**Name 3 things musculoskeletal development is affected by
- Genetics
- Nutrition
- Drugs
- Hormones
- Mechanical forces
- Injury/trauma
- intervention (surgery, splinting, casting, restraints)
**Name specific items you would look for in a child’s medical chart relating to orthopaedic growth ol development
- height
- weight
- head circumference and/or other cranial measures
- In-utero measures
- Signs of skeletal maturity
**4 levels of DDH
- Subluxable: femoral head can easily be partially displaced to the rim of the acetabulum
- Dislocatable: femoral head is in the socket but it it can be displaced completely outside the acetabulum wiht manual therapy
- Dislocated: femoral head lies completely outside hip socket but can be reduced with manual therapy
- Teratologic: femoral head lies completely outside the hip socket & cannot be reduced with manual pressure
**When is ossification of the hind foot first observable?
- Calcaneous: 23 wks of gestation
- Talus: 28 wks
**Describe the anatomy of the CTEV deformity
- Equinas (plantarflexion) at the talocrural joint
- Adduction & inversion at the subtalar & mid tarsal joints. Navicular tuberosity is close to the medial malleolus
- Metatarsal adductored
What condition may be associated with postural TEV?
- facial deformity, mandibular asymmetry
- plagiocephaly
- toricollis
- hip dislocation
- metatarsus adductus
- Postural TEV
Describe the management of Postural TEV
- AROM: encourage DF & eversion
- PROM: gentle passive stretches
- Taping: may include maintaining the corrected alignment of the foot & ankle with adhesive taping
- Follow up: once correction is attained there is no potential for relapse, so you can discharge the child, with parent able to return if concerned
**6 clinical signs of contracture according to the Pirani & Outerbridge Evaluation of CTEV
Postural contracture (hind foot contracture)
- Posterior crease
- Empty heel
- Rigid Equinas
Medial Contrature
- Curvature of lateral border of the foot
- Medial crease
- Lateral part of the head of the talus
Physio management technique for Structural TEV
- Serial casting
- Ponseti method
What is the steps of ponseti correction technique?
- Correct the cavus
o 1st MT is in more fl than other MT (causing cavus) corrected by ext the 1st MT + holding forefoot in supination to align w/ midfoot and calc
o Heel is not touched - Re-align the fore-foot, mid foot and hindfoot= swing foot outwards
o Gradually abduct supinated foot under talus w/ counter-pressure on head of talus to stabilize bone
o Medial tarsal lig are stretched allowing calc to abduct w/ foot + ant tuberosity of calc is disengaged from its position under head of talus - Correct into DF
o Don’t do this early or else mid foot will break – must do above 2 steps first
o Corrected when dots on head of talus and on nav coincide + ant tub of calc is disengaged from its position under headl of talus - Overcorrection – getting to neutral is not enough
Requires full abd of midfoot and forefoot – stretches tight medial tarsal ligs through full ROM
What is treatment for congenital vertical talus
-Refer: surgical correction required to re-align this congential anomaly
S & S of Benign Joint Hypermobility Syndrome
Primary characteristics
- generalised joint hyper mobility
- chronic joint pain
- Other MSK signs related to defect in collagen
Females> Males
Family history
Often posture and motor control diff similar to DCD
Name the items on the Beighton Score test
elbow knee pinky thumb touch floor
Treatment for BJHS
- Joint stability
- Low-impact exercise
- Lifestyle modifications
- Pain management
- Proprioception
- Joint range
MSK issued associated with Ehler’s Danlo Syndrome
- Hyper-flexible joints (unstable, finger deformities)
- Joint & tissue degeneration (early onset OA, tearing muscles and tendons)
- Deformities of the spine (scoliosis, kyphosis, tethered spinal cord syndrome, occipitoatlantoaxial hyper mobility)
- Pain (Myalgia, arthralgia, Osgood-schlatter disease)
- Trendelenburg
Mx Type 1 Osteogenesis imperfecta
Collagen normal quality but insufficient quantities
MSK features: short stature, bone fracture easily, slight spinal curvature, loose joint, poor muscle tone
Gentle to decrease risk of fracture, pain, fear of moving, pressure
- Strengthen muscles & improve flex to reduce deformity
- improve endurance
Developmental therapy
- hydrotherapy
- land play-based therapy
Physio
- Physical aids
- Monitoring & education
S & S Legg-Calve perches disease
- painful limp
- limitaiton of IR and ABD hip
- Most commonly seen in 4-8 year old children
- leg length inequality
S & S Slipped capital/upper femoral epiphysis
-more common in adolescent males
-can be acute
-chronic
-referred pain to thigh and knee
-may limp
hold leg in hip ER
-leg length inequality
S & S Osterosarcoma
- pain a presenting feature: severe joint/bone pain, pain at rest
- swelling in bones/joints
- reluctance to weight bear/accept load with limb
elements of PT role pre-post surgery for osteosarcoma
ASSESS
-Pain, extent of deficiency, AROM, PROM, muscle imbalance, impact motor skills, monitor growth
TREAT
PRE: ROM, strength, mobility
Post: maintain ROM, M strengthening, mobility training, manage pain
What is cranial index and what does it measure
Anteroposterior measures
- ration of anterograde-posterir to lateral diameter of the cranium
- degree of flattening
- identify brachycephaly >width and scaphocephaly
treatment for plagiocephaly
ABC
Active baby- play positions
Balanced handling- carrying in diff postions
Correction strategies- encourage baby to turn their head to their non-preferred side
Treatment for torticollis
- Parent education
- Active facilitation: into limited range of movement
- Positioning: encourage movement into limited range movement
- Carrying positon: encourage lengthening of contracture
Treatment for DMD
stretching, positioning, splinting, orthoses, seating, standing =activities, adaptive equipment, assisted technology, strollers/scooters, wheelchairs
