or fetal development.
How do mechanical, physiological, and environmental factors affect DDH?
Mechanical: small uterine space, primipara mom, breech
Physiological: Maternal hormones resulting in ligamentous laxity (relaxin and estrogen)
Environmental: Wide ABD and flexion (carrying baby in hip sling, not as common); Flat strapping to cradle board in hip ext. increased incidence
How is DDH diagnosed?
- PROM: Limitation or asymmetry in ABD predicts DDH (#1 reason for dx)
- Asymmetric thigh/buttock fold
- Uneven knee height (Galeazzi sign) or LLD
- Barlow or Ortolani test (infants)
- Abnormal gait 18-24 months
- US, X-ray
What would treatment look like for a 0-9 month old with DDH?
Pavlik Harness (1950): restricts hip ext and ADD, allows hip flexion and ABD (enhances normal ace tabular development), promotes spontaneous reduction of dislocation, stabilized hip subluxation, if not effective after ~3 weeks sx is recommended.
Casting Drastically reduces AROM and increases risk of avascular necrosis of femoral head
Treatment for a child 9 months or older with DDH would include?
Usually healed by now
ABD orthoses to decrease dislocation or subluxation
SX recommended if this persists
Describe Slipped Capital Femoral Epiphysis (SCFE) and the incidence at which it occurs.
Growth plate of the femoral head is weak and becomes displaced (slips) from normal position.
10-15 year olds; Males more than females, African Americans more than Caucasian
What are the 3 subtypes of SCFE?
- Acute: significant trauma, immediate pain and restricted hip ABD and IR
- Acute on Chronic: hip aching for months (result of chronic slip) then significant trauma (fall) and acute symptoms start
- Chronic: Hx of limp, pain for months, decreased hip motion esp. into IR and ABD (obese and overwt kids)
Give the grades of SCFE.
I. Less than or equal to 1/3 of femoral head displaced off neck
II. 1/3 - 1/2 of femoral neck displaced off head
III. More than or equal to 1/2 femoral head displaced off neck
What are the symptoms and treatment of SCFE?
Symptoms: Antalgic limp with pain in groin and anteriomedial aspect of thigh and knee
Treatment: Keep displacement to a minimum, maintain motion, delay degenerative arthritis-increase strength, sx fixation with pins/screws
