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Pediatric Orthopedics Flashcards

1
Q

What position is the baby typically in during early childhood?

A

Frog leg position

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2
Q

What 4 areas do babies have increased range in?

A
  1. Shoulder extension and rotation
  2. Wrist flexion
  3. Hip abduction and rotation
  4. Ankle dorsiflexion and inversion/eversion
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3
Q

What 2 areas do babies have decreased range in?

A
  1. Knee and hip extension

2. Ankle plantarflexion

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4
Q

What position are the hips and knees in, during early childhood?

A
  1. Hip anteversion/antetorsion

2. Knee varus/varum

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5
Q

What do the terms version and torsion refer to?

A

Version = position of the femoral head

Torsion = twist of the femur

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6
Q

What is the difference between anteversion and retroversion?

A

Anteversion = femoral head facing forward (thigh in ER with out-toeing and medial femoral torsion)

Retroversion = femoral head facing backward (thigh in IR with in-toeing and lateral femoral torsion)

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7
Q

What is the position of the knees in a new born, 6 months, 1-2 years, 2-4 years, and in 16 year old females/males?

A
  1. New born: moderate genu varum
  2. 6 months: minimal genu varum
  3. 1-2 years: legs straight
  4. 2-4 years: physiologic genu valgum
  5. 16-year-old females:  slight genu valgum
  6. 16-year-old males: slight genu varum
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8
Q

What is the most common form of episodic musculoskeletal pain in children? Age?

A

Growing pains

Affects children 3-12 years of age

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9
Q

List 4 signs and symptoms associated with growing pains.

A
  1. Non-articular, most often in shins, calves, thighs, popliteal fossa
  2. Almost always bilateral
  3. Pain lasts minutes to hours in duration, mild to severe in intensity
  4. Pain free episodes
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10
Q

True or False: Children presenting with growing pains will have no signs of inflammation upon examination.

A

TRUE

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11
Q

List 2 interventions used to treat growing pains.

A
  1. Muscle stretching

2. Massage

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12
Q

Pediatric injuries consist of either single _____ or multiple _____.

A

Single macro traumas

Multiple micro traumas

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13
Q

List 4 types of microtraumas seen in children.

A
  1. Training errors (overuse)
  2. Musculoskeletal imbalance (growth spurts)
  3. Anatomical Alignment
  4. Footwear (too small/over worn)
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14
Q

What is a growth plate?

A

Open area of bone that fills in to facilitate bone growth

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15
Q

What is the most commonly fractured growth plate?

A

Distal femoral growth plate

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16
Q

When does a stress fracture of the cancellous bone typically appear on an x-ray?

A

6-8 weeks post onset of pain

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17
Q

What is the most common stress fracture in children?

A

Greenstick fracture: one side of the bone is broken, while the other is only bent

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18
Q

What 2 joint injuries are common among children?

A
  1. Ligament Sprains

2. Joint Derangement

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19
Q

What 2 conditions can affect the musculotendinous unit in children?

A
  1. Avulsion Fracture

2. Tendonitis

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20
Q

True or False: Children will develop tendonitis first before an avulsion fracture.

A

FALSE

Avulsion fractures are seen before tendonitis

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21
Q

What 4 things are assessed overall during a sports screening?

A
  1. Maturity
  2. Overall fitness
  3. Drug use
  4. Dietary abuse
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22
Q

____ of all musculoskeletal problems ID in screening unknown by primary physician.

A

1/3

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23
Q

How many grades of congenital dislocation/dysplasia are there? What determines treatment for this condition?

A

5 grades

Treatment determined by how early condition is detected (earlier is better)

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24
Q

What are the three classes of metatarsus adductus? How are they typically treated?

A
  1. Flexible: HEP
  2. Semirigid: HEP, taping, casting, shoe wear
  3. Rigid: surgery
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25
Q

What 3 conditions are associated with club foot (talpies equinovarus)?

A
  1. Metatarsus adductus
  2. Hindfoot varus
  3. Ankle equinus (limited DF)
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26
Q

List 7 causes of torticollis.

A
  1. Tumors ~ 1/3,
  2. Trauma
  3. Pseudotumors
  4. Fetal malposition
  5. Uterine compression
  6. Inflammatory conditions
  7. May occur with other conditions (i.e. hip dislocation)
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27
Q

List 3 impairments associated with torticollis.

