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becky: PEDIATRICS > EXAM 3: ortho > Flashcards

EXAM 3: ortho Flashcards

(60 cards)

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1
Q

pediatric sports medicine focuses on

A

treating
prevention injuries
balancing nutrition
physical rehab

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2
Q

review connective tissue disorders
EDS
JIA
hemophila

A
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3
Q

is a congenital condition: babies born with severe contractures of UE and LE.

permanent tightening of infants muscles, skin and tendons that
make their joints short and stiff.

A

AMC: ARTHROGRYPOSIS MULTIPLEX CONGENITA
Arthrogryposis means crooking
(bending) of the joint. “Artho” means joint, and “gryposis” means crooking

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4
Q

AMC:
deficits in motor units lead to ___

fetal immobility leads to ___

Joints are fixed, curved, straight and stiff

A

▪ Deficit in motor units lead to severe fetal weakness
▪ Fetal immobility leads to hypoplastic joint development and
contractures

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5
Q

skin behind the knee looks very taught or tight, triangular membrane with shortness of skin and other soft tissues on back of leg

A

pterygium of the knee

*AMC

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6
Q

What are other features of AMC?

A
  1. cognitive normal
  2. shoulders turned in
  3. face long, jaw large
  4. wrists often bent up/out stiff
  5. hips bent upward or outward stiffly or may be dislocated
  6. hands/fingers weak
  7. arms stiff at elbow, weak
  8. spine curved, trunk strength normal
  9. contractures/ WEBBING of skin at joints
  10. knees bent or straight, stiff
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7
Q

infant AMC PT management includes:

A
  1. ROM/stretching
  2. caregiver education
  3. splinting
  4. ortho intervention

*surgery typically not indicated in infant

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8
Q

What makes kids at increased risk for sports injury?

A
  1. sports specialization
  2. rapid growth spurts/change in body proportion
  3. increased training volume
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9
Q

What is REDs?

A

relative energy deficiency in sport

▪ Definition: Impaired physiologic function including, but not limited to,
metabolic rate, menstrual function, bone health, immunity, protein
synthesis, and cardiovascular health caused by relative energy deficiency
▪ Insufficient caloric intake and/or excessive energy expenditure

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10
Q

REDs is common in what sports?

A

▪ Gymnastics
▪ Figure skating
▪ Ballet
▪ Diving and swimming
▪ Long distance running

female and male athletes

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11
Q

PT implications of RED-S

A

▪ Decreased muscular strength and
endurance performance
▪ Chronic fatigue
▪ Bone loss leads to increased risk of
stress fractures
▪ Physiological stress, depression, and
anxiety

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12
Q

What is a high risk category of RED-S?

A

anorexia
serious conditions related to low energy availability
extreme weight loss techniqes: dehydration, induced hemodynamic instability

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13
Q

What are the sports implications of high risk RED-S

A
  • no competition
  • supervised training allowed when medically cleared for adapted training
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14
Q

medium risk RED-S

A

▪Prolonged atypical % body fat
▪Substantial weight loss
▪Abnormal menstruation and hormone function
▪Reduced BMD
▪Disordered eating behaviors and low energy availability

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15
Q

sports implication of medium risk RED-S

A

▪May compete once medically cleared under supervision
▪Can train within treatment plan

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16
Q

low risk RED-S

A

▪Healthy eating habits with appropriate energy availability
▪Normal hormonal and metabolic function
▪Healthy BMD as expected for sport, age, and ethnicity
▪Healthy musculoskeletal system

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17
Q

sports implication of low risk RED-S

A

full sport participation

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18
Q

RED-S screening should take place every year with PCP.
As physical therapists, we should screen for patients who have

A

recurrent injuries/stress fractures

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19
Q

What is FAI?

