Movement science 2 > Pediatric MSK problems > Flashcards

Pediatric MSK problems Flashcards

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1
Q

In-toeing/out-toeing torsion what should you look for/ask

A
  • w-sitting is typical but with abnormalities it can exacerbate them
  • history: want to know prenatal history, delivery etc
  • age questions: when did you notice this and how is it affecting them
  • family history: was someone else having issues with toeing in or out
  • sleeping and sitting positions: ex: stomach sleeping can cause ER at hips
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2
Q

Examination of pediatric MSK problems

A
  • observe child walking especially when they do not know they are being watched
  • supported stance foot progression angle (FPA): walking on a floor with a line to look at if they are diverting in or out form the line
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3
Q

Contributing factors to in-toeing

A
  • femoral anteversion
  • internal tibial torsion
  • metatarsus adductus
  • w-sitting
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4
Q

In-toeing clinical features

A
  • tripping and falling often is a presentation
  • often noticed around 2 years old
  • internal rotation:
    1. 70-80 degrees: mild FA
    2. 80-90 degrees: moderate FA
    3. 90 degrees= severe FA
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5
Q

Internal Tibial Torsion- how can it be corrected in children?

A
  • children may have to wear bracing that looks like a snowboard
  • this will help turn out the tibia
  • some braces are made to allow for more mobility
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6
Q

Metatarsus adductus or varus causes

A
  • infant foot
  • caused by intrauterine pressure, osseous abnormality and abnormal muscle attachments
  • some genetic component
  • contractures of soft tissue around tarsometatarsal joints
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7
Q

Out Toeing

A
  • rare in infants
  • detected when held upright
  • should not go beyond 2 years of life
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8
Q

causes of out-toeing

A
  • slipped capital femoral epiphysis
  • legg-calve-perthes disease (LCP)
  • idiopathic osteonecrosis of the hip
  • neuromuscular disorders
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9
Q

External tibial torsion

A
  • worsens over time
  • late childhood and adolescence is when they are diagnosed
  • rotational deformity
  • requires surgery
  • derotational tibial osteotomy
  • will complain of pain
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10
Q
  • genu varum
A
  • concerning if present after age 4 years
  • if anterolateral bow of tibia = X-rays needed
  • at risk of fractures the first year of life
  • most common cause blount disease
  • can be hereditary
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11
Q

genu valgus

A
  • many are overweight
  • gait patterns is circumduction
  • angular deformity, anterior and medial knee pain are common
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12
Q

Talipes varus vs talipes valgus

A
  1. walks on the outter portion of the foot
  2. walks on the medial portion of the foot
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13
Q

talipes equinus vs talipes calcaneus

A
  • in more plantar flexion
  • ankle in more dorsiflexion
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14
Q

what is clubfoot/metatarsus adductus

A
  • congenital talipes equinovarus
  • 1-2/1000 births
  • different grades of severity
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15
Q

Clubfoot/metatarsus adductus: treatment/goal of treatmetn

A
  • serial casting birth up to 9 years to get into typical position using ponsetti method
  • may need surgery if casting does not work
  • goals:
    1. full loading
    2. plantigrade position
    3. wear normal shoes
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16
Q

Post ponsetti method improvments

A
  • ambulation improves
  • development of milestones improves
  • motor learning (if left in this position they will develop bad movement patterns)
  • balance
  • strenght
  • functional movement skills
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17
Q

Surgical correction of alignment abnormalities- what indicates it/what do they do?

A
  • timing: so important generally earlier if casting is no working
  • age dependent usually infants
  • severity
  • soft tissue release
  • muscle transfer if muscles are not functioning
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18
Q

Cavus foot

A
  • abnormal elevation of the longitudinal arch of the foot
  • forefoot equinus
  • hindfoot calcaneus or varus deformity
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19
Q

cavus foot and associated neurologic consitions

A
  • 2/3rds have CP, spinal cord or charcot-marie-tooth disease (an immune disease that affects joints and causes them to maintain a contracted position - similar to arthritis)
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20
Q
  • surgical procedures of cavus foot
A
  • soft tissue releases (plantar fascia)
  • tendon transfer (especially with nerve damage)
  • ostotomies: metatarsal, midfoot, or calcaneal osteotomies
  • fusions: triple arthrodesis used as a last resort or children who are immobile to reduce risk of fractures
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21
Q

when are feet normally flat until

A
  • 2 years and sometimes 6 years
  • there are flexibilty flatfoot and rigid flatfeet
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22
Q

flexibile flatfeet
- signs
- treatment
- what occurs at subtalar and forefoot

A
  • most common pediatric foot “deformity”
  • uneven medial shoe wear down
  • orthotics can improve uneven shoe wear
  • tightness of the gastrocsoleus muscle
  • higher incidence of flatfeet in blacks
  • subtalar joint is DF, ER,
  • midfoot: abducted
    forefoot is supinated in relation to hindfoot
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23
Q

