Week 7 Flashcards
Musculoskeletal development in infants
- Matrix for skeleton laid down in first month of conception
- Joints and muscles formed by 3 months gestation and ready
for further development - Features at birth
-Kyphosis from c-spine to sacrum
-Hip flexion/lateral rotation
-Medial rotation of tibia
-Equinus position of feet
-Varying limitation of hip, knee, elbow extension - Response physical demands
- Muscle tissue growth
-Tension leads to longitudinal growth
-Rapid foetal growth passively stretches muscles and stimulates it
to grow longer at the same rate as the bone. - Bone growth
-After birth, long bones grow in length at epiphyseal plate
-Cartilaginous plate (Proliferates, Chondrocytes, Converted to bone, Ossification)
Changes in lower limb alignment
Newborn:
- Moderate genu varum
6 months:
- Minimal genu-varum
1 to 2 years:
- Legs straight
2 to 4 years:
-Physiologic genu valgus
16 year old females:
- Slight genu valgum
16 year old males
- Slight genu varum
Conditions
- Fractures
- Clubfoot (congenital talipes equino-varus)
- Postural foot/hand deformities
- Developmental dysplasia of the hip
- Torticollis/deformational plagiocephaly
-Obstetrical nerve palsies
-Osteogenesis imperfecta
-Arthrogryposis
Developmental dysplasia of the hip (DDH)
- Abnormal development of hip joint
Aetiology:
- Intrauterine positioning resulting in a stretched posterior capsule
- Neurological condition
- The hip presents as dislocated, dislocatable or subluxed
Management:
- All babies screen at birth
- Irremovable splint fitted on day 1 (von rosen splint)
Physio:
- Need to understand DDH
- May suspect the condition if:
* limb length discrepancy
* asymmetry of movement
* limited range of hip abduction
* asymmetrical thigh folds
* limping or waddling gait (toddler)
* may be associated with torticollis
- Immediate referral for orthopaedic
review
Congenital muscular torticollis (CMT)
- Involves shortening of the sternocleidomastoid (SCM)
muscle + tumour - Tilt their head…
- toward the side of the affected muscle
- rotate toward the contralateral side.
- Upper trapezius muscle can also be involved and contribute to the neck deformity
- Unknown cause
- If torticollis persists, craniofacial deformities or plagiocephaly can occur
Torticollis
- Secondary to
- Skeletal
- Neurological
- Muscular (Sternomastoid tumour, Muscular tightness, Postural)
- Visual/vestibular disorder
- Aim for active correction
Deformational plagiocephaly
- Postural condition
- Oblique, misshapen, parallelogram head
- Repeated external pressure to the head as a result of being in the one position for extended lengths of time (sleeping)
- Flattening of the occipital bone,
- More prominent forehead and cheek on that side
- The ear pushed forward compared with the other
Prevention/management:
- Infant positioning is associated with early head orientation and plagiocephaly development. Early parent-reported asymmetry during awake and sleep time is an important indicator for the need for
professional assessment and advice.
-From birth – alternate the head position when sleeping
-Encourage active head control strategies (prone, sideways lift etc)
-If no improvement after 2 sessions, ensure a medical review to rule out pathology (craniosynostosis, cervical rib)
-Do not refer for helmet unless specialist review has occurred
Brachial plexus palsy
Causes:
- Prenatal (position in utero)
- Trauma during labour
- Delivery (shoulder dystonia)
- Klumpke (C7-8, T1 nerve roots)
- Erb (C5-6 nerve roots)
Assessment:
- Background information
- Medical review
- CNS + PNS examination (gentle) and documentation
- X-ray – fractures, hemidiaphragm(phrenic nerve injury)
- Serology e.g. exclude septic join
Objective:
- Observe – supine and prone (including alertness, shoulder muscle
wasting, marked deformities)
- Spontaneous movement whole baby
- Sucking – looking for oromotor involvement
- Active movement – shoulder abduction (Moro), elbow flexion (recoil or stroking of biceps belly), wrist extension (placing reaction)
- Passive movement – including shoulder ER in neutral
- Sensation
- Other problems: # clavicle or humerus, postural foot deformities,
torticollis, DDH
Brachial plexus palsy
Causes:
- Prenatal (position in utero)
- Trauma during labour
- Delivery (shoulder dystonia)
- Klumpke (C7-8, T1 nerve roots)
- Erb (C5-6 nerve roots)
Assessment:
- Background information
- Medical review
- CNS + PNS examination (gentle) and documentation
- X-ray – fractures, hemidiaphragm(phrenic nerve injury)
- Serology e.g. exclude septic join
Objective:
- Observe – supine and prone (including alertness, shoulder muscle
wasting, marked deformities)
- Spontaneous movement whole baby
- Sucking – looking for oromotor involvement
- Active movement – shoulder abduction (Moro), elbow flexion (recoil or stroking of biceps belly), wrist extension (placing reaction)
- Passive movement – including shoulder ER in neutral
- Sensation
- Other problems: # clavicle or humerus, postural foot deformities,
torticollis, DDH
Management:
- Pain relief
- Parental reassurance (90% recover within 3 months)
- Minimal handling – do not passively move/range arm
- Gentle massage and stroking to facilitate active movement
- Swaddling with hands to mouth
- Swaddled bathing
- Positioning - affected side up for feeding and sleeping
- Education parents/staff re supporting arm with handling
- Peanut pillow
Palsies
Sciatic
- presents with foot drop
- Managed with splinting, passive movements and stimulation of affected muscle groups
Facial:
- Presents with feeding difficulties and asymmetrical facial movements
- managed with oral stimulation, including jaw and check support for feeding
- Watch for other asymmetries (torticollis)
Radial
- Presents with wrist drop
- managed with splinting, stimulation of affected groups
Osteogenesis imperfecta
- Brittle Bone Disease
- Failure of bone matrix formation
- Congenital osteoporosis
- Blue sclera
- Early hearing loss
- Developmental approach
- Equipment – bean bags, seating etc.
- # identification and immobilisation
- Parental support
Arthrogryposis multiplex congenital
- Non progressive neuromuscular syndrome
- Joint contractures
- Muscles (poorly developed, replaced by fibrous tissue)
- Early treatment of deformities (clubfoot, hip and knee contractures)
- Casting/Splinting
- Handling and positioning
- Developmental car
