Pediatrics musculoskeletal exam Flashcards
during what months can a baby raise head
2 months
during what months can a baby roll from prone to supine
4 months
during what months will a baby sit using tripod position
6 months
during what months does a child begin creeping
9 months
during what months should a child stand without support momentarily
12 months
a child in extension prone on the floor that keeps its hands from touching the ground may have
neurological problems
what is the cutoff for walking?
18months
when talking about sequence of motor development what is the most important
that babies hit their milestones in order! no skipping
a healthy newborn will exibit some resistance to what position
full extension
how do you get a newborns fingers open
stimulate the ulnar aspect of their hand and they will open their hands.
you bring a babies arm across their chest in the front to touch the other shoulder what is it called and why do you use it
scarf test,
looking for normal flexion/ muscle tone.
holds arms in flexion, for five seconds, suddenly extend them and release them they will come back in flexion what test is this, what is it testing for
arm recoil test, normal flexion tone
a single crease extending across the entire palm
simian crease, down syndrome
in what position should you inspect the spine of a toddler
standing
posture and movement of a toddler should be symmetric, what shouldn’t you see
twitching
child rises from a sitting position by placing hands on the legs and pushing the trunk up. Crawl up their legs
Gower sign, muscular dystrophy
why may muscular dystrophy effected children look like they are strong even when they have muscle atrophy?
the patient will have fatty infiltrates that make the child appear stronger, pseudohypertrophy due to fatty infiltrates
should the child be undressed during inspection?
yes, unless they are of age then use a gown
what are the evaluateions for developmental hip dysplasia
- asymmetrical thigh and buttocks skin folds or creases
- decreased hip abduction > 3 mohts - most reliable sign
- allis’ test
- ortolani’s
what are the three grades of developmental hip dysplaisa
- acetabular displaisa
- subluxation
- dislocation
is plain film good for an infant under 6 months?
no, ultrasound
what is best used to catch subtle signs of hip dislocation
ultrasound
who should you check for hip dysplasia
every pediatric under 1 year old, developmental hip dysplasia.
hip symmetry and no symmetric fat folds or deeper on one side are signs of ?
congenital hip dysplasia
when a hip dislocates what length change happens
leg become shorter.
what type of abduction is sign of hip dysplasia
decreased hip abduction
this test tests for leg length inequality only, not dislocation
allis sign
what is the most reliable sign of hip dysplasia in a child under 3 months old and why
decreased hip abduction
after 3 months child becomes so strong you can get false negatives
what means a positive test for hip dislocation, click or clunk
clunk. clicks are normal
Test one hip at a time, stabilizing the pelvis with the other hand Infant supine, doctor at infant’s feet Flex the hips & knees to 90 degrees
Grasp the leg with your thumb on the inside of the thigh, the base of the thumb on the knee, and your fingers gripping the outer thigh with your fingertips resting on the greater trochanter Adduct the thigh and gently apply downward pressure on the femur
Barlows maneuver,
patient supine you bring the knees in and push the femur down and out to test for subluxation/ dislocation
Barlow’s test
slowly abduct ddthe thigh while maintaining axial pressure
fingertips on the greater trochanter, exert a lever movement in the oppsoite direction
If there is a palpable clunk. femur head slipped into the acetabulum,
ortolani maneuver
what is the gender bias for developmental hip dysplasia
females
name of the brace used to help developmental dysplasia
pavlik harness, greater success less than 6 months old
how do you test for muscle strength in an infant
hold them under the axilla, if they maintain position good, if they slip through your hands weak.
Erb’s Palsy effects what nerve roots
C5 C6
what is the most common brachial plexus injury
Erb’s Palsy
what reflex remains in the effected arm of erb’s palsy
grasp reflex
how far apart should the shoulder scapulae be
3-5 inches
c shape of a babies foot
metatarsus adductus
longitudinal arch is o scured by a fat pad until when
about 3 years
forefoot adduction
metatarsus adductus
what is the most common congenital foot deformity
metatarsus adductus
a line through the midline of the foot may bisect what
the 3rd and 4th toes
when does tibial torsion tend to resolve
months to years of weight bearing
how do you access for tibial torsion
child prone
flex knees 90 degrees
align the midline of the foot parallel to the femur
using the thumb and index finger, grasp the medial and lateral maleoli
place other thumb and index finger on either side of the kn ee
if your thumbs are not parallel to each other. tibial torsion
slight varus curvature of the tibia related to fetal positioning expected to resolve after months or years of weight bearing
tibial torsion
position that places stress on joints related to in-toeing and femoral anteversion
reverse tailor position
increased internal rotation of the hip >70 degrees and decreased external hip rotation
femoral anteversion
what is the gender bias for femoral anteversion
females
femoral anteversion is associated with what type of sitting
reverse tailor sitting
what is the grading for genu varum?
bring ankles together, if greater than 1 inch gap between the knees then genu varum.
what is genu varum normal
until 18 months of age.
how to tell from genu valgum
place knees together and check for greater than 1 inch between feet
when is genu valgum normal
2-4 yoa
congenital defect of the ankle and foot
inversion of the foot
plantar flexion, contracted triceps surae
talipes Equinovarus
what is the gender bias for talipes equinovarus
males 2/1 females
is there a congenital risk with talipes equinovarus?
`yes 10%
bilateral involvement of what percentage of cases of talipes equinovarus
30-50%
what is the name of the treatment of talipes equinovarus
ponseti method
what is the ponseti method
for treateing talipes equinovarus, usually 4-6 full leg cast and adjustments and surgery
exaggerated dorsiflexion allows dorsum of the foot to come into contact with anterior aspect of lower leg
talipes calcaneovalgus
does talipes calcaneovalgus require surgery
no
what happens with most talipes calcaneovalgus’s
they resolve on their own
what usually causes talipes calcaneovalgus
uterine position
avascular necrosis of the femoral head
legg-calve-perthes
legg -calve-perthes is MC in what gender and what age
boys 2-10
capital femoral epiphysis slips over the neck of the femur
SCFE
what is the gender bias and age range for a SCFE
girls 8-16
presents with knee pain and a limp
commonly obese, taller than most
leg weakness and reduced internal hip rotation
SCFE
where does knee pain come from with SCFE,
referred from hip
traction apophysitis
develops in assocation with inflammationof the anterior patellar tendon self limiting
osgood-Schlatter
what is the gender bias and age range for osgood schlatter
MC in boys 9-15 yoa