A
  1. SCM tightness (lateral flexion to tight side, rotation to opp. Side)
  2. Can affect other neck muscles (upper trap, scalenes, hyoids, tongue/ facial muscles)
  3. 2° facial asymm., plagiocephaly (misshaping of the head), scoliosis
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28
Q

List 2 functional limitations associated with torticollis.

A
  1. Usually only affects righting reactions

2. With increasing severity can affect ability to WB on ipsilateral UE

29
Q

What 2 things should the PT ask about regarding patient history when evaluating children with torticollis?

A
  1. How much time is the child spending in equipment?

2. Sleeping position

30
Q

List 4 things that should be assessed when examining a child with torticollis.

A
  1. ROM including resting head tilt
  2. Facial and skull symmetry
  3. Palpation of SCM (note size, physical characteristics, location)
  4. Gross and fine motor development
31
Q

There will be a better prognosis for torticollis if treatment starts early, before _____ year of age.

A

<1 year of age

32
Q

List 5 interventions used to treat torticollis.

A
  1. Stretching (gentle) with slight cervical traction
  2. Strengthening (visual tracking/Righting reactions)
  3. Positioning to provide prolonged stretch (midline positioning of head)
  4. Handling/carrying (positions that elicit stretch of muscle)
  5. Orthotics (must have some passive & active ROM)
33
Q

List 2 ways to prevent the incidence of torticollis.

A
  1. Parent education

2. Prone play time when awake and observed

34
Q

How is torticollis diagnosed?

A
  1. Physical exam (assess shape of head)

2. Head shape for diff dx between deformational plagiocephaly and craniosynostosis

35
Q

What is plagiocephaly? Scaphocephaly? Brachycepahly?

A

Plagiocephaly: flat spot on baby’s head (trapezoid shaped head)
Scaphocephaly: long and narrow head (flat on both sides; too much sidelying)
Brachycephaly: back of the head is pressed in (too much time in equipment)

36
Q

What is craniosynostosis?

A

Fusion of the cranial sutures which prevents the skull from expanding, thereby inhibiting brain growth/development.

37
Q

What is Legg-Calve-Perthes disease? Age?

A
  1. Avascular necrosis of femoral head

2. 5-10 years of age

38
Q

List 3 symptoms of Legg-Calve-Perthes disease.

A
  1. Pain in groin/hip/knee
  2. Limp, positive Trendelenburg secondary to pain/decreased strength
  3. Decreased medial rotation (early sign), abduction
39
Q

What is the first sign of slipped capital femoral epiphysis (SCFE)? Age? Symptoms?

A

1st sign knee pain
Age: 7-15 years
Initially antalgic limp, chronic abductor lurch, outtoeing

40
Q

What occurs with Osgood Schlater’s disease? Age? What should be avoided?

A
  1. Separation of tibial tubercle
  2. Age 10-15 years
  3. Avoid jumping and squatting
41
Q

List 4 ways to manage Osgood Schlatter’s disease.

A
  1. Alleviate pain
  2. Improve/maintains ROM
  3. Improve strength
  4. Improve functional skills (gait pattern/speed, sport specific activities)
42
Q

____ % of of infantile scoliosis resolve spontaneously.

43
Q

True or False: Scoliosis progresses more in females than males.

44
Q

What are 4 characteristics of a progressive scoliotic curve?

A
  1. Increases 5+ degrees on 2 exams
  2. Younger children
  3. Double curves
  4. Before menarche
45
Q

List 8 components of scoliosis screening.

A
  1. Unequal shoulder level
  2. Scapular prominence
  3. Uneven waist lines/hip prominence
  4. Pelvic asymmetry
  5. Unequal distance between arms and body
  6. Unequal knee level
  7. Forward bend test-rib hump
  8. Sideways-lordosis or kyphosis
46
Q

What is the typical treatment for curves less than 25 degrees? More than 40 degrees?

A

Less than 25 degrees = bracing

More than 40 degrees = surgery

47
Q

What 3 muscle groups should be strengthened in scoliotic patients?

A

Trunk extensors
Hip extensors
Abdominals

48
Q

What joints are most commonly affected by hemophilia?