A

decreased hip ROM due to altered alignment of femoral head and acetabulum
*increased risk with history of DDH or other

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20
Q

Diff Dx of pediatric patient limping/hip pain/difficulty WB should rule out

A

SCFE (slipped capital femoral epiphysis)
LCP (legg-calve-perthes)
femoral neck stress fracture
acetabular labral pathology
Dx of exclusion: FAI

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21
Q

disorder of proximal femoral epiphysis in femoral heads slips off femoral neck
MALES 10-16 YRS

A

SCFE

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22
Q

SCFE often presents with:

A
  • loss of hip ROM (IR, ADD)
  • possible limping
  • complain only of knee pain

emergency! NEED XRAY OR MRI, treatment SURGERY

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23
Q

avascular necrosis of femoral head, usually idiopathic
blood flow disruption to medial circumflex artery

A

LCP

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24
Q

typical presentation of LCP

A

children 3-12 years
history of limping/ Trendelenburg gait
hip pain

*hip IR/ABD LIMITED

*usually very active, try to perform normal ADLs

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25
treatment of LCP
period of NWB, LE strengthening in OKC, aquatic PT after clinical management, typically self heals in 1-3 years. May lead to FAI later in life
26
common in female endurance athletes presenting with RED-S
femoral neck stress fx *common sign: deep hip pain with WB and during sport
27
▪Common in athletes that perform excessive ranges of motion such as dancers. Or perform excessive rotation of the acetabulum on the femur with pivoting and cutting (soccer and basketball) clinically presents similar to FAI complaints of clicking, catching in hip
acetabular labral pathology
28
how to rule in/out acetabular labral pathology
MRI/MRA (angiogram) similar presentation of FAI
29
cam vs pincer FAI
cam: enlarged femoral head pincer: rim of acetabulum is extended and causes “over- coverage” of femoral head: deeper socket congenital deformities: hip dysplasia, coxa vara, and coxa valga
30
FAI is typically seen in athletes who perform
excessive hip ROM or rotation of acetabulum on femur with pivoting and cutting (i.e. dance, soccer, basketball)
31
signs and symptoms of FAI
▪Anterolateral hip pain – “C sign” ▪Pain with hip flexion and IR ▪Limited hip ROM ▪Short hip flexors ▪(+) FADIR and/or FABER ▪Trendelenburg sign ▪Weakness in core and LE posterior chain musculature (gluteus and deep hip lateral rotator musculature)
32
PT management of FAI
▪Restore hip joint mobility and muscle flexibility ▪Core stability and strengthening exercises ▪Strengthen hip extensors and abductors ▪Neuromuscular re-education on multi joint movements ▪Patient education on activity modification ▪Progress to sport-specific activities once patient is pain-free and demonstrates normalized hip biomechanics
33
case study: ▪ 12 year old female, soccer player ▪ Anterior hip and groin pain w/ all weightbearing activates ▪ Limited ROM into right hip flexion and IR. ▪ Pain w/palpation of AIIS & pubic symphysis ▪ Denies signs & symptoms of fever, malaise or rash ▪ Referred initially with Dx of “hip flexor strain” ▪ Later determined by orthopedist that present had an AIIS avulsion fx and pubic symphysis avulsion fracture
PT diagnosed FAI
34
etiology of shin splints (MTSS)
▪ A spectrum of tibial stress injuries is likely involved in MTSS, including tendinopathy, periostitis, periosteal remodeling, and stress reaction of the tibia ▪ Dysfunction of tibialis posterior, tibialisanterior, and soleus ▪ Caused by alterations in tibial loading chronic, repetitive loads ▪ More common in females and in athletes who do “too much, too fast”
35
SIGNS and symptoms of shin splints: MTSS
▪ Vague, diffuse pain in LE ▪ Pain with running or ballistic movements ▪ Pain worse at beginning of exercise and subsides during training or cessation of exercise ▪ TTP along medial ridge of tibia ▪ Hyperpronation of subtalar joints ▪ Weakness of core and hip musculature **▪ Impaired flexibility of triceps surae**
36
PT treatment of shin splints
▪ Rest and ice in acute phase ▪ Modify training program ▪ Treat key muscle imbalance and flexibility dysfunctions of the entire kinetic chain ▪ Proper shoes with good shock absorption
37
lateral ankle sprains have peak incidence between ages
15-19
38
lateral ankle sprains are due to ___ motion of ankle typically __ ligament injured
MOTION: inversion with ER typically ATFL injured
39