Test for flexibility in flat feet
- windlass test or jack’s toes raising test

A
  • looks at how flexible the plantar fascia is
  • can be done in sitting or standing
  • when the foot is flat on the ground you raise the big toe and watch if the arch height increases or decreases
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24
Q

Calcaneovalgus:
- commonly seen
- treatments

A
  • commonly seen with CP, spina bifida, idiopathic flatfoot
  • treatments:
    1. stretching
    2. ankle foot orthosis or supramaleolar orthosis
    3. sometimes surgery
    4. serial casting
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25
rocker bottom foot
- less commone - surgery is needed - similar to calcaneovalgus - sometimes with mild cases splinting is needed
26
Knee injuries: adults in relation to kids
- lower incidence in children than in adults - knee injuries are the most common cause of permanent disability in adults
27
Overuse injuries
- 50% of injuries in children are overuse - stress fractures - joint injuries - muscle and tendon injuries
28
overuse injuries are related to
- increased participation in sports - increase in specialization - complex, longer training at younger ages
29
Injury prevention - pre participation examination
- vital sings, height, weight - orthopedic exam - flexibility and strength assessment - body composition - speed, agility, power, balance, endurance
30
Prevention of injuries
- improve muscle reaction time and proprioception - muscle strengthening as a daily training routine - physical examination - diagnosis of muscular imbalances of functional restrictions - proper use of protective equipment - adequate field and surface playing conditions - changes of rules in sports
31
training programs
- individualized based on age and development - energy training aerobic and anaerobic - resistance - speed - nutrition and hydration
32
Risk factors for injury
- training errors - muscle tendon imbalance - anatomical malalignment - improper foot wear (suggested to replace every 3 months) - playing surface - disease - growth-related factors
33
Scoliosis types
- idiopathic - congenital - neuromuscular - degenerative
34
Scoliosis
- lateral deviation of spine from is central axis greater than 10º
35
Structural scoliosis
- person actually has a physical curve
36
functional scoliosis
- person appears to have a curve but caused by another condition such as a different in leg length or muscle spasm - spine will compensate to maintain symmetry
37
What can happen with scoliosis
- can cause trunk imbalances that increase the likelihood for muscle spasms and others leading to pain
38
How does scoliosis progress
- many children is can progress quickly and become deadly - accelerates during growth spurts - estimated that it increases about 0.82º per year adolescent scoliosis is the most common 11-18 years
39
Kyphosis types
- congenital - postural - scheuermann's kyphosis
40
Congenital kyphosis
- babies born with kyphosis often need surgery at a young age
41
postural kyphosis
- due to poor posture which is increased in girls - shows up in teens - if not self-corrected by standing up straight tan PT and bracing is needed for curves create than 65º
42
Scheuermann's kyphosis
- spinal bones grow in an abnormal wedged fashion - usually in teens, - physical therapy, medication, bracing and surgery are needed
43
Halo traction
- used for scoliosis and kyphosis - upward pulling of the head and spine using a weighted pull system to elongate and straighten the spin - stay in the hospital lasts nearly 3 months - not as painful as it looks and you must watch for infections
44
backpack safety: what to look out for
- muscle strain can be caused by improper backpack use - numbness/tingling - tripping - they don't cause scoliosis - should not be carrying more than 15% of body weight in the backpack - put the heaviest items low and near the center of the back
45
Growth related injury risk factors
- affects the growth plate - osteochondritis - apophysitis (inflammation of apophysis) - severs - osgood-schlatters diseases - musculotendinous junction
46
apophysis
- secondary ossification center which acts as an insertion site for tendons
47
Types of injuries in bone
- stress fracture - epiphyseal plate fracture - shaft fracture (more common in adults
48
Salter-harris classification of growth plate fractures
- type 1: Straight across - type 2: Above - type 3: Lowe or beLow - type 4: Two or Through - type 5: ERsture of growth plate or cRush
49
Head injuries from sports
1. concussion = mild traumatic brain injury - more common in skeletally mature kids - rest and return to play guidelines are important 2. skull fracture: environmental trauma, shaken baby syndrome, birth trauma
50
cervical injuries from sports