A

Hinge joints

49
Q

List 5 impairments associated with hemophilia.

A
  1. Pain
  2. Decreased range and strength 2° to joint and intramuscular bleeding
  3. Peripheral nerve lesions
  4. Gait changes
  5. Chronic arthritis
50
Q

List 4 interventions used to treat hemophilia.

A
  1. Range/mobilization
  2. Splinting (dynamic- slowly progress, serial casting)
  3. Strengthening avoid slow speed isokinetics
  4. Gait training (< 10% need WCs)
51
Q

List 4 impairments associated with Juvenile rheumatoid/idiopathic arthritis.

A
  1. Pain
  2. Joint deformity/destruction
  3. Weakness 2° to pain and immobility
  4. Gait changes
52
Q

What 3 characteristics must a patient present with in order to be diagnosed with JRA?

A
  1. Diagnosed before age 16
  2. Persists for longer than 6 weeks
  3. Rule out other causes
53
Q

List 2 functional limitations associated with JRA.

A
  1. Gait/mobility

2. ADLs (lose fine motor control)

54
Q

List 6 interventions used to treat JRA.

A
  1. Range-no long lever arms, AA subluxation
  2. Strengthening
  3. Protect joint alignment
  4. Theraband
  5. Hydrotherapy
  6. Bike riding
55
Q

List 3 characteristics of osteogenesis imperfecta.

A
  1. Decreased type I collagen
  2. Profuse osteoporosis/ multiple fractures
  3. Lax joints/weak muscles
56
Q

List 3 impairments associated with osteogenesis imperfecta.

A
  1. Decreased range
  2. Skeletal deformity
  3. Decreased strength 2° to immobilization
57
Q

What is 1 functional limitation associated with osteogenesis imperfecta?

A

Delayed development/mobility

58
Q

List 5 interventions used to treat osteogenesis imperfecta.

A
  1. AROM
  2. Strengthening (through activity NOT resistance)
  3. Orthotics
  4. Parental training
  5. Surgery (intramedullary rods)
59
Q

What 3 things should be avoided when treating children with osteogenesis imperfecta?

A
  1. PROM
  2. Resistance exercises
  3. Fatigue
60
Q

What is arthrogyrposis congenita?

A
  1. Lack of fetal movement (1st trimester)

2. Muscle normal at first then replaced by fibrosis/fatty tissue

61
Q

What position are the hips, knees, feet, shoulders, elbows and wrists in in type A arthrogryposis congenita?

A 
Hip flexion
Knee extension
Club feet
Shoulder IR
Elbow Flexion
Wrist flexion and ulnar deviation
62
Q

What position are the hips, knees, feet, shoulders, elbows and wrists in in type B arthrogryposis congenita?

A 
Hip Abduction/ER
Knee Flexion
Club Feet
Shoulder IR
Elbow extension
Wrist flexion and UD
63
Q

List 3 impairments associated with arthrogryposis congenita.

A
  1. Severe joint contractures
  2. Muscle weakness and fibrosis
  3. Muscle imbalance
64
Q

List 5 interventions used to manage arthrogryposis congenita.

A
  1. Stretching
  2. Strengthening
  3. Positioning
  4. Foot orthotics due to recurring clubfoot
  5. Surgery (osteotomies)
65
Q

___% of proximal femoral focal deficiencies are unilateral and ___% are bilateral.

A

85% unilateral

15% bilateral

66
Q

How many classes of PFFD are there? Describe classes A and D.

A

4 classes

Class A: short femoral segment
Class D: short femoral segment plus absent femoral head/acetabulum

67
Q

List 3 signs and symptoms associated with PFFD.

A
  1. Shortened thigh held in flexion, abd, ER
  2. Hip and knee flexion contracture
  3. Severe leg length discrepancy
68
Q

List 3 interventions used to treat PFFD.

A
  1. Leg lengthening
  2. Amputation
  3. Rotationplasty
69
Q

List 5 signs of discomfort during range that may be exhibited by nonverbal children.

A
  1. Noisy breathing
  2. Negative vocalizations
  3. Changes in facial expressions (sad, frightening (eye opening), frowning)
  4. Tension in extremities
  5. Fidgeting/trying to get away

Pediatrics (SE) (18 decks)

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