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National Physical Therapy Examination: Pediatrics > Pediatrics: Orthopedic Conditions > Flashcards

Pediatrics: Orthopedic Conditions Flashcards

1
Q

Torsional Conditions: Toeing in/Toeing out: Foot Progression Angle

A
  • Angle made by the foot with respect to a straight line progression in the direction of gait.
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2
Q

Torsional Conditions: Toeing in/Toeing out: Foot Progression Angle

A
  • Can be normal
    • sign=toe out
    • sign=toe in
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3
Q

Torsional Conditions: Toeing in/Toeing out: Thigh-foot angle

A
  • Angle between axis of thigh and axis of foot.
  • Measured with child prone and knees at 90 degrees.
  • The angle describes the degree of Tibial torsion.
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4
Q

Torsional Conditions: Toeing in/Toeing out

A
  • Toeing in is common among children who W sit.
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5
Q

Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus

A
  • Congenital foot deformity
  • More common in females
  • More common on the left side
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6
Q

Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Cause

A
  • Most common cause is intrauterine packing
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7
Q

Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Types

A
  • Rigid

- Flexible

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8
Q

Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Rigid

A
  • Medial subluxation of Tarsometatarsal Joints

- Hindfoot slightly in valgus with navicular lateral to head of talus.

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9
Q

Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Flexible

A
  • Adduction of all five metatarsals at the tarsometatarsal joints.
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10
Q

Torsional Conditions: Toeing in/Toeing out: Deformities: Metatarsus Adductus: Flexible: Diagnosis and Treatment

A
  • Diagnosed through clinical exam.
  • Treatment includes stretching and casting.
  • Surgical option to release of abductor hallucis tendon.
  • Strengthening and regaining proper alignment of the foot
  • 85-90% of cases identified at birth resolve by 1 year.
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11
Q

Torsional Conditions: Toeing in/Toeing out: Internal Tibial Torsion

A
  • Most common cause of toeing in
  • High complication rate for osteotomy of Tibia
  • Associated with W sitting
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12
Q

Torsional Conditions: Toeing in/Toeing out: Increased Femoral Anteversion

A
  • Femoral angle of greater than 25-30 degrees from the frontal plane
  • Associated with W sitting
  • Causes toeing in.
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13
Q

Torsional Conditions: Toeing in/Toeing out: Increased Femoral Retroversion

A
  • Femoral angle of less than 10 degrees from the frontal plane.
  • Causes toeing out.
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14
Q

Torsional Conditions: Toeing in/Toeing out: Other Causes of Toeing-Out

A
  • External Tibial Torsion

- Flat feet

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15
Q

Torsional Conditions: Toeing in/Toeing out: Other Causes of Toeing-Out: External Tibial Torsion Correction

A
  • High complication rate with surgery.
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16
Q

Talipes Equinovarus/Clubfoot: Etiology

A
  • Intrauterine malposition causing

- Abnormal development of the head and neck of thetas due to hereditary or neuromuscular disorders.

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17
Q

Talipes Equinovarus/Clubfoot: Observation

A
  • Foot will be
    • Plantar flexed
    • Adducted
    • Inverted
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18
Q

Talipes Equinovarus/Clubfoot: Anatomical changes

A
  • Planterflexion=Talocrural Joint
  • Inversion=Subtalar, Talocalcaneal, Talonavicular, and calcaneocuboid joints
  • Supination=Midtarsal Joints
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19
Q

Talipes Equinovarus/Clubfoot: Diagnosis

A
  • Prenatal ultrasound
  • Lower quarter exam.
  • Affected foot will be. half size smaller and less movie.
  • Calf muscles will be smaller.
  • Bilateral 50% of the time.
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20
Q

Talipes Equinovarus/Clubfoot: Physical Therapy

A
  • Manipulation followed by casting
  • Stretching following casting
  • Orthosis throughout the day for up to 3 months
  • Orthosis at night for up to three years
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21
Q

