Pediatric Rehab MSK

Question 1

What is Sprengel’s deformity?

Answer 1

Failure of scapula to descend from its cervical region overlying the 1st through 5th ribs (instead of 2nd to 8th).

Question 2

Clinical presentation of Sprengel’s deformity

Answer 2

1- Shortened neckline, 2-Lack of normalscapulothoracic motion, 3-malposition of the glenoid limiting forward flexion and abduction, and 4- Presence of an omovertebral bar (connects scapula to cervical spine)

Question 3

Clinical presentation of Klippel-Feil Syndrome

Answer 3

Short neck, low hairline, restricted neck movement.

Question 4

Sports contraindicated in Klippel-Feil Syndrome

Answer 4

Contact sports

Question 5

Atlantodens Interval (ADI) up to __mm is accepted

Answer 5

5mm

Question 6

Rigid pes planus is associated with other anomalies in 50% of cases. These are….

Answer 6

Tarsal coalition:

• Talocalcaneal coalitions (8-12 years)
• calcaneonavicular coalition (12-16 years)

Question 7

Diagnosis of tarsal coalition

Answer 7

CT

Question 8

Differential diagnosis of pes cavus

Answer 8

CMT, spinal dysraphysm, Friedrich’s ataxia, spinal tumor

Question 9

Rocker bottom foot

Answer 9

Congenital vertical talus

Question 10

congenital vertical talus is associated with

Answer 10

neuromuscular and genetic disorder including trisomy 13, 14, 15 and 18.

Question 11

Larsen syndrome clinical signs

Answer 11

-flat facies, -multiple congenital dislocations, -ligamentous laxity, -cervical spine instability

Question 12

Arthrogryposis multiple congenita. Before therapy needs to rule out….

Answer 12

Fractures. The birth can be complicated with the contracture are results in fracture. Therapy should not be initiated until such fractures are ruled out.

Question 13

Risk of surgical correction of knee flexion contractures…

Answer 13

Neurovascular overstretching

Question 14

Indicators of poor outcome in Juvenile Idiopathic Arthritis

Answer 14

• greater severity or extension of arthritis at onset
• symmetrical disease
• early wrist or hip involvement
• presence fo RF
• persistent active disease
• Early radiographic changes (erosion or joint space narrowing)

Question 15

Drug scalation in oligoarthritis JIA

Answer 15

NSAIDs-> IA steroid -> methotrexate -> TNF alpha inhibitors.

Question 16

Septic arthritis organism

• in all age group
• in neonates and infants

Answer 16

• all age group: Gram positive aerobe (s.aureus 60%)

- neonates and infants: S. aureus and gram neg anaerobes.

Question 17

Reactive arthritis

Answer 17

Autoimmune response triggered by antigen deposit in the joint space.
Preceding infections: Chlamydia
Yersinia and Campylobacter (can be associated with HLAB-27)

Question 18

Treatment of Reactive arthritis

Answer 18

Antibiotics if organism still present. Analgesics, steroids and immunosupressants.

Question 19

Hemophilia treatment /rehab

Answer 19

• Main treatment is injections of cryoprecipitate.
• Joint immobilization for 48 hours. Once pain and swelling subside start PROM.
• Analgesics, anti-inflammatory and aspiration of blood from the joint if skin is tense.
• Aquatherapy
• Contact sports are generally contraindicated.

Question 20

Legg-Calve-Perthes disease

• What is?
• Age of presentation

Answer 20

• Osteonecrosis of the capital femoral epiphysis

- 4-10 years

Question 21

Physical findings in Legg-Calve-Perthes

Answer 21

• Limitation in internal rotation, extension and abduction of the affected hip
• Shortening of the leg
• hip or knee pain

Question 22

Treatment of Legg-Calve-Perthes

Answer 22

• Disease process is self-limited, but may last for 2-4 years.
• Goal is to reduce pain and stiffness
• NSAIDs
• Non-weight bearing with crutches (if significant pain)
• Hip abduction (40-45 degrees ) orthosis. Full time, until subchondral ossification is demonstrated on Xray, although controversial
• Surgery if Caterall classification III or IV.

Question 23

Most common type of hip pain in children

Answer 23

Acute Transient Synovitis of the hip

Question 24

Peak age for transient synovitis of the hip

Answer 24

3-6 years

Question 25

Age at presentation of Slipped Capital Femoral Epiphysis

Answer 25

-12-16 years for boys, 10-14 for girls

Question 26

Conditions associated with SCFE

Answer 26

Endocrine

• Hypothyroidism, hypopituitarism, hypogonadism, excessive growth hormone.
• Specially when presentation is outside of the usual age.

Question 27

Presentation of SCFE

Answer 27

External rotation of the leg, leg shortening, Trendelenburg’s gait, hip pain

Question 28

SCFE, diagnosis and treatment

Answer 28

-Diagnosis with lateral hip xray showing displacement, using Klein’s line
-Treatment- Non weightbearing -> In situ pinning.
Weightbearing avoided for at least 6 weeks.

Question 29

Highest risk factors for Developmental Dysplasia of the Hip

Answer 29

First-born female presenting with breech position.
Other risk factors: 
-Caucasian
-Hip swaddling in extension
-Family history
-Primiparity
-Ligamentous laxity
-Birth weight >4,000gm
-Torticollis
-Metatarsus adductus
-Oligohydramnios
-Hip asymmetry
-Congenital knee dislocation/recurvatum

Question 30

Treatment of Developemental Dysplasia of the hip if

• Positive Barlow’s but negative Ultrasound
• Positive imaging (ultrasound or xray)

Answer 30

-Positive Barlow’s but negative Ultrasound- Serial CLINICAL examination until reaches walking age.
-Positive imaging (ultrasound or xray)- Pavlik harness with monthly ultrasound if less than 6 months. Then xray through growing years.
Hip abduction orthosis if more than 6 months of age.

If Pavlik fails in children under 18 months-> closed reduction with spica cast.

If the previous fails, surgical reduction is required after 18 months.

Question 31

What is Nursemaid’s elbow? Mechanism of action?

Answer 31

Radial head subluxation from a upward pull on the extended pronated arm.

Question 32

Nursemaid’s elbow clinical presentation and treatment

Answer 32

The child will hold the arm in felxed and pronated position.

Treatment: closed reduction with the patient under sedation.