MSK

Question 1

congenital muscular torticollis (CMT)

Answer 1

• unilateral shortening of the SCM
• laterally flexed toward shortened muscle and rotated away

Question 2

what does torticollis put infants at higher risk of (4)

Answer 2

• facial asymmetry
• plagiocephaly (80-90%)
• developmental delay
• vision problems

Question 3

there is a higher incidence of what 2 condition in those with torticollis

Answer 3

hip dysplasia
foot deformities

Question 4

plagiocephaly

Answer 4

unilateral flattening of the head

Question 5

what are some causes of torticollis

Answer 5

• intrauterine crowding
• muscle trauma during delivery
• congenital abnormalities of SCM
• “back to sleep”
• baby carriers

Question 6

what condition can cause a “fake torticollis”

Answer 6

reflux

babies with torticollis are also at higher risk of reflux

Question 7

what are some things to check for during an exam for possible torticollis

Answer 7

• palpate SCM
• visual and auditory tracking
• ROM
• strength/endurance
• gross motor delays

Question 8

what can you use to measure ROM in infants

Answer 8

arthrodial protractor

Question 9

what test can you use to assess muscle strength in infants (esp torticollis)

Answer 9

muscle function scale which uses the lateral righting reaction

Question 10

what is typically the PT goal for infants with torticollis

Answer 10

full PROM with no regression during growth spurts over 3 months

Question 11

T or F: most infants recover from torticollis with conservative treatment

Answer 11

T: 70-99% in 12 months

Question 12

what are some PT interventions for torticollis

Answer 12

• prolonged passive stretching
• promote symmetry through positioning and handling
• active cervical ROM and strengthening
• symmetric developmental activities

Question 13

if pts with torticollis are not responsive to more conservative treatment they may get an orthotic. what are the requirements for this (4)

Answer 13

• 4 months or older
• constant head tilt of at least 5 degrees
• PROM lateral flexion to 10 degrees to contralateral
• active lateral righting reaction

Question 14

should infants wear a torticollis orthotic when sleeping? how often do you remove it

Answer 14

• no, only when awake
• remove every 2 hours

Question 15

what is an orthotic for plagiocephaly

Answer 15

dynamic orthotic cranioplasty band (DOC)

Question 16

what does a DOC orthotic do

Answer 16

applies pressure to prominences while allowing growth in the flattened areas

Question 17

how often should infants wear a DOC

Answer 17

23-24 hours a day and then when symmetry is achieved only while sleeping

Question 18

DOC orthotics are recommended for infants less than _____ months of age

Answer 18

12

Question 19

when is surgery considered for torticollis

Answer 19

• does not respond after 6 months of treatment
• residual head tilt > 15 degrees in passive rotation and lateral flexion

Question 20

what does surgery for torticollis involve

Answer 20

they release one or both heads of SCM and/or excise mass

*PT after

Question 21

what can untreated torticollis lead to? (3)

Answer 21

• facial and cranial asymmetries
• scoliosis
• occular and vestibular impairments

Question 22

Your pt is a 4-month-old arriving to PT in a carrier. His head is titled towards the left ear. Mom reports a normal pregnancy. She states the infant is colicky, spits up frequently, and hates tummy time. What does this infant likely have? Should you refer out?

Answer 22

left torticollis
yes, for unmanaged reflux

Question 23

what are some red flags for back pain?

Answer 23

• <20 or >55
• non-mechanical
• thoracic pain
• hx of cancer
• neuro signs
• deformities
• steroids
• weight loss
• HIV

Question 24

scoliosis

Answer 24

• a lateral curvature of the spin
• adolescent idiopathic most common

Question 25

how is scoliosis named? is right or left more common

Answer 25

the apex of the rib prominence right (90%)

Question 26

structural vs non-structural scoliodid

Answer 26

in structural curves are fixed while in non-structural curves are correctable (tumor, muscle spasm, etc.)

Question 27

ideally, all kids are screened for scoliosis between ___ and ____ years old

Answer 27

10-15 *not in most schools anymore

Question 28

a cobb angle of _____ degrees or greater = scoliosis

Answer 28

10

Question 29

what can you use to measure scoliosis curve in clinic? if there is a rib hump greater than _____ degrees you should refer out

Answer 29

scoliometer 5 degrees

Question 30

treatment for scoliosis based on cobb angle measurement

Answer 30

<25 = regular observation 25-40 = non surgical, brace if skeletally immature >40-45 = surgery >90 = respiratory failure

Question 31

what does the Risser scale look at

Answer 31

if iliac crest is ossified

Question 32

T or F: if someone with scoliosis is pre-puberty the curve will likely progress

Answer 32

T

Question 33

what are some measurements (outside of strength/ROM) you can take in pts with scoliosis

Answer 33

- shoulder to pelvis - shoulder to plinth - hamstring flexibility

Question 34

what is the goal of an orthotic for scoliosis? how often should you wear it

Answer 34

- maintain the curve - 18-23 hours a day until skeletal maturity unless curve progresses

Question 35

T or F: there is good evidence for use of e-stim in scoliosis

Answer 35

F

Question 36

what are some PT interventions for scoliosis

Answer 36

- core strengthening - cardiopulm fitness - schroth method - breathing techniques

Question 37

what surgery is usually completed for scoliosis

Answer 37

posterior spinal fusion

Question 38

scheuermann's disease

Answer 38

rigid postural kyphosis due to anterior wedging of vertebrae

Question 39

Yout pt is a 16 y/o male who presents with back pain. He has increased rigid kyphosis, tight pecs/hamstrings, incrs lumbar lordosis and forward head posture. What does he likely have and how will you treat it?

Answer 39

-Scheuermann's disease -strengthen extensors, stretching -swimming and volleyball are good -may need orthotic management

Question 40

spondylolysis is a defect of the...

Answer 40

pars interarticularis

Question 41

spondylolisthesis

Answer 41

forward translation of vertebra

Question 42

where does spondylolisthesis usually occur? what can cause it?

Answer 42

L5 repetitive hyperextension or rotational loading

Question 43

longitudinal limb deficiency

Answer 43

- reduction or absence of an element or elements within the long axis of the bone - may have normal skeletal elements distally

Question 44

what are some things that can cause a limb length discrepancy

Answer 44

- congenital conditions - growth plate infections/fractures - neuromuscular disorders - tumors - disease processes

Question 45

Wolfe's law

Answer 45

bone formation occurs along lines of stress *you need WB for bone growth

Question 46

When a leg length difference is greater than _______ cm you start to see functional deficits, postural compensations, and less efficient gait

Answer 46

2

Question 47

epiphysiodesis

Answer 47

- surgical procedure where the growth plate of the longer limb is shut and the shorter limb is lengthened - for LLD>5cm and the child has to be still growing

Question 48

ilizarov method

Answer 48

- metaphyseal lengthening and external apparatus to distract ends - 0.25mm 4x/day

Question 49

pediatric prostheses may need to be replaced every _____ to _____ months

Answer 49

9 to 12 - to accommodate for growth/wear and tear