Talipes Equinovarus/Clubfoot: Non-Postural Treatment

A
  • Surgery
  • Casting and Splinting
  • Possible Achilles tenotomy
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22
Q

Angular Conditions: Genu Valgum

A
  • Excessive Lateral Tibial Torison
  • Referred to as knock knees
  • Accompanied by excessive LATERAL patellar position
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23
Q

Angular Conditions: Genu Varum

A
  • Excessive Medial Tibial Torsion
  • Referred to as Bowlegged.
  • Accompanied by excessive MEDIAL patellar position
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24
Q

Angular Conditions: Other

A
  • Excessive medial patellar tracking

- Pigeon toed

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25
Q

Angular Conditions: Age Norms

A
  • Genu varum=normal in newborn and infants
  • Maximum varum at 6-12 months of age
  • 0 Tibiofemoral angle by 18-24 months.
  • Knees drift into valgus by 3-4 years
  • Valgus corrects at age 7 to an adult alignment.
  • 8 degrees in female and 7 degrees in males.
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26
Q

Angular Conditions: Diagnosis

A
  • Imaging

- Clinical examination

27
Q

Angular Conditions: Physical Therapy

A
  • Decreased loading on the knee

- Maintenance of strength

28
Q

Hip Dysplasia: Etiology

A
  • Abnormality of the femoral head, acetabulum, or both.

- Can result in subluxations, dislocations or both

29
Q

Hip Dysplasia: Risk Factors

A
  • Females more often than males
  • Breech position
  • History
  • Low levels of amniotic fluid
  • Swaddling an infant too tightly
30
Q

Hip Dysplasia: Diagnosis

A
  • Ultrasound after 4 weeks.
  • Radiographs for infants 4-6 months.
  • Clinical Exam
31
Q

Hip Dysplasia: Gold Standard Treatment

A
  • Pavlik Harness
32
Q

Hip Dysplasia: Other Treatment

A
  • Maintain hip in flexion and abduction to maintain femoral head in acetabulum for newborns and 6 month olds
  • Closed reduction and anesthesia followed by spica castor 12 weeks for children 6 months to 2 years
  • Open reduction + spica cast for 6-12 weeks for children older than two years.
33
Q

Hip Dysplasia: Physical Therapy

A
  • Moderate exercise

- Maximize function

34
Q

Transient Synovitis: Etiology

A
  • Acute onset of sudden hip pain in children ages 3-10

- Transient inflammation of the synovium of the hip

35
Q

Transient Synovitis: Diagnosis

A
  • Clinical exam showing decreased hip abduction and and internal rotation
  • Biopsy that shows effusion that causes bulging of the anterior joint capsule
36
Q

Transient Synovitis: Signs and Symptoms

A
  • Hip or groin pain that is unilateral
  • Less common is medial thigh or knee pain
  • Crying at night
  • Antalgic limp
  • Child does not commonly have hip pain.
  • Recent history of upper respiratory infection.
37
Q

Transient Synovitis: Treatment

A
  • NSAIDS and rest while healing.
38
Q

Legg-Calve-Perthes Disease: Etiology

A
  • Blood supply interrupted to the femoral head
  • Age of onset between 2-13 years of age
  • Higher likelihood in males than females
39
Q

Legg-Calve-Perthes Disease: Diagnosis

A
  • MRI showing positive bony crescent sign
40
Q

Legg-Calve-Perthes Disease: Clinical exam

A
  • Psoatic limp due to weakness of poses major
  • Moves in external rotation, flexion, adduction
  • Gradual onset of aching in hip, thigh, or knee
  • AROM limited in abduction and extension
41
Q

Legg-Calve-Perthes Disease: Treatment

A
  • Acetominophin
  • NSAIDS
  • Casting
  • Surgery
42
Q

Legg-Calve-Perthes Disease: Physical Therapy

A
  • Joint/bone protection
  • Maintain/improve joint mechanics/connective tissue function
  • Implementation of conditioning activities
  • Post surgical interventions, regaining functional flexibility, improving strength, endurance, coordination, and gait
43
Q

