musculoskeletal lecture 3

Characteristics of Pediatric Muscular Skeletal System

• Pediatric bones have growth plates that facilitate growth, closing in adulthood.
• Children's bones are more flexible due to higher cartilage content, making them less prone to fractures.
• Healing rates are faster in children due to a thicker periosteum that is more active in remodeling.
• Lower bone density leads to increased porosity and risk of deformities with improper healing.
• Muscles are still developing, increasing in size rather than number; children exhibit greater muscle elasticity and fatigue resistance due to faster recovery from exertion.

Pediatric Muscular Skeletal Disorders

Disorders are frequently influenced by genetics, rapid growth, or active mobility. Many conditions are temporary with restoration of function. Key aspects of assessment:

• Observe head-to-toe during examination.
• Evaluate gait, muscle tone, and range of motion.
• Palpate for pain, redness, or swelling.

Developmental Dysplasia of the Hip (DDH)

• Defined as an abnormality of the femoral head and/or acetabulum; can range from mild to severe dislocation.
• Higher incidence in girls and familial history; associated with conditions like spina bifida and breech presentation.
• Types of dysplasia: normal, dysplastic, subluxated, and dislocated.
• Common causes: tight swaddling, uterine positioning, maternal hormone secretion.

Manifestations

• Shortened femur on the affected side, uneven thigh and gluteal folds.
• At prone position: limited abduction.
• In ambulatory children: affected leg may be shorter, waddling gait or Trendelenburg sign observed.

Diagnosis and Treatment

• Early diagnosis improves treatment outcome—may utilize X-ray examinations and hip stability tests (Barlow and Ortolani maneuvers).
• Treatment for infants < 6 months: use of a Pavlik harness.
• For 6-24 months: use of hip spica cast; surgical intervention may be necessary.
• Nursing care prioritizes maintaining hip joint position, preventing complications, and involving parents in care.

Congenital Talipes Equinovarus (Clubfoot)

• Most common congenital deformity; occurs in 1 in 1000 births, more prevalent in boys.
• Characterized by foot twisting from normal position.
• Diagnosis through examination, manipulation, and definitive X-ray.
• Treatment includes serial casting, passive stretching, and possibly surgery.

Nursing Interventions

• Provide support and education to parents regarding care and adjustments needed for the child.
• Conduct neurovascular assessments and maintain proper cast care strategies.

Muscular Dystrophy (DMD)

• Description: genetic condition causing muscle degeneration and weakness, mainly via mutations in the dystrophin gene.
• DMD starts at ages 2-3, first affects lower limbs, then heart/respiratory muscles.
• Symptoms include delayed walking, waddling gait, and calf pseudohypertrophy.

Diagnosis and Management

• Elevated creatine kinase and genetic testing confirm diagnosis.
• Treatment focuses on maintaining mobility through physical therapy—no cure to reverse progression.
• Family support and coping strategies are vital; prognosis for DMD generally poor (life expectancy ~20 years due to complications).

Final Tips

• Understanding pediatric muscular skeletal disorders is crucial for your nursing role.
• Review the provided points and be prepared for discussions in Q&A and case studies.