what sports often have lateral ankle sprain
softball basketball cheerleading
40
signs and symptoms of lateral ankle sprain
Signs and Symptoms ▪ History of recurrent ankle sprains or chronic instability ▪ Pain, swelling, and bruising around ankle joint ▪ Pain with weightbearing ▪ (+) anterior drawer test if ATFL involved; (+) talar tilt test if CFL involved ▪ Weak ankle musculature and short gastrocnemius/soleus
41
PT management of lateral ankle sprain
early motion proprioception (balance, nm control) normalize gait address strength/ROM impairments
42
ACL injuries are more common in __ athletes
female
43
etiology of ACL injuries
-ACL resists anterior tibial translation, gives rotational stability -typically due to rapid direction change (landing from jump, quick twisting motion)
44
ACL injury causes:
Lower Limb and Knee Position ▪ Landing with knees in valgus or extended ▪ Sudden deceleration: high quad activity ▪ Outside cut: varus internal rotation knee ▪ Anterior tibial shear forces *loss of knee ROM, LE weakness, gait abnormal
45
ACL injuries can commonly occur with a _ in ped patients
fracture to the growth plate *growth plates located in knee, weakest part of bone *growth plate directly in path where surgical holes would be drilled *growth plate during ACL reconstruction can potentially injure the physis:
46
fractured growth plate during ACL reconstruction can potentially injure the physis. What can this cause?
premature closure leg length discrepancies and angular deformities
47
PCS (post concussion syndrome is diagnosed as persistent symptoms beyond ___ with these symptoms:
beyond 7-10 day normal recovery period 3+ symptoms: 1. fatigue 2. sleep disturbances 3. headache 4. dizziness 5. concentration difficulty 6. memory difficulties
48
In pediatrics, _ and _ are associated with prolonged recovery of concussion
LOC dizziness
49
PT management of PCS
based on ss severity: ▪ Symptoms are allowed to increase 2 points on verbal rating scale and should recover with a brief rest before beginning the next exercise ▪ Vestibular rehabilitation: visual tracking ▪ Aerobic exercise on stationary bike or treadmill ▪ Address strength and flexibility impairments of cervical musculature ▪ Balance training ▪ Progress to dual-tasking activities ▪ Cognitive challenges, hand-eye coordination with balance tasks, etc.
50
What are signs and symptoms of PCS
▪Somatic: slowed reaction time, dizziness, blurred vision, sensitivity to light and sound ▪Cognitive: mental fogginess, confusion ▪Sleep disturbances: increased or decreased amount of sleep, fatigue ▪Mood disruptions: irritability, depression, increased emotional behavior ▪Functional deficits: Balance, coordination, and exertion impairments ▪Altered cerebellar, oculomotor, and vestibular function ▪Cervical muscular weakness or flexibility impairments
51
PT PRECAUTIONS FOR PCS
▪ Avoid overstimulation during rehab that may trigger a headache, dizziness or nausea and may delay recovery
52
PT complications of PCS
Pre-existing conditions of: * anxiety or depression * eye alignment issues (amblyopia) * learning disabilities, ADHD * history of migraines
53
estimated ___ sports related concussion injuries per year in ER in the US
3.8 million * but underestimated, many not seen in ER
54
ESTIMATED that _% of all concussions occur in children between _ and _ years of age
65% of all concussions **4 and 15 years of age**
55
children and concussions: _ due to falls _ due to unintentional blunt trauma
half due to falls 15% due to unintentional blunt trauma
56
Four patient severity outcome measures for PCS
1. The verbal rating scale for ranking of symptoms 2. PCSS: Post-Concussion Symptom Scale 3. ImPACT 4. DHI: Dizziness Handicap Inventory
57
What does screen of PCS include?
Vestibular/Ocular-Motor Screening (VOMS) – clinical screen that assesses: * smooth pursuits * horizontal and vertical saccades * near point of convergence
58
For children with atypical prolonged recovery of concussion ss lasting more than _ and _ weeks, multidisciplinary management is recommended
longer than 6-8 weeks *vision therapy (optometrist) *more detailed neurocognitive or psych assessment
59
What should therapist educate family about with planning for discharge post concussion tx?
*risk of reinjury! * should be able to return to school without accommodations, monitor academics
60
PCS POC: _ should be introduced once patient tolerates functional activities with minimal symptoms
cognitive challenges

becky: PEDIATRICS (30 decks)

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