Peds Mini Series Flashcards
injury to the upper and lower brachial plexus during difficult vaginal delivery
obstetric brachial plexus injury
How does obstetric brachial plexus injury occur?
forceful traction or rotation of the head and shoulders (breech delivery)
fracture to the clavicle or humerus
how will a baby present with a diagnosis obstetric brachial plexus injuries?
made at birth
arm appears flaccid or moves only slightly
What is the condition called if obstetric brachial plexus injury does not improve?
erb’s palsy
A baby with erbs palsy (injury to c5-c6) how will they present with a resting posture?
rhomboids, levator, serratus, subscap, supraspinatus, infraspinatus
biceps, supinator affected
baby sits in internal rotation and adduction flaccid shoulder
baby will sit with a “waiters tip” position
If a baby sits with an arm in a waiters tip position what injury would you think?
obstetric brachial plexus injury
erbs palsy (C5-C6)
With Obstetric brachial plexus injury would a stretch or a rupture heal faster?
stretch
what percentage of OBPI babies recover in 3 months?
80-90%
what is a cookie test?
if a baby can bring their hand to their mouth
If a baby is unable to bring their hand to their mouth at_____ months they have a poor recovery for OBI
> 6 months
A pt should focus on ___ and _____ activities to promote recovery in OBPI?
developmental and functional
Current evidence suggest conservative treatment is an _______ intervention for most BPI at this time
effective
nonprogressive, congenital neuromuscular syndrome
Clinical picture:
severe joint contracture
muscle weakness
muscle fibrosis
absence of muscles
Arthrogryposis Multiplex Congenita
What causes arthrogyposis multiplex congenita
etiology unknown
What are the primary impairments of arthrogyposis multiplex congenita
severe joint contracture
muscle weakness
Do children with arthrogyposis multiplex congenita have impaired congnition?
no normal cognition and speech
Can arthrogyposis multiplex congenita be diagnosed in utero?
no definitive test but ultrasound may be suggestive
What are some interventions for decreased ROM for AMC?
stretching
positioning
splinting/bracing
casting
By 5 years old what percentage of those with AMC are independent with ADLs and mobility?
85%
Will indvidiuals with AMC have pain with aging, increased muscle weakness
yes
will individuals with AMC have a compromised lifespan?
no but increased secondary impairments
Brittle bone disease; sneezing could cause bones to break
defect in structure of synthesis of type 1 collagen
osteogenesis imperfecta
Which type of OI is most severe and most rare; frequently fatal in infancy?
type 2
Do mild or moderate forms of OI affect life expectancy?
No
Signs and symptoms of OI
brittle bones
short small bones
loose joints
curved spine
blue sclera of the eye
brittle teeth
hearing loss
What are 3 good interventions for an individual with OI
- early intervention/positioning handling
- strengthening/ aerobic conditioning/ aquatic therapy
- protected ambulation
are there any congitive declines with OI?
no most are ambitious productive 1/2 adults choose to marry
Do most individuals with OI use for community mobility?
wheel chair
is calcaneiovalgus the same as club foot?
no its a condition that more than 30% of babies have excessive dorsiflexion that corrects spontaneously
what is the presentation of clubfoot- talipes equinovarus
forefoot curved medially
small calcaneus, hindfoot varus
ankle plantarflexion
Is there good outcomes with conservative treatment of talipes equinovarus (clubfoot)
yes
What condition do you use ponseti casting method?
talipes equinovarus Club foot
Do pt need to be trained in the ponseti method?
yes
What are 3 risk factors for development dysplasia of the hip?
- female
- twins
- breached
What are 4 conditions from tight packaging?
- CMT
- plagiocephaly
- metatarsus adductus
- calcaneovalgus
What is the barlow test?
hip is flexed and abducted gradually adducted with pressure posterior
what does a positive Barlow test determine
unstable hip
What is an ortolani test?
in the positive hip the hip is dislocated gentle flexion and abduction and slight anterior traction reduces the hip
At what age can you stop using barlow ortolani test
3 months
Who uses a pavlik harness
newborns
who uses a hip spica
8 months old
a disease of the growth or ossification centers in children which begins as a degeneration or necrosis followed by regeneration or recalcification
Osteochondrosis
self limiting disease of hip produced by ischemia varying degrees of avascular necrosis of femoral head and spontaneous regeneration
legg calve perthes disease
Legg calve perthes disease is most common in boys or girls
boys
what are the impairments associated with legg calve perthes disease?
pain often in knee, groin or hip
limited ROM: abduction, internal rotation
Herring lateral pillar classification is a measure of what in legg calve perthes disease
amount of collapsed area
approximately 50% of individuals with legg calve perthes will have _____by the 5th decade?
degenerative hip disease
Displacement of femoral head on femoral neck: head inferior and posterior in relation to the femoral neck
slipped capital femoral epiphysis (SCFE)
true/false tend to be obese skeletally immature males around time of puberty/growth spurts
true
What are the 5 common impairments associated with SCFE
- ROM limited hip flexion and lateral rotation
- rest in hip lateral rotation
- limp
- pain
- shortening of affected limb
true/false surgical intervention for unstable acute SCFE most return to normal function within 3-6 months
true
What are the 3 main questions for clinical decision making children with a limp
- history of trauma
- normal neurological examination
- fever
surgical shortening of long leg
epiphysiodesis
surgical limb lengthening on affected short leg
wagner or illizarov
