Peds Orthopedics Flashcards
Babies usually have increased ROM where?
shoulder ext/rotation
Wrist Flexion
Hip abd/rotation
Ankle DF/inv/ev
Babies usually have decreased ROM where
knee and hip ext
ankle PF
femoral head facing forward
back?
anteversion
retroversion
anteversion puts baby in ____.. what happens when they WB?
ER
toe in.
What is developmental progression of varus to valgus?
newborn: Varum
6 mo: mild varum
1-2 y/o: straight legs
2-4:genuvalgum
When is valgus not normal?
after 6 y/o
most common form of episodic MS pain in kids 3-12 y/o with no signs of inflammation
growing pains.
What are symptoms of growing pains?
- pain in shin/calf/thigh/popliteal fossa
- Bilateral
- only lasts a bit
how do you resolve growing pains?
- Stretching
- Massage
- Time
What are the types of injuries?
Fx
Joint injury
Muscle.
single/repetitive trauma
Reasoning for repetitive macro trauma?
training error
imbalance
anatomical alignment
footwear
Types of Fx?
Growth plate (usually femur) STress Fx: seen 6-8 weeks post onset
in children, what is seen before tendonitis
avulsion Fx.
What are things to take into consideration with sports screening?
- assess maturity/fitness
- be specific to sport
- Drug use
- dietary abuse.
What are some orthopedic issues during infancy?
Congenital Dislocation
Metatarsus adducts
Talipes equinovarus.
how many grades are there for congenital dislocation
5.
due to a a tight SCM, stuck in lateral flexion to same side and rotation to opposite
Developmental Muscular Torticollis.
What are causes of Developmental muscular torticollis?
-tumor (1/3)
-fetal malposition
-uterine compression
-
Along with SCM, what are other impairment of torticollis?
upper trap/scalenes/hyoids/tongue/face muscles.
plagiocephaly
scoliosis
What are functional limitations of torticollis?
affects righting reactions.
if very severe, affects ability to WB on ipsilateral UE
What is included in examination of torticollis?
ROM (including at rest)
- Face/skull symmetry
- Palpate SCM
- Gross/fine motor development.
Interventions for Torticollis?
better to start before 1 y/o
- stretch with traction
- strengthen (visual tracking)
- prolonged stretch
- orthotics
How are skull deformities prevented?
managed?
parent edu
Prone playtime
helmets
mechanical adjustment.
Plagiocephaly
Scaphocephaly
Brachycephaly
wedge
long
flat.
Caniosynestosis?
sutures fuse and skull will stop expanding. but brain still does. increasing pressure.
cranial helmets used for
head shaping.
What are childhood conditions?
Legg-calve perthes
slipped capital femoral epiphyses SCFE
osgood schlatters
What is lego-calve pethes?
avascular necrosis of femoral head.
signs of legs-calve perthes?
pain in groin/hip AND KNEEE.
shuts of glut med( trendelenberg)
lose abd and decrease IR
any knee pain always examine hip.
sign of SCFE?
knee pain.
antalgic/lurch/outtoe
What is osgood schlatter and what is signs?
what do you avoid?
separation of tibial tubercle
pain at sight
avoid jumping/squatting.
What are the 2 avulsion fractures?
osgood schlatter sever disease (achilles)
what are period of severs disease?
during growth spurts
pain at heel.
how do you treat osgood and sever?
heel lift.
ice
reduct activity
stretch carefully
Management for peds ortho?
- alleviate pain
- improve/maintain range
- improve strength
- improve functional skill.
ages of scoliosis
infant <3
juvenile 3-puberty
adolescent at puberty
more common in female because of estrogen.
progressive scoliosis curve is
increase of 5 degrees from 2 exams.
What to look for in scoliosis screening
shoulder levels soap prominence uneven waist pelvic asymmetry waist window knee levels adams bend test lordosis/kyphosis
how is scoliosis managed?
bracing after >25 deg.
- strengthen trunk
- flexibility laterally, trunk, shoulder.
- respiratory management.
blood clotting disorder
hemophilia
impairments of hemophilia
usually in hinge joints/arthritis can develop from bleed.
pain intramuscular bleed peripheral nerve lesion decreased range/strength gait change
how do you manage hemophilia?
range them splints strengthen (NO low speed isokinetic gait training (with muscle not joint)
JRA
impairments?
rheumatoid arthritis.
before 16 >6 weeks
pain
jt deformity
weak 2ndary to pain
gait change
ADL and gait limited.
management of JRA?
no long lever arm ranges. strengthen protect alignment theraband hydrotherapy/bike.
What a big danger of JRA?
AA sublux.
Osteogenesis imperfecta
brittle bones.
fractures very common
What are types OI
4 types . mild to severe
ambulatory-lethal
Pathology of OI
decreased type 1 collagen
Impairments of OI
decreased range
deformity
decreased strength
delayed development
Management of OI
Active range only! strengthen with activity not resistance orthotics. parent edu surgery.
2 types of arthrogryposis congenita?
hip flex
frog leg
bot that blue feet.
Why does arthrogryposis congenita happen?
lack of fetal mvmnt in 1st trimester
muscle turn to fibrous fatty tissue
impairments of arthrogryposis congenita?
jt contractures
weak muscles and imbalance.
management of arthrogryposis congenita
stretch strengthen position orthotic surgery.
what is PFFD
femur doesn’t form properly.
either short or literally not there.
What develops from PFFD
frog leg position
hip/knee contracture
leg length discrepancy
gets amputation/rotationplasty.
in nonverbal kids
what are signs of discomfort during range
noisy breathing
facial expression
tension at end range
fidgeting.
children with disability more likely to be
abused
neglected
