Pedia 2 Module 5B: Responses to alterations in musculoskeletal coordination

Fracture

Fracture

• a crack or break in the continuity of the bone

• an interruption of a bone’s wholeness

• symptoms:

  • Pain and tenderness at the site

  • swelling and loss of function

  • deformity and crepitus

  • dislocation and bleeding from the open wound

Strain

• stretching or tearing of muscle

• injury to the muscle or to the tendon

• sudden and powerful contraction

• hamstring and back injuries are among the most common

  • grade 1 - stretching and no tear

  • grade 2 - larger, but incomplete tear

  • grade 3 - complete tear

• symptoms:

  • swelling, bruising, or redness

  • pain at rest, pain in a specific muscle

  • weakness of muscle or tendon

Sprain

• is an injury to the ligament

dislocation

• displacement of a bone from its normal joint position, contact

• common causes can be:

  • trauma

  • disease

  • congenital condition

• symptoms:

  • burning pain to joint

  • deformity

  • stiffness and moderate - severe edema

transverse fracture

• a fracture that is straight across the bone

oblique fracture

• fracture that break run in slanting direction

Spiral fracture

• fracture that breaks spiral around the bone

• occurs when bone is twisted

comminuted appearance

• bone splintered into fragments

Impacted appearance

• one end of the fractured bone is forcefully driven into the interior of the other

compression appearance

• vertebra collapses in itself

depressed fracture appearance

• broken bone being driven inward

longitudinal fracture

• break runs parallel with bone

fracture dislocation

• fracture is accompanied by a bone out of joint

pathologic fracture

• results from a diseased bone

burst fracture

• resulting from direct pressure leading to impaction of the disc

avulsion fracture

• pulling away of a fragment of a bone by a ligament or tendon and its attachment

greenstick fracture

bone bends without fracturing completely

Supracondylar Fracture Femur

• above the knee joint; often involve the cartilage surface of the knee point

Intertrochanteric hip fracture

• between the greater and lesser trochanter

Stages of bone healing

1. Hematoma formation

2. Granulation phase

3. Callus formation

4. Bone ossification

Hematoma formation

stage in bone healing wherein:

• torn blood vessels hemorrhage

• a mass of clotted blood at the fracture site

• site becomes swollen, painful, and inflammed

Granulation phase

stage in bone healing wherein:

• active proliferation of osteoprogenitor cells

• angiogenesis

• extracellular matrix production

Callus formation

stage in bone healing wherein:

• minerals are deposited in the osteoid forming a large mass of differentiated tissue, bridging the fracture gaps called callus

bone ossification

stage in bone healing wherein:

• mineral deposition continues and produce firmly reunited bone thus, fracture ends knit together

Transcutaneous Electric Nerve Stimulation

• sends a painless electrical current to specific nerve

• the current maybe delivered intermittently. the mild electrical current generates heat that serves to relieve stiffness, improve mobility & severe pain

• stimulate the body’s production of endorphins

Juvenile Rheumatoid Arthritis

• autoimmune systemic arthritis

• occurs in children under age 3 years and in those age 13 years for more than 6 weeks

• risk factors

  • european ancestry

  • genetic

  • develops before 16 Y/O

• symptoms:

  • swelling and tender in the joint area

  • limping and warmth in the area

  • sudden high fever and rash

Polyarticular juvenile rheumatoid arthritis

• affecting five or more joints

• more common in girls than boys

• occur the same joint on both sides of the body

pauciarticular juvenile rheumatoid arthritis

• affects four or fewer joints

• occur a joint on only side of the body (knee)

systemic onset juvenile rheumatoid arthritis

• equally common in boys and girls

• highly degree fever for weeks or months

• affects small the small joints: hands, wrist, knees, and ankles

Scoliosis

• a lateral or sideways curve in the spine that is apparent when viewing the spine from behind

• symptoms:

  • uneven musculature on one side of the spine

  • rib hump and uneven shoulder or hips

  • unequal distance of arms to body and clothes do not hang right

Congenital Scoliosis

is due to a problem with the formation of vertebrae or fused ribs during prenatal development

Neuromuscular scoliosis

caused by problems such as poor muscles control or muscular weakness or paralysis due to disease such as cerebral palsy, muscular dystrophy, spina bifida, and polio