1. damage to CNS leading to paralysis - football causes most injuries - tends are high % risk of kids who have this 2. hyperflexion or hyperextension injury: - caused by tackling 3. traction injury to brachial plexus (burner)
51
Thoracic spine injuries from sports
- rara - costovertebral injury - occurs with high impact
52
lumbar spine injuries from sports
1. spondylolysis - result of overuse and hyperextension of the lower back often with gymnastics, racket sports, wrestling and football - stress fracture to pars interarticularis 2. spondylolisthesis: may require surgery - slippage - usually L5 overS1 or L4 over L5
53
Shoulders injuries from sports
more mature MSK tends to have these 1. acromioclavicular sprains: - fall on an outstretched arm - common in skeletally mature 2. clavicular fracture - direct blow - middle third 3. dislocation: anterior or posterior 4. rotator cuff: - impingement - tears - 50% of swimmer 12-18 years
54
little league shoulder
- affects proximal humeral physis of the throwing arm - skeletally immature youth baseball pitchers 13-16 years - overuse injury - widening of the growth plate at the humeral scapular junction - also know as epiphysiolysis, epiphysis, osteochondrosis, apophysitis or stress fracture of the proximal humerus - can also occur in swimmers, and football quarterbacks
55
elbow injuries from sports
1. supracondylar fracture - 2nd most common fracture - 5-10 years old - landing on an outstretched arm
56
other elbow fractures
- epiphyseal fracture of radial head from pitching (occurs at growth plate) - subluxation of radial head = nursemaid's elbow (don't pull on the arms of young kids) - elbow dislocation = throwing injury - little league elbow: extreme valgus and stress on epicondyles (overuse) - tennis elbow (lateral epicondylitis = overuse)
57
wrist and hand injuries from sports
- age rrelated - distal radial epiphysis fracture in the younger population - distal radius and ulna fracture in children 10+ - navicular and scaphoid fractures 12-15 years old that fall on a dorsiflexed hand with elbow extended
58
mallet finger-
- caused be over stretching - extensor tendon ruptures - or an avulsion injury - long, ring, and small fingers of the dominate hand
59
bony Gamekeepr's (skiers thumb)
- MCP joint - chronic or acute - partial or complete rupture of the UCL - hyperabduction trauma of the thumb
60
Pelvis and hip injuries: avulsion fractures - common sites - caused by - common in what sports and situations
- avulsion fractures - occurs most commonly at ASIS, ischium, lesser trochanter, AIIS, iliac crest - related to a sudden stretch or strong muscle contraction - common in sprinting, soccer, jumping, football, weight lifting - can happen with child abuse
61
pelvis and hip injuries: stress fracture or osteitis pubis
- related to micro trauma - occurs more in runners - bone scan to identify stress fracture - snapping hip =IT band irritation - vascular necrosis - hip pointer bruise to iliac crest (mostly in football na hockey)
62
knee injuries
- distala femoral epiphyseal fracture - proximal tibial epiphyseal fracture - ACL injuries - avulsion frractures - meniscal injuries - patellar femoral malalignment: most frequent in young children - intrapatellar tenditinitis (jumpers knee) - patellar subluxation or dislocation (high impact and change in positions) – most common in soccer dancing, cheerleading, gymnastics, track
63
Blount's disease
- 3 years and up - lateral epiphysis is not growing but medial is - abnormality of the growth plate in the upper part of the tibia - awkward walking - persistent bowing leads to discomfort in hips, knees, nakles - adolescents experience pain - bracing for tubers and up to adolescence - surgery over 4 years old
64
Q-angle
- pull from quad can cause valgus and a wider stance - normal angle should fall between 8-20º - women <22 degrees with knee extension and less then 9 with knee in 90º of flexion - men <18 in knee extension and 8º in 90º of knee flexion
65
injuries of the ankle and foot
- distal tibia and fibula growth plate fractures related to ankles sprains - metatarsal stress fractures - avascular necrosis of metatarsal epiphysis - Freiburg infarction (often seen in toe walkers) - ankle sprains
66
Sever's disease
- most common cause of heel pain in growing children - growth plate in the back of the heel becomes inflammed and painful - caused by repetitive stress on growth plate - usually between 8-13 years old - most common with basketball and socer
67
symptoms of sever's disease
- heel pain with limping especially after running - swelling and redness - foot discomfort and stiffness after sleeping - pain when the heel is squeezed on both sides
Movement science 2
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