Week 4 Flashcards
Five ‘S’ for atypical musculoskeletal development
Symmetry
Symptoms
Stiffness
Systemic
Skeletal dysplasia
Osteochondrosis
Non-articular traction:
-Osgood Schlatter’s (tib tuberosity)
-Sinding-Larsen-Johansson’s disease (inferior pole of patella)
-Severes disease (calcaneus)
-Iselin’s disease (5th MT)
Articular cubchondral (crushing)
-Perthes disease (femoral head)
-Kienboc’s disease (lunate)
-Kohler’s disease (navicular)
-Freiberg’s disease (2nd MT)
Articular chondral (splitting)
-Osteochondritis dissecans (femoral condyle, capitellum, talar dome)
Physeal
-Scheuermann’s disease (thoracolumbar spine)
-Blount’s disease (tibia - proximal)
Slipped capital femoral epiphysis (SCFE)
-Very common disorder in adolescents
-Caused by anatomic disruption occurs through the proximal femoral physis. As a result, there is damage to the anterior acetabular cartilage, the labrum and the rim.
-This damage usually occurs very early and the extent of the extent of articular damage is influenced by the duration of the slip, the severity of the deformity as well as the activity level of the patient.
Diagnosis:
-Pain: +/- hip, knee, thigh, and groin.
-The leg is typically externally rotated
-Antalgic gait
-Limb
-Painful hip ROM: internal rotation, flexion, and abduction are limited. External rotation and adduction are often increased
-Typically, the involved hip will fall into external rotation when the hip is passively flexed beyond 90 degrees
-CT
-Xray
-MRI
Risk factors:
-Obesity
-Femoral retroversion (not common)
-Increased physis height
-More vertical slope of the physis
-Metabolic and pathological conditions
-Endocrine disorders
Management:
-Stop weightbearing initially o prevent the further slipping and avoid complications (avascular necrosis)
-Often requires surgery
-Spica Casting, easy range of motion exercises and hydrotherapeutic exercises.
-Progress to partial weightbearing on advise of orthopaedic surgeon and begin gentle strengthening of LL muscles
-Progress to proprioceptive exercises, plyometrics and return to sport
Can be an emergency: avascular necrosis
Adolescent idiopathic scoliosis (AIS)
- Scoliosis not present from a congenital or neuromuscular course
- can effect respiratory function
- Often shaped like an ‘S’ whilst neuromuscular presents more like a ‘C’
-More common in females
-Classified by origin, location magnitude and direction
-Often treated with a brace: 22-23 hours a day, any less doesn’t show any benefit and needs to be worn until growing has ceased
-Can have spinal fusion surgery
Growing pains
Must contain the following criteria
-Intermittent
-Bilateral
-Vague: often anterior thigh, calf, popliteal fossa, shins
-Normal physical examination
-No functional limitation
-Evening/night pain
Other musculoskeletal conditions in childhood
-Juvenile arthritis (Eligoarthritis, polyarticular JIA, systemic, enthesitis-related, psoariatic, undifferentiated)
-Osteogenesis Imperfecta (disorder of connectuve tissue classified by presentation, radiologic criteria and mode of inheritance)
-Limb deformities and deficiencies
-Fractures
-Joint hypermobility (Beighton score: 0-3 = normal, 4-9 = presenting some signs of ligamentous laxity)
-Idiopathic toe walking (diagnosis of exclusion, majority self-resolve)
Fracture types
-Buckle
-Plastic deformation
-Greenstick
-Spinal fracture
-Transverse fracture
-Oblique fracture
Growth plate
-Much less resistance to tensile and shear forces
-Type 1: straight across (6%)
-Type 2: above (75%)
-Type 3: below (8%)
-Type 4: through (10%)
-Type 5: ruined/compression (1%)
Benefits of physical activity for children
- promoting healthy growth and development
- helping to achieve and maintain a healthy weight
- building strong bones and muscles
- improving cardiovascular fitness
- improving balance, coordination and strength
- maintaining and developing flexibility
- improving posture
- assisting with the development of gross motor and fine motor skills
- providing the opportunity to develop fundamental movement skills
- helping to establish connections between different parts of the brain
- improving concentration and thinking skills
- improving confidence and self-esteem
- relieving stress and promoting relaxation
- providing opportunities to develop social skills and make friends
- improving sleep
Physical activity guidelines
Babies:
-Physical activity: several times a day, supervised floor play, >30mins
-Sedentary behaviour: Restrained <1hr at a time (stroller, car seat etc.) and no screen time
Toddlers (1-2 years):
-Physical activity: At least 180 minutes spent in a variety of physical activities, including energetic play, spread throughout the day; more is better
-Sedentary behaviour: Restrained <1hr at a time and no sitting for extended periods. < 2 years, sedentary screen time is not recommended for those aged 2 years, sedentary screen time <1hr; less is better
Pre-schoolers (3-5 years):
-Physical activity: At least 180 minutes spent in a variety of physical activities, of which at least 60 minutes is energtic play, spread throughout the day more is better;
-Sedentary behaviour: restrained <1hr at a time and not sitting for extended periods, screen time <1hr; less is better
Children and adolescents (5-17 years):
-Physical activity: at least 60mins of moderate to vigorous physical activity per day involving mostly aerobic activities - more is better. Vigorous activity and strengthening should be incorporated at least 3 days a week. Several hours of a variety of light physical activities should be undertaken each day. Recreational screen time <2 hours per day
PA behaviours and fitness levels of children with disability
-Children and adolescents with physical disabilities benefit from regular physical activity to prevent comorbidities and functional decline/fatigue.
-Children with chronic disease or disability are less active and/or reduced physical capacity than typically-developing children
-Children with Cerebral Palsy (CP) have reduced exercise tolerance, CR fitness, lower physical work capacity and higher O2
cost during exercise compared with typically developing (TD) peers
-Activity limitations associated with CP tend to result in reduced self-reported quality of life
Factors associated with PA in children with physical disabilities
Personal factors:
– Fitness
– Motivation
– Age
– Time
– Socialisation
– Abilities
– Acceptance of disability
– Knowledge
Environmental factors:
– Family
– Knowledge and support of others (teachers, coach, parents etc)
– Environment (adaptive equipment, suitable facilities etc)
– Sports (type, opportunity, suitable adaptation etc)
– Accessibility
– School
– Transport
Benefits of sports for children
Development of:
* Tracking moving objects and judging velocity - not fully developed until 6-7yrs
* Posture and balance skills - more automatic by 7-8yrs
* Selective attention skills and use of complex memory strategies - mature during the 10–12yrs
* Social skills of concise, effective communication, defining team roles
and being more responsible to others with regard to their actions – maturing by 12-14yrs
Exercise in boys and girls
- Muscular strength of girls may be greater than boys up to age 14 or 16
- Cardiovascular fitness of boys is often greater than girls by age 10
- No reason to segregate (even contact sports) by gender until about age 14 when speed and size begins to favour the developing boys
Injuries in childhood sport
Types:
* Fractures
* Joint injuries
* Concussion
* Muscle-tendon injuries
Location:
* Forearm
* Head
* Lower back
* Hip
* Knee
* Foot and ankle
* Shoulder
> 50% of sports-related injuries in children are likely overuse injuries
Prevention of injury in childhood sports
-Pre-participation assessment
-Individualised training
-Supervision
-Protection – equipment, footwear, padding, helmets
-Environment – playing surfaces, lighting
-Hydration, nutrition, temperature
