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Unit 2 > Changes to Pediatric Bone & Muscle (10/18c) [Biomedical] > Flashcards

Changes to Pediatric Bone & Muscle (10/18c) [Biomedical] Flashcards

1
Q

Periods of change and variability

A

Skeletal maturation

Muscle growth

Sexual maturation

Skill acquisition

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2
Q

Growth, size, volume, structure and function of the skeleton are affected by

A

Hormones

Metabolic factors

Nutrition

Mechanical forces over time

Genetics

Disease or Pathologic processes

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3
Q

Muscle vs Bone Growth

A

Bone growth is affected by muscle action and activity

Muscle development and function is in turn affected by bone growth

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4
Q

Bone Growth - Growth Hormone (GH)

A

Stimulates synthesis of IGF-1

GH deficiencies lead to decreased BMD during childhood

Contribute to longitudinal bone growth and mass after birth

During puberty along with sex hormones continue to contribute to bone growth and development

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5
Q

Bone Growth - Insulin like growth factor 1 (IGF-1)

A

IGF-1 important during skeletal maturation for longitudinal growth, skeletal maturation, and BM acquisition

IGF-1 also important for maintenance of BMC during adulthood

Contribute to longitudinal bone growth and mass after birth

During puberty along with sex hormones continue to contribute to bone growth and development

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6
Q

Bone Growth - Thyroid Hormone (TH)

A

Direct impact on bone metabolism

Children with hypothyroidism have decreased bone lengthening

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7
Q

Bone Growth - Sex Hormones

A

Increased estrogens and androgens at puberty

Rapid longitudinal bone growth

Fusion of physis - leads to cessation of bone growth

Increased lean body mass

Contribute to significant variability

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8
Q

Bone Growth - Fibroblast Growth Factors (FGF)

A

23 different FGFs identified

A lot of interplay, continually regulate skeletal patterning and bone growth throughout the skeletal growth period

In periosteum, perichondrium surrounding the growth plate, chondrocytes, osteoblasts, etc

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9
Q

Bone Growth - Vitamin D

A

Vitamin D3 is produced in the skin following ultraviolet light exposure

Metabolized in the liver to 25D, then metabolized in the kidney to 1α,25-dihydroxyvitamin D (125D)

125D plays a critical role in the intestinal absorption of calcium and ionic phosphate

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10
Q

Bone Growth - Calcium

A

Calcium can only be absorbed 500mg at a time (4-6 hrs)

Calcium supplementation has positive effects on bone mineral density (BMD)

Change in dietary habits may be easier to maintain vs taking a pill

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11
Q

Anthropometrics

A

Measurements of age, growth, and development

  • height
  • weight
  • BMI
  • skeletal maturity
  • sexual maturity
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12
Q

Measurements of Skeletal Maturity and Bone Age

A

All use left hand and wrist (due to majority right hand dominance)

Atlas technique of Greulich and Pyle

Tanner-Whitehouse bone-specific scoring

Fels hand-wrist method

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13
Q

Atlas technique of Greulich and Pyle

A

Modal maturity indicators described for a specific age

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14
Q

Tanner-Whitehouse bone-specific scoring

A

Total bone maturity indicator score up to 1000

Typically used in Europe

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15
Q

Fels hand-wrist method

A

Requires software to translate ratings into age

Typically used in North America

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16
Q

Growth Data - Females

A

Towards the end stage of sexual development for girls (~12.6 yo), 90% had their first period already

2 years left of long bone growth after getting first period

Increasing Growth Velocity: 9-11.5 yo

Peak Growth: 11.5 yo (8.3 cm/yr)

Velocity Stops: 15 yo

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17
Q

Growth Data - Males

A

Increasing Growth Velocity: 11-13.5 yo

Peak Growth: 13.5 yo (9.5 cm/yr)

Velocity Stops: 18 yo

18
Q

Timing of Growth Plates with Injury

A

Consider timing of growth in males and females when there are injuries to determine if there could be growth plates still

Can also influence decision of timing of surgeries

Females — completion of fusion 12.5-18 yo

Males — completion of fusion 15-18 yo

19
Q

Bone Mineral Content (BMC) aka mass

A

Total bone tissue in an area

Measured in grams

20
Q

Bone Mineral Density (BMD)

A

Amount of bone tissue per volume

Measured as g/cm2 or g/cm3

21
Q

Peak Bone Mass

A

Maximal amount of bone tissue following skeletal maturation

22
Q

Density and Mass Measurements

A

USE Z SCORES, NOT T SCORES

Dual-energy X-ray absorptiometry (DXA)

Quantitative computed tomography (QCT)

Peripheral QCT (pQCT)

Quantitative Ultrasound (QUS)