Idiopathic scoliosis

unknown cause and appears in a previously straight spine

forward bending test

a test used often in schools and doctor’s offices to screen for scoliosis during the test, child bends forward with feet together and knees straight while the arms dangle. any imbalances or other deformities in the ribs cage or along the back could be a sign of scoliosis

Carpal Tunnel Syndrome

• a disorder caused by compression at the wrist, of the median nerve suppling the hand, causing numbness and tingling

  • at the base of the palm is a tight canal or tunnel thru which tendons and nerve must pass

  • median nerve

• risk factors:

  • repetitive activities

  • arthritis, hypothyroidism, pregnancy, and diabetes

• symptoms:

  • trouble with holding objects, grasping, and pinching

  • trouble using hands for simple tasks

  • base of the thumb are smaller and weaker than before

• medical management

  • rest splint worn

  • NSAIDs and Carpal Canal Cortisone injections

Tinel’s sign

the doctor will gently tap the front of your wrist to see if you feel tingling or pain in your fore arm

Phalen’s test

the doctor will ask you to bend your wrist down as far as it will go and hold this position up to 1 minute to see if you feel tingling or pain

Nerve Conduction test

• performed to evaluate nerve function

• measure the nerve’s between ability to send electrical impulses to the hand muscles, to see if the electrical impulses slow down the carpal tunnel

Club foot

• a congenital deformity of the foot characterized by inward and downward position of the foot

• risk factors:

  • heredity

  • position of baby in the uterus, child with neuromuscular disorder

  • prenatal infections and drug abuse

• symptoms

  • fixed plantar flexion

  • adduction and abnormal size of calf muscles

• treatment objectives

  • correct the deformity early

  • correct the deformity fully

• Management

  • NSAIDs

  • Casting

Ponsetti Method

serial manipulation and plaster casting. ligaments and tendons of the foot are gently stretched with weekly, gentle manipulation

Dennis Brown Splint

used when long legs cast is removed after 3 weeks of treatment. the bar is fit shoulder width apart and worn with reverse last shoes. It is worn full time for the 1st 2 months after the last cast is removed

Congenital Hip dislocation

• an abnormal formation of the hip joint in which the ball at the top of the thighbone is not stable in the socket

• the ligaments of the hip joint may be loose and stretched

• symptoms:

  • Tenderness and edema

  • associated bruising and discoloration

  • loss of pulse and sensation in the affected leg

Acetabular dysplasia (Preluxation)

deficient development of the acetabulum and femoral head; hip socket is shallow and remains shallow, so that hip is unstable. some have apparently normal hips at birth, but develop the problem in the first year of life

Subluxation

partial displacement of a joint with incomplete contact between the articular surfaces of the femoral head and acetabulum. thus, dislocates partially when stressed

Ortolani sign

• hip click on routine exam

• initial downward pressure further dislocated the hip

• relocates as the thigh is adducted

Barlow’s Test

• the leg is pulled forward then adducted in an attempt to dislocate the femur

Trendelenburg test

• used if child is old enough to walk

  • have the child walk on affected leg only

  • pelvis will dip on normal side as child attempts to stay erect

Osteotomy

• bone is cut to shorten, lengthen or change its alignment

Tenotomy

to cut the tightly contracted tendons or muscles in the hip are to relax the tight structure around the hip joint and allow the hip to be placed in the socket

Osteogenesis Imperfecta

• a genetic disorder characterized by bones that break easily without specific cause

• a genetic defect that affects the body’s production of collagen (the major protein of the body’s connective tissue which gives bones its tensile strength

Spina Bifida

• split spine

• a condition in which there is abnormal development of the back bone, spinal cord, surrounding nerves, and the fluid filled sac that surrounds the spinal cord

Otitis Media

• inflammation of the middle ear

• the middle ear is an air-filled cavity; air supplied to it each time the eustachian tube opens with swallowing, yawning, or chewing. if this source of air to the middle ear is closed off due to secrete a thin, watery mucus. overtime the compartment becomes so filled with this and the fluid becomes thick and tenacious that it appears glue-like. some children notice a feeling of fullness or sound of popping or ringing in their ears