Lecture three (Peds MSK), EXAM 3 Flashcards
What do you need to observe for in newborn and infants?
Observe for any abnormal curvature or deformities of the spine, extremities, hands and feet
What are the normal hand creases?
Most newborns have two major creases on the palm, neither of which completely extend from one side of the palm to the other.
What is the transverse palmar crease?
* How common?
* A single palmar crease is associated with what?
- A common variant, found in approximately 5% of newborns, frequently inherited as a familial trait.
- A single palmar creases is also associated with Down’s syndrome (Simian crease) & other genetic disorders but in the absence of other abnormalities no further evaluation is necessary.
What is polydactyl?
The condition of having
more than the normal number of fingers or toes.
What is the extra digit characteristics?
The extra digit may seem almost fully formed or may be attached only by a thin fleshy stalk. This is typically an isolated finding. A positive family history is often obtained
What is syndactyly
- The condition of having some or all fingers or toes wholly or partly united
- Usually an isolated finding and often has no impact on function.
- What is clinodactyly?
- What can it be associated with?
- A congenital defect in which one or more toes or fingers are abnormally positioned, often inherited as a familial trait.
- This can be associated with several genetic disorders, including Down’s syndrome. In the absence of other physical findings it is a benign, isolated finding
What is overlapping toes?
- A positional deformity that is considered a minor isolated finding of no significance.
- Does not affect mobility.
- Usually flattens out over time when you start standing
What is positional deformities?
- A position that is flexible (need to see if it can move easy!!!) and is therefore due to in utero position.
- More outward, not inward
- Spontaneous resolution is expected.
What is club foot? Txt?
- The feet are plantar-flexed and inverted. Because this is a bony deformity, this position is rigid.
- Any attempt to bring the foot to a neutral position is not successful
- Serial casting to bring feet back to normal but might need surgery (earlier the better)
What amniotic band syndrome?
Congenital abnormality that occurs when bands of amnion (the inner lining of the amniotic sack or “bag of water”) peel away from the sack and attach or wrap around parts of the baby’s body, disrupting normal development.
What is this?
Amniotic band syndrome
What is the vertex persentation?
The normal position of hips
What is the breech presentation?
- Happens when baby sits in different poition for a long period of time
- Will not happen if baby flips to breech towards end
What are the different variations of breech presentation?
- When an infant has been in breech position in utero, the legs tend to what?
- Infant born breech have a higher risk of what?
- When an infant has been in breech position in utero, the legs tend to remain in this position for the first few days. Spontaneous resolution is anticipated.
- Infants born breech have a higher risk of Developmental Dysplasia of the Hip (DDH)
*
What is barlow and ortolani?
- Barlow maneuver: A test used to identify an unstable hip that can be passively dislocated. The infant is placed in a supine position with the hip flexed to 90o and in neutral rotation. The examiner adducts the hip while applying a posterior force on the knee to cause the head of the femur to dislocate posteriorly from the acetabulum. A palpable clunk or “hip click” may be detected as the femoral head exits the acetabulum.
- Ortolani maneuver: Identifies a dislocated hip that can be reduced. The infant is positioned in the same manner as for the Barlow maneuver, in a supine position with the hip flexed to 90o. From an adducted position, the hip is gently abducted while lifting or pushing the femoral trochanter anteriorly. In a positive finding, there is a palpable clunk or “hip click” as the hip reduces back into position.
What is the galeazzi sign?
- Hips can also be assessed by looking at the symmetry of the height of the knees when the infant is supine
- When legs appear symmetric this is a negative Galeazzi sign
What is a positive galeazzi sign?
A positive Galeazzi sign (unequal knee heights) suggests a unilaterally dislocated hip.
What is the treatment for Developmental Dysplasia of the Hip
Treatment for Developmental Dysplasia of the Hip = Newborn-6 months old Pavlik Harness is rarely successful after age 6 months and surgery is required.
Do all “hip clicks” mean Developmental Dysplasia of the Hip (DDH)? Explain
NO
* There are many ligaments inside an infant’s hip joint that can make snapping or popping noises in certain positions as the baby develops.
* All clicks, pops, clunks require further monitoring and Hip Ultrasound at 4-6weeks of age.
* Breech babies even w/o pops, clicks, need an ultrasound at week 4
How are infant joints different than adult joints?
The bones of an infant’s joints are much softer than an adult joints
What makes the baby ligament’s laxity
- The mother makes hormones that allow the mother’s ligaments to become lax so that the baby can pass through the birth canal.
- Some infants may be more sensitive to these hormones than others, allowing for excessive ligament laxity in the baby.
