1
Q
obstetric brachial plexus injury
OBPI/BPI
A
- to upper and/or lower brachial plexus during difficult vaginal deliveries - can be at any level of brachial plexus
- 52% are C5-C6
- forceful traction or rotation of the head or shoulder: can also have fracture of clavicle or humerus
- usually made at birth - arm appears flaccid or only moves slightly, parents told right away
- EMG shows injury
- Erb’s palsy
2
Q
erb’s palsy
A
- injury to C5-C6, sometimes C5-C7
- sensory loss possible
- “waiter’s tip” position
3
Q
OBPI prognosis
A
- stretch heals faster than a full rupture
- 80-90% resolve in 3 months
- biceps recovery is predictive: cookie test
4
Q
OBPI intervention
A
- ROM
- sensory: protect, increase awareness, sensory input, never pull or traction affected arm
- active movement: meaningful, age appropriate, gross, and fine motor skills
- electrical stimulation
- possible splinting and kinesiotape
- constraint therapy
- the earlier the better
- focus on developmental and functional activities
- conservative treatment is effective intervention
5
Q
arthrogryposis multiplex congenita
A
- nonprogressive, congenital NM syndrome (multi system involvement)
- 2 or more body areas, may just have distal involvement
- incidence 1/3000-4000 births
- clinical picture is variable: joint contractures, muscle weakness/fibrosis, absence of muscles (amyoplasia)
- etiology unknown: correlates with lack of movement in utero
- possible causes: taratogens, virus, maternal fever, somee forms hereditary (chromosome 5)
6
Q
arthrogryposis multiplex congenita impairments and conditions
A
- primary impairments: joint contractures, muscle weakness
- associated conditions: clubfoot, hip dislocation, typically have normal cognition and speech
- diagnosis: no definitive tests, rule out other causes
7
Q
arthrogryposis presentations and associated factors
A
- scoliosis
- dimpling of skin over joints
- hemangiomas
- absent or decrease finger creases
- congenital heart disease
- faacial abnormalities
- respiratory problems
- abdominal hernias
8
Q
developmental dysplasia of the hip
A
- packaging
- test with Barlow maneuver
- treat with Ortolani maneuver
9
Q
torticollis
A
- sternocleidomastoid - named for side of tightness
- ipsilateral lateral rotation, contralateral rotation
- thir most common congenital abnormality
- active ROM - muscle function scale
- passive ROM - arthodial goniometer
10
Q
osteogenesis imperfecta
A
- brittle bone disease: mobility and developmental delays, pain, posture, ROM
- genetic, autosomal dominant, 1/20,000
- Type 1 - most common, mild, little or no deformity
- Type 2, 3, 7, 8 - severe symptoms, compromises respiratory or cardiac compromise
- Type 4, 5, 6 - moderate
- PT: family education, moving and positioning, adaptive/assistive equipment, aquatic therapy, robotics
not casts, too heavy to lift
transition well to adults
11
Q
clubfoot and ankle-foot conditions
A
- metatarsus adductus/varus
- calcaneovalgus
- talipes equinovarus (clubfoot)
12
Q
metatarsus adductus/varus
A
- mild: forefoot correctable, spontaneously corrects by 4-6 months
- moderate: straight last or reverse last shoes, possible serial casting
- severe: forefoot not correctable, serial casting, surgery
a packaging issue
can watch until 4 to see if it spontaneously resolves
13
Q
calcaneovalgus
A
- hindooft valgus, more than 30% of neonates have bilaterally
- excessive dorsiflexion
- corrects spontaneously
14
Q
clubfoot - talipes equinovarus
A
- 1-2/1,000, genetic, mostly male
- 50% bilateral
- forefoot curved medially, small calcaneus, hindfoot varus, ankle PF, calf atrophy
15
Q
ponsetti method
sequential serial casting
A
- standard for clubfoot outside of US
- can cause skin breakdown if not careful
- begin 7-10 days, most effective before 9 months
- PT’s can be trained in Ponsetti
- goals after casting: normal strength (PF and DF), mobility, positioning during gait, closed-chain and open-chain activities
16
Q
developmental dysplasia of the hip (DDH)
