wk 6: musculoskeletal defects, neuromuscular dysfunction, integumentary system

Clubfoot gen info

Front of foot turned inwards due to shortened tendons

• rigid deformity present at birth

• More common in boys

• Bilateral-often

Clubfoot deformity components

Midfoot- Down (plantarflexion)

Hindfoot- inward (varus)

Forefoot- inward and upward (Adduction and cavus)

Lower leg atrophy, leg length normal

Clubfoot tx

Early tx CRITICAL

• Pondering method- serial casting within first 1-2 wks of life

• Surgery (3-12 months )

Long term management

• braces, corrective shoes

Developmental Dysplasia of the Hip gen info

Abnormal development of the acetabulum

Hip socket is shallow, dislocating head of femur

Due to breech positioning in utero or 3rd trimester crowding, or developmental abnormalities

DDH Manifestation

Limited hip abduction

Asymmetrical gluteal/thigh folds

Telescoping of thigh-shortened appearance

Limp in older child

DDH dx

Physical exam- Barlow or Ortolani

Ultrasound- infants

X-ray- older infants/children

DDH tx

<6 months: Pavlik harness- first line

Bryant traction- select cases

6 months+ →surgery and spica cast

18 months+ → surgery, casting, bracing

Prognosis- 60-80% resolve by 2 months

Leg Calves Perthes Disease Gen info

Self-limited a vascular necrosis of the femoral head

Due to a temporary interruption of blood supply to the femoral epiphysis

Cause: can be genetic, mild traumatic injury, breech position

4:1 males to females, 3-13 yrs old, peaks at 7

Leg Calves Perthes Disease manifestation

Painless limp

Atrophy of the affected thigh

LCPD tx

Limited weight bearing

Activity restriction

Casting or bracing to keep femoral head in socket

Severe- adductor release or osteotomy

Slipped Capital Femoral Epiphysis gen info

Femoral head slips off the femoral neck

Occurs at epiphysis (growth plate) during pubertal growth spurts

Classification- acute- less than 3 wks, chronic- more than weeks

SCFE manifestations

Inflammation edema and pain

Untreated: hip deformity and limit ROM

More common in males and African American children

SCFE clinical findings

Limp

Hip/knee pain(referred pain)

Out-Toeing gait

Limited internal/external rotation

Inability to bear weight

SCFE management

NON weight bearing activities

Goal: stabilize the femoral head to prevent further displacement

Scoliosis Gen info

S or C shaped curvature of spine

• any curve >10% is abnormal

• More common in females

Scoliosis Dx and tx

Cob Technique and Risser scale

-mild 10-20 degrees: exercise and muscle toning

-mod 20-40 degrees: Boston brace 23 hrs a day

Severe 40-50 degrees: requires surgery, spinal fusion w segmental hooks, rods, wires, screws. May need bone grafting and casting

Kyphosis

Hunchback

Kyphosis tx

Support

Exercise

Brace wear

Lordosis

Swayback

Giga arch

Lordosis tx

Support

Child outgrows as they mature

Annual follow up

Torticollis gen info

Tilt of the head caused by the rotation of the cervical spine

• seen in plagiocephaly (top view head goes /), and brachycephaly (side view head goes /, cone head )

Ex: right sided torticollis- tight ear tilts to right shoulder, face and nose rotates left, tight right SCM muscle

Torticollis tx

MOST IMPORTANT- Physical therapy: general stretches

Repositioning- look towards non-preferred side

Tummy time

Helmet therapy

Surgery- if PT failed after 6-12 months

Osteogenesis Imperfecta gen info

Genetic disorder= brittle bone disease

• defect in the production of collagen in the bone

Autosomal dominant

Osteogenesis imperfecta manifestation

BLUE SCLERA

Frequent fractures

Conductive hearing loss

No cure :(

Osteogenesis imperfecta tx

No cure :<

Prevention, bone density medications, PT, supportive care-casts, bracing, splinting

Pamidronate used to inhibit bone breakdown and strengthen fragile bones

Med- Ibandronate

Bone renewal, slows bone loss

AW- osteonecrosis of jaw, fractures in the thigh bone

Contraindication: breastfeeding or pregnant

Teaching- take a daily calcium and vit D supplement

Osteomyelitis gen info

Infection of long bones may spread via bone or surrounding tissue

Boys more at risk than girls

Osteomyelitis RF

URI, trauma to bone, surgery, sickle cell disease, compromised immune system

Cause- bacterial, fungal, viral

• most common s. Aureus, E.coli, M. Tuberculosis

Osteomyelitis presentation

Pain/tenderness

Swelling

Fever

Nausea

Decreased mobility

Limping

Erythmia

Rapid onset

Osteomyelitis DX

Leukocytosis

Elevated ESR and CRP, positive culture

Osteomyelitis TX

IV broad spectrum abx before cultures resulted- Vanco, clindamycin

Juvenile Idiopathic arthritis gen info

Autoimmune inflammatory disease- body attacks the synovium in the joint causing damage

Peaks 1-3 yrs

No cure

JIA dx

More than 1 joint affected for more than 6 weeks

Diagnosed before age 16

More in females than males

JIA manifestation

Joint swelling, pain, stiffness with inactivity

JIA subtypes

Systemic: fever rash

Psoriatic: nail changes

Uveitis: eye inflammation

Oligoarthritis: up to 4 joints

Polyarthritis: 5 or more joints

JIA tx

Pharm:

NSAIDS

CCS

DRAMDS- slows disease progression

Non-pharm:

PT/OT/Exercise

Splints

Heat therapy

Joint alignment- avoid pillows under joints

Fracture s/s

Generalized swelling

Pain or tenderness

Deformity

Diminished functional use

May also demonstrate:

Bruising

Severe muscular righty

Crepitus

Compartment syndrome eval

Pain

Pulse

Pallor

Parenthesis

Paralysis

Pressure

Dislocation gen info

Bones come apart at the joint

Common in sports

Dislocation rf

Ehlers-Danlo’s syndrome

Cerebral palsy RF

Pre-me babies

Birth complications: pre-e, asphyxia

Sepsis, TBI, stroke, hypoxia, hypoxia

CP manifestation

Abnormal muscle tone (hyper/hypotonia)

Poor coordination

Delayed milestones

Motor patterns: Diplegia: Hemiplegia (one side worse), quadriplegia