Magnetic resonance imaging (MRI)

23
Q

Continued increase of bone mass and density following end of height growth

A

Greater bone mass and density associated with decreased fragility fracture
- 10% increase in peak bone mass can decrease female fracture risk by 50%

Still important to optimize bone health after adolescence

24
Q

Muscle/Lean Body Mass (US measurement study)

A

Females (3-13 yo) have greater quadriceps muscle mass than males

Possibly hormonal since most females are well into puberty at 13 yo

25
Muscle/Lean Body Mass (DXA measurement study)
Tanner stage 5 Males have greater extremity lean soft tissue and total body skeletal muscle mass Tanner stage < 5 No difference in extremity lean soft tissue and total body skeletal muscle mass No differences between ethnicities
26
Isometric Muscle Strength Study
Children Ages 4 to 16 Suggests using weight related muscle reference data especially when testing “patients suffering from growth retardation” Unable to demonstrate gender differences in LE strength in subjects > 15 years old
27
Differences Based on Socioeconomic Status, Culture, and Ethnicity - Studies
Black vs White - black children have longer legs and greater long bone strength - similar femoral density - 0.5 SD ahead of white children in bone age, could be delayed when age-matched US Born vs Southeast Asian Refugees - US heavier and taller Bone density similar prepuberty for Caucasian, Asian, Hispanic and African American
28
Pediatric Skeletal Difference
Preosseus cartilage Physis – growth plate Periosteum - thicker, stronger, more osteogenic - Faster and bigger callous More shock absorption - Lower BMC and greater porosity
29
Pediatric Orthopedic Concerns
Growth Plate Injuries and conditions - Apophysitis - Salter Harris fractures Lower Extremity Deformities Growing Pains Pediatric Fracture Remodeling
30
Apophysitis
inflammation or stress injury to the areas on or around growth plates in children Telltale sign no matter where it is located, if you palpate on it they will jump To treat, you have to strengthen the muscle and do slow static stretches
31
Why Does Physis Injury Occur Before Ligament Injury?
Younger age is more likely to have physics injury Ligaments attach to epiphyses, transferring force to physis (most stresses occur horizontally) Ligaments shoer and continuous tissue type (greater tensile strength) Ligaments are generally stronger than bones in kids
32
Structural Contributions to Physis Injury
Physis is sandwiched between epiphysis and metaphysis of growing bone - Relatively soft tissue between relatively hard tissue Histologically, metaphyseal trabeculae are initially oriented longitudinally in long bones - Progress to horizontal orientation with skeletal maturity - Predisposes the region to certain fracture modes
33
Apophysitis - Osgood Schlatter Disease
Traction apophysitis of the tibial tuberosity Characterized by prominent tibial tuberosity Significant tenderness to palpation of tibial tuberosity
34
Apophysitis - Sinding Larsen Johansson Syndrome
Traction apophysitis of the inferior pole of the patella Significant point tenderness to inferior patella tubercle and proximal patella tendon
35
Apophysitis - Sever’s Disease
Traction apophysitis of the posterior calcaneus Pain with shoes, toe walking, running Significant tenderness to posterior calcaneus Prominent “pump bump” Gastroc-soleus tightness
36
Apophysitis - Iliac Apophysitis
Traction apophysitis along the iliac crest and/or spine - TFL - Rectus femoris - Sartorius - Gluteus medius - Abdominal obliques Track and field athletes and dancers
37
Growing Pains
No conclusive evidence regarding cause Diagnosis of exclusion Anecdotally related to: - Biochemical/hormonal factors - Muscle strain during growth Working while trying to keep up with the length of bone - “instability” at growing junctions Treatment for comfort - Massage, hot/cold packs, analgesics
38
Bone Remodeling Following Fracture - Major Factors
Age – younger children Proximity to a joint – closer to a physis Joint Axis – deformity in the plane of “primary” osteokinematic motion
39
Bone Remodeling Following Fracture - Overgrowth
< 10 yo frequently have a 1 to 3 cm overgrowth in long bone Bayonet apposition to compensate Due to physeal stimulation during fracture healing
40
Youth Resistance Training Programs - Requirements
Specifically designed program - General muscle strengthening towards end of puberty - Avoid max lifting until at least Tanner Stage 5 (16-17 yo) Supervised settings with low instructor : participant ratio Proper Technique Safety guidelines for gym behavior and and equipment use
41
Strength Training Study - Changes in strength likely due to neural components
Motor unit recruitment Frequency of motor unit firing Changes in muscle activation Changes in contractile properties
42
Strength Training - Factors Contributing to Injury
Poorly designed/supervised programs Excessive load Unqualified supervision Poorly designed equipment Free access to equipment

Unit 2 (27 decks)

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