A
- packaging and associated conditions: CMT and plagiocephaly, metatarsus adductus, calcaneovalgus
- Barlow and ortolani tests until 3 months old
- use Pavlik harness, hip spicea, osteotomies, ROM and developmentally appropriate activity and strengthening
17
Q
tests for infant hip DDH
A
- B before O
- barlow test: flex and abducted, then gradually adduct with pressure in posterior direction
- ortolani maneuver: if B test is positive, gentle flexion then abduction, slight anterior traction
can also look at asymmetrical skin folds, atypical gait
18
Q
legg-calve-perthes disease
A
- osteochondrosis: ossification which begins as degeneration followed by regeneration
- avascular necrosis of femoral head (obturator if < 10, med circumflex femoral if > 10)
- 1/1200 under 12, mostly active boys 4-8
- pain in knee, hip, groin - unilaterally (10% bilateral)
- limp/trendelenburg gait
- PT: pain management, ROM, rest or activity modification, crustches or WC, promote symmetry
50% have degenerative hip disease by 50
19
Q
slipped capital femoral epiphysis (SCFE)
A
- displacement of femoral head on femoral neck, head inferior and posterior in relationship to femoral neck
- 10/100,000, more boys than girls, more children who are Black or PI
- tend to be obese, skeletally immature males, around time of puberty/growth spurt
- ROM limited hip flexion and lateral rotation, rest in lateral rotation, limp, pain
- surgical intervention
- PT: strength, ROM, nWB most often pre-op, promote symmetry, have THA 11 years earlier than OA patients
20
Q
limping and leg length discrepancy
A
- history of trauma
- normal neurologic examination
- fever
21
Q
differential diagnosis of antalgic gait
A
- congenital conditions: hemihypertrophy, hemiatrophy, focal deficiencies
22
Q
treatments for leg length discrepancy
A
- conservative: observation (0-2 cm), lift (2-4 cm)
- surgical: shortening (4-6 cm), lengthening (4-20 cm), prosthesis (>20 cm)
- epiphysiodesis: surgical shortening of long leg
- Wagner or Ilizarov: lengthening for short leg
- PT post-op: ROM, strengthening, stretching, pain management, gait training, functional activities, developmental
23
Q
pediatric amputation
A
- congenital, traumatic, cancer, focal deficiencies, other
- rotationplasty
24
Q
pediatric pelvis begins in [ ] tilt
A
posterior tilt
* increases through 2-4 years
* age 3-5 between 10-20 degrees anterior tilt
25
test to measure femoral anteversion
* Craig's or Ryder method
* 40 degrees at birth, 35 at 1 year, 21 at 9 years, 15-20 for adult
* if anteverted, improves possible around age of 6
26
4 possible reasons for pediatrics toe-in
* increased femoral anteversion at hip
* increased tibial torsion at knee (less common)
* increased axial tibio-femoral rotation at knee -- W-sitting
* metatarsus adducts at foot (in babies)
| babies at the foot, toddlers at the knee, school at the hip
26
4 possible reasons for pediatrics toe-in
* increased femoral anteversion at hip
* increased tibial torsion at knee (less common)
* increased axial tibio-femoral rotation at knee -- W-sitting
* metatarsus adducts at foot (in babies)
| babies at the foot, toddlers at the knee, school at the hip
27
general changes from birth to adulthood in MSK
* sacral angle
* acetabulum
* coxa vera and valga
* anteversion
* hip ER
* hip flexion
* genu varum and valgum
* foot progression angle
* axial tibio/femoral rotations
* arch development
* sacral angle: posterior to anterior
* acetabulum: retroverted to anteverted
* coxa vera and valga: valga to vera
* anteversion: 40 degrees to 8-15 degrees
* hip ER: large to less
* hip flexion: large to less (contracture to extension)
* genu varum and valgum: varum to valgum
* foot progression angle: 10 degrees to 0 degrees
* axial tibio/femoral rotations: 65 degrees to less than 40
* arch development: increases from birth to 3 years
MSK IV
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Decks in class (8)
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