3.4 - peds orthopedics 2

arthrogryposis multiplex congenita

_______________ is a condition that is described as a non-progressive neuromuscular syndrome that is present at birth with severe joint contractures of 2 or more body areas that are present at birth

• amyoplasia (**most recognized)

• central nervous system (not compatible with life)

• heterogeneous

what are the 3 types of arthrogryposis multiplex congenita?

which is the most common?

• frog legged

• jack knifed

what are the 2 presentations of arthrogryposis multiplex congenita

T

T/F: clubfoot is common in BOTH frog legged and jack knifed positions of arthrogryposis multiplex congenita

• knee extension

• hip IR and adduction

what is the presentation of jack knife position in arthrogryposis multiplex congenita

hip abduction and ER

what is the presentation of frog legged position in arthrogryposis multiplex congenita

• contractures

• muscle weakness

• fibrosis

what are the 3 body structure and function abnormalities associated with arthrogryposis multiplex congenita

fetal akinesia (lack of movt in whomb) or possible insult during first trimester (hyperthermia, infection, vascular compromise, uterine fibroids and septum in uterus, fetal crowding, decreased amniotic fluid)

what is the etiology of arthrogryposis multiplex congenita

osteogenesis imperfecta

_______________ is a condition that is described as brittle bone disease

11; 1

PT = 1, 3, 4, 5, 6, 11, mild 7

there are ________ types of osteogenesis imperfecta, type _______ is the most common

which types are appropriate for physical therapy?

FALSE!!!!!!!!!! DO NOT STRETCH THEM THEY WILL BREAK

T/F: passive stretching is effective for treating a child with osteogenesis imperfecta

C5-6

what nerves does erb’s palsy affect?

C5-T1

what nerves does global palsy affect?

T1 - sympathetic ganglion

what nerves does horner’s syndrome affect?

C8-T1

what nerves does Klympke’s palsy affect?

waiters tip

erb’s palsy is also called ___________

klympke’s

does erb’s palsy or klympke’s have more shoulder innervation?

erb’s palsy (note the shoulder IR)

what neurological injury is this picture demonstrating?

1mm/day

what is the rate of nerve growth?

klumpke’s palsy

what neurological injury is this picture demonstrating?

long

neonatal brachial plexus injuries are more common when labor is (short or long)

high

neonatal brachial plexus injuries are more common when the birth weight is (low or high)

brachial plexus and hip dysplasia

breech deliveries often cause _____________ and _____________ injury

active movement scale (AMS)

the ________________ test is used to assess upper-extremity motor function in infants and children with obstetric brachial plexus palsy (OBPP)

birth to 3

what age range does the active movement scale apply to

• 0

• 4

• 7

grading for Active Movement Scale (AMS)

• a score of ______ is no contraction

• a score of ______ is full motion gravity eliminated

• a score of ______ is full motion against gravity

3+ years

what age range does the mallet’s classification of function apply to

• 5

• 1

grading for the mallet’s classification of function:

• grade ______ is normal

• grade ______ is no function

FLACC

what test would you use to assess an infant’s pain

• torticollis

• hip dysplasia

what are 2 conditions can co-occur with a brachial plexus injury

• left

• female

• first born

developmental dysplasia of the hip:

• more likely for left or right

• more likely for female or male

• more likely for first born or siblings

• breech delivery

• + family history

• post-maturity birth

• increased weight

likelihood factors of hip dysplasia (4)

• torticollis

• hip dysplasia

what other conditions are likely to be present with a brachial plexus injury

• torticollis

• metatarsus adductus

what other conditions are likely to be present with a hip dysplasia injury

< 4 months

ultrasound is the gold standard for diagnosing hip dysplasia if the child’s age is ____________

ultrasound (if under age 4 months)

______________ is the gold standard for diagnosing hip dysplasia

4-6+ months

radiographic imaging for hip dysplasia is for if the child’s age is __________

• barlow (pop hip out, “bar” = we going out)

