Musculoskeletal Conditions Children Flashcards
Bony structure children
Physis - growth plate, causes longitudinal bone growth
Epiphysis - cartilagenous, then develops into secondary ossification centres
Apophysis - grows where large tendon attaches to the bone, contributes to overall shape of the bone
increased blood vessel concentration = reduced density
- means more elastic, highly vascular speeds up healing
Apophysitis - pathophysiology
traction of the msucle tendon unit on the apophysis distraction
causes very localised pain and swelling
can occur at any apophysis in the body
Apophysitis - assessment
onset related to increased activity or growth spurt
very localised pain
pain with contraction of relevant muscles
pain with palpation of local site
very localised swelling
Apophysitis - management
self limiting - will eventually resolve once the growth plate closes and ossifies need to manage their pain load reduction and modification stretching of involved muscle strengthening of involved muscles address biomechanics
Osteochrondroses - pathophysiology
disorder of the subchondral bone
may follow trauma/microtrauma
avauscular necrosis can cause it
family genetic defect
Osteochondritis Dissecans
can develop from osteochondroses - when bony damage causes loose bony fragment
has pain and may develop severe mechanical symptoms
Osteochondroses - management
Type 1 and 2 - activity modifcation, immobilisation
Type 3 and 4 - surgical intervention
Diaphysis/Metaphysis Fracture
Greenstick - partial fracture, doesn’t completely break the bone
Plastic Bowing - bone bent with pressure and doesn’t return to normal position
Buckle - crush fracture, tend to occur at metaphysis
Physis Fractures
Salter-Harris Classification of fractures Type 1 - straight across the physis Type 2 - above the physis Type 3 - lower than the physis Type 4 - two or through the physis Type 5 - erasure of teh physis
Avulsion Fracture
occur at the attachment of large tendons or ligaments to bone
Manage through load management, rest, gradually reloading
Red Flags Fractures
complete diaphysis fracture - not normal for childrne
Paediatric Limp - Red Flags
refusal to walk
pain
out toeing - when acute and with pain
Potential Diagnosis Limp 0-3yo
septic arthritis
DDH
fracture
soft tissue injury
Potential Diagnosis 3-10yo
irritable hip
septic arthritis
Perthes disease
Potential Diagnosis 10-15yo
SUFE septic arthritis Perthes disease fracture soft tissue injury
Acetabular Dysplasia
develops from DDH
Transient Synovitis/Irritable Hip
most common cause of hip pain in 2-10 yo diagnosis of exclusion - need to rule out other possibilities first Present with - limp - all movement is limited by discomfort - anterior thigh, groin or knee pain - normal x-ray Should begin to resolve within 3 days Be fully resolved by 2 weeks
Perthes Disease - pathophysiology
avascular necrosis of the femoral head
Perthes Disease - presentation
Presentation
- typically young male <13 yo
- usually small, thin and extremely active
- limp which is exacerbated by activity
- mild pain in groin, thigh or knee
- reduced ROM into Abduction, IR and maybe hip flexion
- gluteal atrophy
Perthes Disease - management
want to maintain the height of the femoral head
reduced weight bearing
use orthotic devices if needed
if >8 yo = require surgery
Leg Length Discrepancy - pathophysiology
Potential Causes
- congenital
- neurological conditions
- trauma
- infection
- tumours
- juvenile arthritis
- DDH
- perthes
- SUFE
Leg Length Discrepancy - assessment
Observation - gait, in standing, scoliosis, look at spine in sitting Galeazzi sign Measure anatomical landmarks x-ray CT scan
