Muskuloskeletal dysfunction

Question 1

Where is the weakest point of the long bones?

Answer 1

epiphyseal plate

Question 2

What is the treatment of epiphyseal injuries?

Answer 2

open reduction and internal fixation to prevent growth disturbances

Question 3

compound or open fracture

Answer 3

fractured bone protrudes through the skin

Question 4

Complicated fracture

Answer 4

bone fragments have damaged other organs or tissues

Question 5

Comminuted fracture

Answer 5

small fragments of bone are broken from fractured shaft and lie in surrounding tissue

Question 6

Greenstick fracture

Answer 6

compressed side of bone bends, but tension side of bone breaks, causing incomplete fracture

Question 7

Buckle

Answer 7

compression of porous bone

Question 8

CMs of fractures

Answer 8

generalized swelling
pain or tenderness
diminished functional use
may have bruising, severe muscular rigidity, crepitus

Question 9

5 Ps of fractures

Answer 9

Pain and point of tenderness
Pulselessness (distal to site)
Pallor
Paresthesia- distal
Paralysis- distal

Question 10

3 hip abnormalities in DDH

Answer 10

shallow acetabulum
Subluxation
Dislocations

Question 11

Acetabular dysplasia

Answer 11

femoral head remains in acetabulum, delay in development

Question 12

Subluxation

Answer 12

incomplete dislocation of the hip

Question 13

Dislocation

Answer 13

femoral head looses contact with acetabulum and is displaced posteriorly and superiorly, ligaments elongated and taut

Question 14

What are physiologic factors of DDH?

Answer 14

maternal hormones

Question 15

What are the mechanical factors of DDH?

Answer 15

twins, large gestational weight, and breech

Question 16

What are the genetic factors of DDH?

Answer 16

siblings who also have DDH

Question 17

CMs of DDH

Answer 17

shortened limb on affected side
restricted abduction of hip on affected side
Asymmetric thigh and gluteal folds
Positive Ortolani: click
Positive Barlow: press and feel for movement of the femoral head

Question 18

Therapeutic Management of DDH

Answer 18

splinting
Pavlik harness (3-6 months)
*most successful if treated before two weeks of age
*Treat pain !!!

Question 19

DDH in older infant and child

Answer 19

*may not be noted until infant starts walking
-affected leg shorter
-telescoping or piston mobility of the joint
-trendelenburg sign
-greater trochanter is prominent and appears above line from anterior superior iliac spine to tuberosity of ischium
-marked lordosis and waddling gait if bilateral dislocations

Question 20

Talipus varus

Answer 20

inversion or bending inward

Question 21

Talipes Valgus

Answer 21

eversion or bending outwards

Question 22

Talipes equinus

Answer 22

plantar flexion with toes lower than the heel (95% of causes)

Question 23

Talipes calcaneus

Answer 23

dorsiflexion with toes higher than the heel

Question 24

Positional clubfoot

Answer 24

beleived to be d/t intrauterine crowding, may correct spontaneously

Question 25

Syndromic club foot

Answer 25

associated with other congenital anomalies

Question 26

Congenital club foot

Answer 26

unknown, wide range of severity and prognosis

Question 27

Therapeutic management of club foot

Answer 27

correct the deformity maintenance of the correction until the normal muscle balance is regained Follow up observation for recurrence

Question 28

Metatarsus adductus

Answer 28

often results from abnormal position in the uterus, usually evident at birth *pigeon toed gait *most common congenital foot deformity *cast changed weekly until desired correction

Question 29

Bowleg

Answer 29

knees widely spread and lower legs are turned inward

Question 30

Knock knee

Answer 30

knees close together and lower legs directed outwards

Question 31

Considerations for Genu Varum and Genu Valgum

Answer 31

braces should be worn at night for bowleg braces should be worn day and night for knock knees *begin wearing a brace for 1-2 hours and then progress **Avoid powder and lotions and wear a white liner beneath the brace

Question 32

Legg Calve Perthes Disease

Answer 32

*self limited, idiopathic *avascular necrosis of the femoral head, mostly unilateral *most have delayed bone age *circulation can become obstructed by trauma, inflammation, and coagulation defects

Question 33

CMs of Legg Calve Perthes Dx

Answer 33

*insidious onset, may have history of a limp, soreness or stiffness, limited ROM, vague history of trauma *pain and limp most evident on arising and end of activity *Acute slip: sudden and sever pain, cant bear weight *diagnose by X-ray

Question 34

Therapeutic management of Legg calve perthes

Answer 34

keep head of the femur in the acetabulum containment with various appliances and devices rest, no weight wearing initially surgery in some cases home traction

Question 35

Osgood Schlatter disease

Answer 35

inflammation of proximal tibial physis as it inserts into patellar tendon Associated with repeated stress during adolescent growth spurt from running and jumping

Question 36

CMs Osgood schlatter

Answer 36

swelling or prominence of tubercele may be present painful just below kneecap

Question 37

Treatment of osgood schlatter

Answer 37

resting limb from vigorous activity for several weeks anti-inflammatory meds stretching to strengthen quads wrap knee during activity ice afterwards

Question 38

kyphosis

Answer 38

abnormal increased convex angulation in the curvature of the thoracic spine

Question 39

Lordosis

Answer 39

accentuation of the cervical lumbar curvature beyond physiological limits

Question 40

Scoliosis

Answer 40

complex spinal deformity in 3 planes: -lateral curvature -spinal rotation causing rib asymmetry -thoracic hypokyphosis

Question 41

Septic Arthritis

Answer 41

may result from extension of soft tissue infection

Question 42

CMs of septic arthritis

Answer 42

joint is warm, tender, painful and swollen frequently follows a traumatic injury fever, leukocytosis, increased ESR *Neisseria gonorrheae frequent