Module 8: Developing Spine & Extremities Flashcards
Three types of peripheral nerve injuries
- Neuropraxia = transient complete motor paralysis, MC 2ndary to mechanical pressure
- Axonotmesis = Motor, sensory & ANS complete paralysis. loss continuity of axon, maintain schwann sheath.
- Neurotmesis = complete loss continuity axon & schwann sheath.
What is most common hip pain in 3-8 yr old and often follows viral URTI?
- Transient synovitis
- Sudden onset hip pain
- Reduced ROM - esp IR
- Often self resolving in couple of days
What is the presentation of Erbs Palsy, what Nerve roots involved?
Erb palsy = MC brachial plexus injury
- C5, C6 Nerve roots involved
- IR of shoulder
- unable to abduct arm or bend elbow
- waiter tip deformity wrist
- may have atrophy of arm muscles
- May also have Horners syndrome = eyelid droop (ptosis) & smaller pupil size same side
- may be d/t clavicle fracture
which conditions can cause a limp in child and swelling/ heat over hip & fever?
- Septic arthritis - bacterial infection of synovial joints. Investigate MRI
- Osteomyelitis - Staph Aureus MC, Investigate MRI
- Transient synovitis
Painful vs Painless limp in child 1-3 yrs
Painful
- Septic arthritis/ osteomyelitis
- Transient synovitis
- Trauma
Painless;
- DDH
- JIA (juvenile idiopathic arthritis)
- Neuromuscular (CP)
Painful vs painless limp in child 3-10 yrs;
Painful
- Transient synovitis
- Septic arthritis/ osteomyelitis
- Trauma
- JIA
- Legg calve Perthes (acute)
- Malignant
Painless
- Perthes (Chronic)
- Neuromuscular (DMD)
- JIA
- DDH
Painful vs painless limp in child 11-18yrs?
Painful
- SUFE
- Perthes/ avascular necrosis
- JIA
- Trauma
- Septic arthritis/ myelitis
- Tumour
Painless:
- SUFE (chronic)
- JIA
Loss of internal hip rotation is common in which hip conditions?
- Transient synovitis
- Legg calve perthes
- SUFE
Presentation of SCFE?
- MC hip disorder in adolescents
- MC 8-15/16yrs
- Ass w obesity & metabolic disorders & growth hormone supplementation
- Limping
- poorly localised pain - hip px w ref to ant’ thigh & knee
- Dx imaging = Xray (Ap & frog leg)
- Reduced IR
- Can’t flex hip properly - on flexion roles into ER & ABD
Presentation/ pathophysiology of Leg calve Perthes?
- AVN of femoral head, often prior trauma
- M:F = 4:1
- good prognosis if dx before 6 yrs
- Pain - hip, can ref to ant thigh & knee
- limp, trendelenberg sign
- Pain relieved by rest
- LLD
- reduced IR & ABD
- Ref for XRAY
Pathophysiology & presentation of Transient synovitis:
- MC cause of limping in child - often due to URTI or gastro infection MC 3-4 yrs
- initiated by minor trauma
- inflammation of synovial membrane of hip resulting in synovial effusion w in joint capsule
- Groin & Ant thigh pain, limp, spasm hip muscle, reduced hip IR & ABD
- symptoms can last 1-2 weeks
significance of child not walking by 18 months
Red flag
But shuffling indicates?
Sign of poor central control, low tone.
often won’t have +ve support reflex
Homecare given for kids who are but shuffling;
- Ball rocking
- Opposites touch
- pre crawl rocking
- Deep pressure/ vibration to Bl feet and ankles
- supported crawl with parents doing cross pattern
Causes for asymmetrical crawl:
- Low tone = contributing factor
- DDH
- Plagio
- dural torque