Slipped Capital Femoral Epiphysis: Etiology

A
  • Unknown etiology

- Most common hip disorder in adolescents

44
Q

Slipped Capital Femoral Epiphysis: Etiology

A
  • Femoral head is displaced posteriorly and inferiorly in relation to the femoral neck and within the acetabulum
45
Q

Slipped Capital Femoral Epiphysis: Etiology: Age of Onset

A
  • Onset in males is 10-17 years with average onset of 13 years
  • Onset in females 8-15 years with average onset at 11 years
  • More common in males than females
46
Q

Slipped Capital Femoral Epiphysis: Diagnosis

A
  • AROM restricted in abduction, flexion, and internal rotation
  • Patient described pain as vague at knee thigh and hip
  • Trendelemberg Gait
  • Imaging shows positive displacement of upper femoral epiphysis.
47
Q

Slipped Capital Femoral Epiphysis: Treatment

A
  • Operative internal fixation
48
Q

Slipped Capital Femoral Epiphysis: Physical Therapy

A
  • Joint/bone protection strategies
  • Maintain/improve joint mechanics and connective tissue functions
  • Implementation of conditioning programs
  • Flexibility
  • Improving strength
  • Endurance
  • Coordination
  • Gait
49
Q

Tendon Lengthening Conditions: Osgood-Schlatter Disease: Etiology

A
  • Mechanical dysfunction resulting in apophysitis of the Tibial Tubercle at the patellar tendon insertion.
50
Q

Tendon Lengthening Conditions: Osgood-Schlatter Disease: Diagnosis

A
  • Radiograph

- Clinical examination

51
Q

Tendon Lengthening Conditions: Osgood-Schlatter Disease: Treatment

A
  • Occasionally surgery
52
Q

Tendon Lengthening Conditions: Osgood-Schlatter Disease: Physical Therapy

A
  • Modify activities to prevent excessive stress to irritated site
  • Flexibility
53
Q

Tendon Lengthening Conditions: Sever’s Disease: Etiology

A
  • Most common cause of heel pain in children occurs before or during peak growth spurt
  • Caused by repetitive micro trauma due to increased traction by the achilles tendon on the insertion site
  • Bilateral 60% of the cases
54
Q

Tendon Lengthening Conditions: Sever’s Disease: Diagnosis

A
  • Imaging
55
Q

Tendon Lengthening Conditions: Sever’s Disease: Treatment

A
  • Temporary cessation of running/jumping activities

- Heel lifts/heel cups

56
Q

Tendon Lengthening Conditions: Sever’s Disease: Physical Therapy

A
  • Stretching

- Strengthening

57
Q

Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Etiology

A
  • Traction apophysists at the patella/patellar tendon junction.
  • Overuse injury due to repeated stresses can occur after significant growth spurt or increased activities.
58
Q

Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Diagnosis

A
  • Radiographs

- Clinical examination

59
Q

Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Treatment

A
  • Temporary cessation of activities
60
Q

Tendon Lengthening Conditions: Sinding-Larsen-Johannson’s Disease: Physical Therapy

A
  • Stretching and strengthening

- Activity modifications

61
Q

Growing Pains/Benign Nocturnal pains of childhood: Etiology

A
  • Unknown etiology
  • Possibly muscular fatigue
  • Poor posture
  • Stress
62
Q

Growing Pains/Benign Nocturnal pains of childhood: Etiology

A
  • No evidence linking growing pains to growing

- Most likely between the ages of 3-5 and 8-11

63
Q

Growing Pains/Benign Nocturnal pains of childhood: Diagnosis

A
  • Clinical exam
  • Increased pain at night
  • Typically bilateral leg pain
  • Not associated with redness, temperature, swelling and tenderness
64
Q

Growing Pains/Benign Nocturnal pains of childhood: Treatment

A
  • Pain management

National Physical Therapy Examination: Pediatrics (18 decks)

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