• ortolani (go back in)

what are the special tests for hip dysplasia

barlow (the “dislocate”/”out” part of the test)

when conducting the hip dysplasia tests, the ____________ test puts the babies legs in an adducted position and applies a mild posterior force

ortolani

when conducting the hip dysplasia tests, the ____________ test puts the babies legs in an abducted position to reduce the hip

spica cast; pavlik harness

______________ or _____________ can be applied to help correct hip dysplasia

flexion, abduction, ER; 23hrs/day

the casting to correct hip dysplasia puts the hip in a _____________ position and wear for __________ amount of time

clubfeet/talipes equinovarus

what condition?

talipes equinovarus

clubfeet is also called ________________

• adductus

• varus

• equinus (limited dorsiflexion)

positioning of club feet/talipes equinovarus:

• forefoot ____________

• hindfoot ____________

• ankle ______________

• thickened

• hypoplastic

• small (flattened superior surface)

• downward and medial

affected structures in club feet/talipes equinovarus:

• ligaments: ______________

• muscles: ______________

• talus: ______________

• navicular: ______________

ponseti

_______________ casting is used to help correct clubbed foot

forefoot (correct one plane at a time)

the first stage of ponseti casting to correct club feet/talipes equinovarus would be correcting the ____________ part of the foot

medial

metatarsus adductus is a (medial or lateral) forefoot curve

• intrauterine

• anterior tibialis; posterior tibialis

• cuneiform

• club foot

contributing factors for metatarsus adductus:

• ______________ positioning

• different insertion point for ________ and ________ muscles

• abnormal ____________ shape

• _______________

1

grade _________ metatarsus adductus:

mild, flexible, can correct beyond midline

2

grade _________ metatarsus adductus:

moderate, can correct to midline

3

grade _________ metatarsus adductus:

severe, cannot correct to midline

• casting

• surgery (if child is 4+ years)

what are the invention options for metatarsus adductus

T

T/F: flat foot usually does NOT need treatment

flat foot

which has less problems:

flat foot or high arch

DF

calcaneal valgus is excessive (DF or PF)

laterally

the forefoot in calcaneal valgus is curved (medially or laterally)

varus

clubbed feet is calcaneal (valgus or varus)

vara; medial

in blount’s disease, there is tibia _______ and (medial or lateral) growth plate dysfunction

D

rickets disease is a vitamin ________ deficiency

C

scurvy is a vitamin ______ deficiency

scurvy

signs/sx of ___________ disease:

• joint pain

• swollen and bleeding gums

• petechial hemorrhaging

legg-calve perthes

_______________ is avascular necrosis of the hip in childhood

epiphyseal plate

legg-calve perthes is decreased blood to the ______________

• 3-12

• 5-7

legg-calve perthes occurs from ages _____-_____ but is most common from ages ______-_____

males

legg-calve perthes occurs more in (females or males)

T

T/F: maternal smoking and secondhad smoke can play a factor in a child developing legg-calve perthes

it’s the same but legg-calve perthes is non-weight bearing

what’s the difference in hip dysplasia and legg-calve perthes casting

less than 6

if the a child has legg-calve perthes and they are age ________, conservative treatment is recommended

F

T/F: Slipped capital femoral epiphysis is more common in females

peri-puberty

• males = 10-16

• females = 10-14

what age does slipped capital femoral epiphysis typically occur in males and females

flexion and IR

someone with slipped capital femoral epiphysis will have decreased ROM in…..

• PT

• surgical pins

treatment options for slipped capital femoral epiphysis

covex

scoliosis is labeled via the __________ side

cobb angle

the _____________ is used to measure the angle of scoliosis

risser’s sign

________________ is a radiographic grading system that assesses skeletal maturity by measuring the ossification and fusion of the iliac crest apophysis on a pelvic X-ray which is used to test for scoliosis

presence of structural scoliosis

what does the forward bending test asses

schroth

the _____________ technique is used to treat scoliosis and it involves stretching the concave side and strengthening the convex side

osgood schlatters

what condition?

severs

what condition?